Enlarged Prostate (Benign Prostatic Hyperplasia): A Normal Part of Aging?

Kidney Health Care - David Mangusan Jr, PTRP

Other Names: Prostate Enlargement, Benign Prostatic Hypertrophy, Prostatic Enlargement

Is prostate enlargement a normal part of aging? Or a urinary condition that men should worry about as they age? Read on to know more about prostate enlargement.

Benign prostatic hyperplasia (BPH) is a common urologic condition in older men wherein the prostate gland enlarges but is not considered as cancerous. The enlargement of the prostate does not usually cause problems until later in life. In fact, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), BPH rarely causes symptoms before the age of 40.However, more than half of men in their sixties and as many as 90 percent in their seventies and eighties experience some symptoms of BPH.

The Prostate: Structure and Function

Male urinary tract, front and side views.The prostate gland, which is about the size of a walnut, is a part of the male reproductive system. It consists of two regions, or lobes, which is surrounded by an outer tissue covering.

The prostate wraps around the urethra — the tube that carries urine out of the bladder.

Scientists do not know all of the prostate’s functions. But one function of the gland is to produce a fluid that becomes part of the semen. This fluid helps to energize the sperm and helps in making the vaginal canal less acidic.

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How BPH occurs.

The exact cause of BPH is not fully understood. What is known is that, as a man gets older, the prostate gland grows larger. As the prostate enlarges, however, the tissue surrounding the gland prevents its expansion. As a result, the gland presses against the urethra causing it to become narrow. The bladder wall, which normally contracts to empty bladder contents (urine), becomes thicker and irritable. Over time, the bladder weakens and loses the ability to empty itself, which causes some of the urine to remain in the bladder.

The narrowing of the urethra and incomplete emptying of the bladder cause many of the problems associated with benign prostatic hyperplasia.

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Signs and Symptoms

Many of the signs and symptoms of an enlarged prostate result from the obstruction of the urethra and the incomplete bladder emptying. Symptoms may include:
 Hesitant, interrupted, weak stream of urine

 Frequent urination, often at night

 Urgency

 leaking or dribbling after urinating
BPH can become severe and can cause serious complications over time. Severe BPH can lead to
 urinary tract infections (UTI)

 kidney or bladder damage

 urinary incontinence — the inability to control urination

 bladder stones
Signs and symptoms of benign prostatic hyperplasia may be similar to other health conditions. Consult your physician if you experience these symptoms or if you think you have BPH for proper diagnosis.

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Diagnosis

Early diagnosis and treatment of BPH can lower the risk of developing serious complications.When permanent damage occurs in the bladder, treatment for BPH may be ineffective.

Some people with BPH may not know they have the condition. The enlarged prostate may first be noticed by the doctor during a routine exam or when finding the cause of another health problem.

In addition to getting a complete medical history and performing a physical examination, the doctor may recommend tests or diagnostic procedures to help identify the problem and to see whether surgery is needed. Diagnostic procedures may include:
  • Digital Rectal Exam (DRE). A procedure in which the doctor inserts a gloved finger into the rectum where part of the prostate (next to the rectum) can be felt. This procedure gives the physician a general idea of the size and condition of the gland.
  • Prostate-Specific Antigen (PSA) Blood test. A diagnostic test used to rule out cancer as the cause of the symptoms.
  • Rectal Ultrasound and Prostate Biopsy. The doctor may recommend rectal ultrasound and prostate biopsy if prostate cancer is suspected. In rectal ultrasound, a probe inserted in the rectum directs sound waves at the prostate. The echo patterns of the sound waves form an image of the prostate gland on a display screen. The doctor may recommend biopsy of the prostate to help determine whether an abnormal-looking area is indeed a tumor. The doctor uses the probe and the ultrasound images to guide a biopsy needle to the suspected tumor. The needle collects a few pieces of prostate tissue for examination under a microscope.
  • Cystoscopy. A diagnostic procedure in which a small tube, called cystoscope, is inserted through the opening of the urethra in the penis. This procedure can help the physician see the inside of the urethra and the bladder.
  • Urine Flow Study. A diagnostic test in which the patient urinates into a special device that measures how quickly the urine is flowing. A reduced flow may suggest BPH.
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Treatment

Treatment of BPH varies from patient to patient and depends on the severity of the condition. Available treatment options may include:
  • Active surveillance or watchful waiting. If your symptoms are not too bad, your doctor may tell you to wait before starting any treatment to see if the problem gets worse. You will need a checkup each year. You can start treatment later on if your symptoms get worse.
  • Medications. There are medicines that can relax muscles near your prostate to ease your symptoms or medicines to help shrink the prostate. Talk with your doctor about possible side effects.
  • Surgery. If nothing else has worked, your doctor may recommend surgery to help urine flow. There are many types of surgery. Talk with your doctor about the risks. Regular checkups are important after BPH surgery.
  • Other treatments. Sometimes radio waves, microwaves, or lasers are used to treat problems caused by BPH. (National Institute on Aging)
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For More Information: (Links Open in a New Window)
Prostate Enlargement: Benign Prostatic Hyperplasia (National Institute of Diabetes and Digestive and Kidney Diseases)
Prostate Problems (National Institute on Aging)

References:
National Kidney and Urologic Diseases Information Clearinghouse (June 2006). Prostate Enlargement: Benign Prostatic Hyperplasia (NIH Publication No. 07—3012). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD. Web URL: http://kidney.niddk.nih.gov/kudiseases/pubs/prostateenlargement/. Accessed: November 11, 2008

National Institute on Aging (March 2008). Age Page: Prostate Problems. U.S. Department of Health and Human Services (DHHS), National Institutes of Health (NIH), Bethesda, MD. Web URL: http://www.nia.nih.gov/HealthInformation/Publications/prostate.htm. Accessed: November 11, 2008

Image Credit: NIDDK Image Library


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This Page Last Revised: January 7, 2010

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