Total Kidney Failure: Treatment Options

Introduction

Having totally failed kidneys, also called end-stage renal disease (ESRD), would have a great impact on a person’s life including his or her lifestyle, work, and emotional well being. But with the help of the health care team, family, and friends, a person with total kidney failure can lead a full and active life.

The kidneys are two bean-shaped organs that help get rid of wastes and excess fluid from the blood. Each kidney is about the size of a fist.

Within the kidneys are tiny filtering units called nephrons. They let extra fluid and waste products out of the body in the form of urine. In addition, they help balance substances such as sodium, phosphorus, and potassium in the body. Anything in excess that the body does not need, also becomes part of the urine.

Other functions of the kidneys include:

 stimulating production of red blood cells—the oxygen carrying cells in the body.

 controlling or regulating blood pressure, and

 aids in maintaining calcium levels.

When the kidneys totally fail.

When the kidneys totally fail because of continuous destruction of the nephrons, normal functions of the kidneys are disrupted. Excess fluid and dangerous wastes accumulate in the body.

You cannot survive without your kidneys. However, there are treatment options that you can choose to replace the work of the failed kidneys. Treatment choices include hemodialysis, peritoneal dialysis, and kidney transplantation.

Let us have a look at these kidney failure treatment options.

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See Also: Kidney Disease

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Treatment Choice 1: Hemodialysis

Hemodialysis is a treatment procedure that a person who has totally failed kidneys would sometimes choose to replace the work of the failed kidneys. Hemodialysis makes use of a machine that filters the blood outside the body. The machine can temporarily rid the body of harmful wastes, extra water and other substances.

In hemodialysis, the patient’s blood is sent through a filter called a dialyzer that removes waste products. The cleaned blood is then returned to the patient’s body.

If a patient chooses this treatment procedure, he or she would undergo hemodialysis for about 3 times a week. Each treatment may last for about 3 to 5 hours.

When a patient undergoes hemodialysis, diet, medications, and limiting fluid intake are also often necessary.

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See Also: Diet and Dialysis

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Treatment Choice 2: Peritoneal Dialysis

Peritoneal dialysis is another treatment procedure that removes wastes, extra water, and chemicals from your body.

In peritoneal dialysis, the peritoneal membrane—the lining of the abdomen or belly—is used to filter the blood. The peritoneal membrane acts as the artificial kidney.

With the use of a catheter, a dialysis solution is introduced in the abdomen. The dialysis solution is a mixture of minerals and sugar dissolved in water. The sugar—called dextrose—pulls wastes, chemicals, and extra fluid from the blood vessels in the peritoneal membrane into the dialysis solution. The used solution, along with the wastes, is then drained from the patient’s abdomen. The patient’s abdomen is refilled with a new dialysis solution, and the cycle is repeated.

There are different types of peritoneal dialysis that have different daily schedules of exchanges. An exchange is the process of draining and refilling of dialysis solution.

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Treatment Choice 3: Kidney Transplantation

Another treatment option for patients with complete kidney failure is kidney transplantation. In this treatment method, a healthy kidney is surgically placed into the patient’s body. The transplanted kidney then takes on the work of the two failed kidneys. Sometimes the failed kidneys are left in place if they do not cause infection or high blood pressure.

The donated kidney may come from a donor who has recently died or from a living donor. However, the transplanted kidney should closely match the patient’s body to prevent rejection of the organ.

To prevent the patient’s immune system from attacking the new kidney, the doctor will give the patient medicines called immunosuppressants. However, taking immunosuppressants can make the immune system weak. A weakened immune system can cause a person to become easily sick or prone to infections.

A successful transplant takes a coordinated effort from your whole health care team, including your nephrologist, transplant surgeon, transplant coordinator, pharmacist, dietitian, and social worker. But the most important members of your health care team are you and your family. By learning about your treatment, you can work with your health care team to give yourself the best possible results, and you can lead a full, active life. (National Institute of Diabetes and Digestive and Kidney Diseases, May 2006)

References:
National Kidney and Urologic Diseases Information Clearinghouse (May 2006). Treatment Methods for Kidney Failure: Peritoneal Dialysis (NIH Publication No. 06–4687). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes f Health (NIH), Bethesda, MD. Web URL: http://kidney.niddk.nih.gov/kudiseases/pubs/transplant/. Accessed: November 30, 2008

National Kidney and Urologic Diseases Information Clearinghouse (May 2006). Treatment Methods for Kidney Failure: Peritoneal Dialysis (NIH Publication No. 06–4688). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes f Health (NIH), Bethesda, MD. Web URL: http://kidney.niddk.nih.gov/kudiseases/pubs/peritoneal/. Accessed: November 30, 2008

National Kidney and Urologic Diseases Information Clearinghouse (November 2007). Kidney Failure: Choosing a Treatment That’s Right for You (NIH Publication No. 08–2412). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes f Health (NIH), Bethesda, MD. Web URL: http://kidney.niddk.nih.gov/kudiseases/pubs/choosingtreatment/index.htm. Accessed: November 30, 2008

National Kidney and Urologic Diseases Information Clearinghouse (December 2006). Treatment Methods for Kidney Failure: Hemodialysis (NIH Publication No. 07–4666). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes f Health (NIH), Bethesda, MD. Web URL: http://kidney.niddk.nih.gov/kudiseases/pubs/hemodialysis/. Accessed: November 30, 2008

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Pessary

A Treatment Option for Women with Stress Incontinence.

A pessary is a small device placed in the vagina, which may help in correcting the position of the bladder and preventing leakage of urine, which occurs in people with stress incontinence.

Stress incontinence is a type of urinary incontinence wherein the person leaks urine during actions such as coughing, sneezing, laughing, during an exercise or lifting heavy weights. Such actions or activities may put pressure on the bladder, thus, causing leakage of urine.

Pessaries come in a variety of shapes and sizes. Your health care provider can fit you with the best shape and size of pessary. Your doctor or nurse will also teach you how to care for it.

The pessary should be regularly removed to avoid possible complications such as infections or ulcers. Also, women using pessaries should see their doctor regularly.

Note: Your doctor can provide you with more information about pessaries and other treatment options for urinary incontinence.

Related Topic:

Urinary Incontinence: Bladder Control Problems

References:
National Kidney and Urologic Diseases Information Clearinghouse (October 2007). Urinary Incontinence in Women (NIH Publication No. 08-4132). National Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD. Web URL: http://kidney.niddk.nih.gov/kudiseases/pubs/uiwomen/. Accessed: November 20, 2008

National Kidney and Urologic Diseases Information Clearinghouse (August 2007). What I need to know about Bladder Control for Women (NIH Publication No. 07-4195). National Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD. Web URL: http://kidney.niddk.nih.gov/Kudiseases/pubs/bcw_ez/index.htm. Accessed: November 20, 2008

Image Credit: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

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Kidney Dysplasia

Kidney dysplasia, also called renal dysplasia or multicystic dysplastic kidney (MCDK), is a disorder that can occur in babies while they are developing in the womb. In this disorder, the internal structures of one or both of the kidneys do not develop normally. Normal kidney tissues are replaced by cysts, which are fluid filled sacs.

The kidneys are two bean-shaped organs that help filter fluid and wastes from the blood to form urine. Urine from the kidneys flows to the bladder through tubes called ureters.

Kidney dysplasia usually occurs in only one kidney. A baby, with one normal kidney can grow normally with few, if any, health problems. Babies whose both kidneys are affected with the condition generally do not survive pregnancy. Those who do survive will eventually need to undergo dialysis or kidney transplantation very early in life.

What happens in Kidney Dysplasia?

During normal development in the womb, the tubules that collect urine branch out throughout the baby’s kidneys. In kidney dysplasia, however, the tubules fail to branch out completely. Since the urine that normally flows through these small tubules has nowhere to go, it collects inside the affected kidney and forms cysts.

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Causes

Kidney dysplasia may occur if the mother is exposed to certain drugs. Prescription medicines, such as drugs to treat seizures and certain blood pressure medications may cause the condition. Such blood pressure medications may include angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers. Also, pregnant women who use illegal drugs such as cocaine may increase the risk of the unborn child to develop kidney dysplasia.

Genetic factors may also play a role in the development of kidney dysplasia. The parent may have passed on the condition to the child.

In some cases, kidney dysplasia occurs as a part of several genetic syndromes that affect other parts of the body as well.

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Signs and Symptoms and Complications

Most children with kidney dysplasia in only one kidney have no signs or symptoms. In fact, many people lead normal, healthy lives with only one normal kidney.

The child’s affected kidney may be enlarged at birth. Also, urinary tract infections may occur because of abnormalities in the urinary tract.

Rarely, children with the condition may develop high blood pressure. Also, children with kidney dysplasia have a slight increase in risk of developing cancer. If the child has other urinary problems that affect the normal kidney, chronic kidney disease (CKD) or kidney failure may develop.

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Diagnosis

Often, kidney dysplasia is found during fetal ultrasound during pregnancy. Fetal ultrasound, also called sonogram, makes use of sound waves to produce images of the fetus growing in the mother’s womb. Kidney dysplasia, however, may not always be detected before the baby is born.

After birth, an enlarged kidney may be discovered during routine examination for a urinary tract infection or other health problem.

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Treatment

Treatment may not be necessary if the condition affects only one kidney, with the other kidney performing normally. However, continuous monitoring of both the affected and unaffected kidneys is necessary. Also, children and adults who have only one kidney should be checked for high blood pressure and kidney damage regularly.

The doctor may prescribe antibiotics if the child develops urinary tract infection.

In some cases, surgical removal of the kidney may be recommended but should be considered only if the kidney:

 causes pain
 causes high blood pressure
 shows abnormal changes as seen on ultrasound.

A child may need to undergo dialysis or kidney transplantation if kidney failure occurs.

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Here are some helpful questions that you can ask your doctor:

 Does my child have any other problems in the urinary tract?
 Does my child need to take antibiotics to prevent urinary tract infections?
 Will my child need special medical care?
 How often should my child be checked for high blood pressure and kidney damage?
 How often should the dysplastic kidney and the normal kidney be evaluated by ultrasound?

Reference:
National Kidney and Urologic Diseases Information Clearinghouse (June 2008). Kidney Dysplasia (NIH Publication No. 08—6291). National Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD. Web URL: http://kidney.niddk.nih.gov/kudiseases/pubs/kidneydysplasia/index.htm. Accessed: November 19, 2008

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Diabetes Insipidus (DI)

Diabetes insipidus (DI) is a rare disorder that causes a person to frequently urinate, which commonly results from inadequate secretion of antidiuretic hormone (ADH). Because of the large volume of fluid lost in the urine, the person with the condition tends to drink large amounts of fluid. This would likely make the person urinate frequently, even at night that it can disrupt sleep and, occasionally, cause bedwetting.

The condition can lead to dehydration if fluid lost is not replaced. In children, diabetes insipidus may cause a child to be irritable or listless and may have fever, vomiting, or diarrhea.

Milder forms of DI can be controlled by drinking enough water. The condition rarely causes severe complications.

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Diabetes Insipidus (DI) and Diabetes Mellitus (DM): The difference.

Although some of their signs and symptoms are similar, such as excessive thirst and excessive urination, DI and DM are unrelated.

Diabetes mellitus is more common and results from insulin deficiency or resistance, which leads to high blood glucose. DI does not cause blood sugar to become elevated.

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Fluid Regulation in the Body

The kidneys remove harmful materials and extra body fluids from the blood. These fluids are stored in the bladder as urine. When the fluid regulation system is working properly, the kidneys make less urine to conserve fluid when water intake is decreased or water is lost. Also, the kidneys make less urine at night because, during this time, the body’s metabolic processes are slower.

The rate of fluid intake is governed by thirst and the rate of excretion is governed by the production of antidiuretic hormone. These processes make sure that the volume and composition of body fluids are balanced. The hormone antidiuretic hormone, also called vasopressin, is made by the hypothalamus, which is a small endocrine organ in the brain. ADH is stored in the pituitary gland and is released into the blood when it is needed. ADH directs the kidneys to concentrate the urine by reabsorbing some of the filtered water to the bloodstream. As a result, less urine is formed. Diabetes insipidus occurs when this precise system for regulating the kidney’s handling of fluid becomes disrupted.

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Types

There are several types of diabetes insipidus including:

Central DI

This is the most common type of serious DI. Central DI occurs when the pituitary gland is damaged causing disruption in the normal storage and secretion of ADH. Head injuries, neurosurgery, some genetic disorders, and other health problems can cause damage to the pituitary gland.

Nephrogenic DI

This type of DI occurs when the kidneys are not able to respond to ADH. Some drugs such as lithium can affect the ability of the kidneys to respond to ADH. Chronic diseases, such as polycystic kidney disease, kidney failure, sickle cell disease may also cause Nephrogenic DI, and some inherited genetic diseases. In some cases of nephrogenic DI, the cause is unknown.

Dipsogenic DI

Dipsogenic DI occurs when the thirst center located in the hypothalamus is damaged or defective. As a result, the abnormal increase in thirst and fluid intake suppresses ADH secretion. Consequently, the decline ADH secretion causes an increase in urine output.

Gestational DI

This type happens only during pregnancy. It occurs when the ADH in the mother is destroyed by an enzyme made by the placenta. The placenta is composed of blood vessels and other tissues, which develops with the fetus. It allows exchange of nutrients and waste products between the mother and fetus.

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Diagnosis

Sometimes, the doctor may suspect that a patient with diabetes insipidus has diabetes mellitus. This is partly because DM is more common and DM and DI have similar symptoms. However, thorough testing should make the diagnosis clear. In addition, the doctor must determine which type of DI a patient has before proper treatment can begin.

Diagnosis of DI is based on a series of tests, which may include urinalysis and a fluid deprivation test. In some patients, imaging tests such as magnetic resonance imaging (MRI) of the brain may also be necessary.

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Treatment

Treatment of diabetes insipidus depends on the type of DI a patient has.

Central DI

This type is treated with a synthetic hormone called desmopressin, which is similar to the effects of ADH. The synthetic hormone can be taken through an injection, nasal spray, or a pill. The drug prevents water excretion. While taking the drug, a person should drink fluids only when thirsty.

Nephrogenic DI

Nephrogenic DI is treated with hydrochlorothiazide (HCTZ), indomethacine, or a combination of HCTZ and amiloride.

Dipsogenic DI

Experts have not yet discovered an effective treatment for dipsogenic DI.

Gestational DI

Most cases of gestational DI can be treated with desmopressin. However, desmopressin should not be used when gestational DI is due to an abnormality in the thirst center.

Reference:
National Kidney and Urologic Diseases Information Clearinghouse (September 2008). Diebetes Insipidus (NIH Publication No. 08—4620). 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/insipidus/index.htm. Accessed: November 17, 2008

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Diet and Dialysis

Dialysis, or hemodialysis, is the most common treatment method for advanced and permanent kidney failure.

Normal kidneys help to clean the blood by removing harmful wastes and excess fluid. In addition, they also make hormones, which keep the bones strong and the blood healthy. When the kidneys fail, it can lead to buildup of harmful wastes in the body, elevation of blood pressure, buildup of excess fluid, and a decline in red blood cells. When this occurs, treatment to replace the work of the failed kidneys is necessary.

In hemodialysis, the patient’s blood is allowed to flow through a special filter that removes wastes and extra fluids. The clean blood is then returned to the body.

Following a strict diet can help improve your dialysis and your health. A dietitian can help you plan meals. Following your dietitian’s advice is important to get the most from your hemodialysis treatments. Here are a few general guidelines.

 Fluids. By limiting how much fluid you drink each day, you can prevent extra fluid from building up in your body. Extra fluid can cause your blood pressure to rise, which makes your heart work harder, and increase the stress of dialysis treatments. Many foods—such as fruits, soup, and ice cream—contain plenty of water. Your dietitian can help you determine how much to drink each day. He or she can also provide you with tips on how to control your thirst.

 Phosphorus. Consuming too much of the mineral phosphorus can result in weakening of bones and can make your skin itchy. Having too much phosphorus in your blood can cause calcium to be pulled out from your bones. Foods high in phosphorus—such as milk and cheese, peas, dried beans, nuts, colas, and peanut butter—should be avoided.

You probably will need to take phosphate binder to control the phosphorus in your blood between dialysis sessions. Your dietitian can provide you with more specific information regarding phosphorus.

 Potassium. The mineral potassium effects how steadily your heart beats. It is found in many foods, especially milk and fruits and vegetables, such as avocados, oranges, bananas, tomatoes, potatoes, and dried fruits. Consuming too much foods high in potassium can be very dangerous to your heart. Your dietitian can give your more specific information about potassium and the potassium content of foods.

 Protein. Before you were on dialysis, your doctor may have told you to follow a low-protein diet. Being on dialysis changes this. Most people on dialysis are encouraged to eat as much high-quality protein as they can. Protein helps you keep muscle and repair tissue. The better nourished you are, the healthier you will be. You will also have greater resistance to infection and recover from surgery more quickly.

Your body breaks protein down into a waste product called urea. If urea builds up in your blood, it’s a sign you have become very sick. Eating mostly high-quality proteins is important because they produce less waste than others. High-quality proteins come from meat, fish, poultry, and eggs (especially egg whites).

 Calories. Calories provide your body with energy. Some people on dialysis need to gain weight. You may need to find ways to add calories to your diet. Vegetable oils—like olive, canola, and safflower oils—are good sources of calories and do not contribute to problems controlling your cholesterol. Hard candy, sugar, honey, jam, and jelly also provide calories and energy. If you have diabetes, however, be very careful about eating sweets. A dietitian’s guidance is especially important for people with diabetes.

 Supplements (vitamins and minerals). Because you have to avoid so many foods, vitamins and minerals may be missing from your diet. In addition, dialysis also removes vitamins from your body. Your health care provider may prescribe a vitamin and mineral supplement, which is specifically designed for people with kidney failure. You should avoid taking vitamin supplements that you can buy off the store shelf. They may contain vitamins or minerals that may be harmful to you.

Talk with your doctor or dietitian about foods that you can take when you are receiving dialysis treatments.

References:
National Kidney and Urologic Diseases Information Clearinghouse (December 2006). Treatment Methods for Kidney Failure: Hemodialysis (NIH Publication No. 07—4666). National Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD. Web URL: http://kidney.niddk.nih.gov/kudiseases/pubs/hemodialysis/index.htm. Accessed: November 15, 2008

National Kidney and Urologic Diseases Information Clearinghouse (August 2008). Eat Right to Feel Right on Hemodialysis (NIH Publication No. 08—4274). National Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD. Web URL: http://kidney.niddk.nih.gov/kudiseases/pubs/eatright/. Accessed: November 15, 2008

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Urinary Incontinence: Bladder Control Problems

Urinary incontinence, or UI, is the accidental leakage of urine. It occurs because of problems with muscles and nerves that help in holding or releasing urine. While urinary incontinence can happen to anyone, it is more common in older people. Women are more likely than men to have incontinence. This is because of the structural differences in the pelvic region and the changes induced by pregnancy and childbirth.

Urinary incontinence can often be cured or managed. Talk with your health care provider about the particular problem you have and about treatments available for urinary incontinence.

Bladder Control

Urine is stored in the bladder—a balloon-like organ. During urination, muscles in the wall of the bladder tighten or contract to move urine out of the bladder and into the urethra. At the same time, muscles around the urethra called sphincter muscles relax and let urine pass out of the body. Urinary incontinence occurs if these muscles relax or tighten without warning.

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Types of Urinary Incontinence

There are several types of urinary incontinence, which include:

Stress incontinence. This type of urinary incontinence occurs when urine leaks as pressure is put on the bladder during actions such as coughing, sneezing, lifting, or during exercise. Also, physical changes that results from pregnancy, childbirth, and menopause often cause the condition. Stress incontinence is the most common type of bladder control problem in younger and middle-age women.

Urge incontinence. It occurs when people have sudden need to urinate and aren’t able to hold their urine long enough to get to the toilet in time. This type of incontinence is commonly caused by inappropriate contractions of the bladder muscles.

Some health problems may lead to or worsen incontinence. Such conditions include uncontrolled diabetes, Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, and stroke.

Overactive bladder occurs when abnormal nerves send signal to the bladder at the wrong time, which causes the bladder muscles to contract without warning.

Overflow incontinence. This type of incontinence occurs when small amounts of urine leak from a bladder that is always full. Weak bladder muscles or blocked urethra can cause this type.

Functional incontinence. This type occurs in many older people who have normal bladder. They just have a problem getting to the toilet because of arthritis or other disorders or problems that make it hard to move quickly.

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Causes

Incontinence is often seen as part of aging. But it can occur for many other reasons. For example, urinary tract infections, vaginal infection or irritation, constipation, and some medicines can cause bladder control problems that last a short time. When incontinence lasts longer, it may be due to:

 weak bladder muscles

 overactive bladder muscles

 damage to nerves that control the bladder from diseases such as uncontrolled diabetes, multiple sclerosis or Parkinson’s disease

 diseases such as arthritis that may make it difficult to get to the bathroom in time

 blockage from an enlarged prostate in men

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Diagnosis

The first step in solving a urinary problem is talking with your heath care provider. Your doctor will take your medical history and perform a thorough physical examination. He or she will ask about your symptoms and the medicines you use. Also, your doctor will want to know if you have been sick recently or have had surgery.

Your doctor may also recommend a series of tests to find the cause of incontinence. These may include:

 urine and blood tests

 tests that measure how well you empty your bladder

 imaging tests, such as ultrasound and cystoscopy

In addition, you may be asked to keep a voiding diary, which is a record of fluid intake, the number of times you urinate, and the amounts of urine you produce. This voiding diary will provide your doctor a better idea of your problem and help direct additional tests.

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Treatment

There are more treatments for urinary incontinence today than ever before. However, no single treatment works for everyone. The choice of treatment depends on

 the type of bladder control problem you have
 the severity of your problem, and
 what best fits your lifestyle.

As a general rule, the simplest and safest treatments should be tried first

Bladder Control Training

Your health care provider may recommend bladder training to help you get better control of your bladder. With bladder training, also called timed voiding, you can change how your body stores and releases urine. In timed voiding, you urinate on a set schedule or planned regular trips to the bathroom. Other ways to do bladder control training include:

 Kegel exercises, also known as pelvic muscle exercises, which strengthen the pelvic muscles that help hold urine in the bladder.

 Biofeedback uses sensors that can make you aware of signals from your body. This can be helpful when learning pelvic muscle exercises. Biofeedback may be helpful in regaining control over the muscles in your bladder and urethra.

 Lifestyle changes that may help with incontinence include quitting smoking, avoiding alcohol, drinking less caffeine, losing weight, preventing constipation, and avoiding lifting heavy objects.

Other Management

Besides bladder control training, you may want to talk to your doctor about other ways to help manage incontinence:

 Some drugs can help the bladder empty more fully during urination. Other drugs tighten muscles and can lessen leakage. Talk with your doctor about the benefits and side effects of using these medicines.

 A doctor may inject a substance that thickens the area around the urethra to help close the bladder opening. This reduces stress incontinence in women. This treatment may have to be repeated.

 Special devices for both men and women could help control incontinence.

 Surgery can sometimes improve or cure incontinence if it’s caused by a change in the position of the bladder or blockage due to an enlarged prostate.

 You can buy special absorbent underclothing that can be worn under everyday clothing.

If you suffer from urinary incontinence, tell your doctor. Remember, under a doctor’s care, incontinence can be treated and often cured. Even if treatment is not fully successful, careful management can help you feel more relaxed and confident. (National Institute on Aging)

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References:
National Kidney and Urologic Diseases Information Clearinghouse (June 2007). Urinary Incontinence in Men (NIH Publication No. 07—5280). National Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD. Web URL: http://kidney.niddk.nih.gov/kudiseases/pubs/uimen/index.htm. Accessed: November 14, 2008

National Kidney and Urologic Diseases Information Clearinghouse (October 2007). Urinary Incontinence in Women (NIH Publication No. 08—4132). National Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD. Web URL: http://kidney.niddk.nih.gov/kudiseases/pubs/uiwomen/index.htm. Accessed: November 14, 2008

National Institute on Aging (June 2008). Age Page: Urinary Incontinence. National Institutes of Health (NIH), Bethesda, MD. Web URL: http://www.nia.nih.gov/HealthInformation/Publications/urinary.htm. Accessed: November 14, 2008

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

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

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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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