Enlarged Prostate: Symptoms, Causes, Problems, Treatment

Enlarged prostate is a common medical condition in men that develop as they get older. The condition is also known as benign prostatic hyperplasia (BPH). It develops when the cells of the prostate gland begin to multiply. These additional cells cause the prostate gland to swell, squeezing the urethra and limiting the urine flow. Enlarged prostate is not prostate cancer and does not increase your risk of getting it. 

Most men experience continued prostate growth throughout their life. This continued growth can enlarge the prostate enough to block the urine flow. The exact cause of the enlarged prostate is unknown. However, it is believed that changes in male sex hormones due to ageing may be a factor. 

Risk Factors of Enlarged Prostate

The risk factors of an enlarged prostate include:-

1. Family history: Having a family member with prostate problems increases the risk of enlarged prostate problems. 
2. Ageing: The risk of enlarged prostate increases after the age of 40. About one-third of men experience symptoms of an enlarged prostate by age 60, and about half of them experience symptoms by age 80. 
3. Lifestyle: Obesity can increase the risk of an enlarged prostate, and regular exercise can lower the risk. 
4. Heart disease and diabetes: According to studies, heart diseases, diabetes, and beta-blockers can increase your risk of an enlarged prostate.

Enlarged prostate symptoms are often mild at the start but gradually worsen over time. Common symptoms include:-

1. Inability to empty your bladder completely
2. Frequent need to urinate
3. Nocturia (increased need to urinate at night)
4. Difficulty starting urination
5. A weak urinary stream
6. Straining while urinating
7. Dribbling at the end of urinating
8. Incontinence (leakage of urine)

Less common symptoms include:-

1. Infection in the urinary tract
2. Blood in the urine
3. Inability to urinate

In some men, the symptoms might eventually stabilise and improve over time. 

For the diagnosis of an enlarged prostate, your doctor will likely start by asking you about your medical history. Next, they will conduct a physical exam. The initial tests may include:-

1. Digital rectal exam: During this test, the doctor will insert a finger into your rectum to estimate your prostate’s size and shape. 
2. Urinalysis (urine test): A urine sample is checked for blood and bacteria. 
3. Prostate-specific antigen (PSA) blood test: Prostate-specific antigen is a substance in your prostate whose level increases when you have an enlarged prostate. 

Additional tests to confirm an enlarged prostate include:-

1. Postvoid residual volume test: It tests how much urine is left in the bladder after urination. The test can be performed using ultrasound or inserting a catheter into your bladder after urination. 
2. Urinary flow test: Your doctor will ask you to urinate into a receptacle attached to a machine to measure the speed and strength of your urine flow. The test is used to check the working of the bladder and sphincter. 
3. 24-hour voiding diary: It is a 24-hour recording of your liquid intake and urine output, especially beneficial if more than one-third of your urine output occurs at night. 

If your condition seems more complex or severe, the doctor might recommend:-

1. Transrectal ultrasound: The doctor will insert an ultrasound probe into the rectum to look for abnormalities and evaluate your prostate. 
2. Prostate biopsy: The doctor will use a needle to collect tissue samples (biopsies) from your prostate gland. Examining the tissue sample helps confirm or rule out prostate cancer. 
3. Urodynamic test: In this test, your healthcare provider will fill your bladder with liquid through a catheter to evaluate your bladder’s pressure during urination. 
4. Cystoscopy: A flexible instrument called a cystoscope is inserted into the urethra to examine the lining of your bladder and urethra.

There are several treatment approaches to cure an enlarged prostate, including medications, therapies, and surgery. The doctor will choose the best treatment depending on the size of your prostate, your overall health, age, and the symptoms you are experiencing. You can ease mild symptoms with self-care and lifestyle changes. 

Medications: Medication is a common treatment for mild to moderate symptoms of an enlarged prostate, recommended when lifestyle changes fail to relieve your symptoms. These medications include:-

1. Alpha-blockers: These medications help relax bladder muscles and muscle fibres in the prostate. They make it easier for urine to flow and work in men with relatively small prostates. Alpha-blockers include:-
   1. Doxazosin (Cardura)
   2. Alfuzosin (Uroxatral)
   3. Silodosin (Rapaflo)
   4. Tamsulosin (Flomax)
2. 5-alpha reductase inhibitors: These medications shrink the prostate by reducing the hormone level produced by the prostate gland. Medications such as dutasteride (Avodart) and finasteride (Proscar) can take up to six months to be effective. 
3. Antibiotics: They are effective if bacterial prostatitis causes your prostate to become chronically inflamed. 
4. Tadalafil (Cialis): According to studies, this medication used to treat erectile dysfunction can also treat prostate enlargement.

An enlarged prostate can cause mild to severe symptoms. The benefits of treating an enlarged prostate include:-

1. Enlarged prostate treatment can relieve uncomfortable urinary symptoms, such as blocked urine flow. 
2. The treatment can also prevent bladder, urinary tract, and kidney problems. 

If the treatment is a minimally invasive procedure, it offers additional benefits such as:-

1. Smaller incisions
2. Quick recovery time
3. Shorter hospital stay
4. Less pain
5. Low risk of complications

Early treatment of enlarged prostate can help you avoid dangerous complications. If left untreated, the enlarged prostate can cause the following complications:-

1. Urinary retention (sudden inability to urinate)
2. Urinary tract infections (UTIs)
3. Bladder damage
4. Bladder stones
5. Kidney damage
6. Bleeding in the urinary tract

Call your healthcare professional if you experience:-

1. Fever or chills
2. Less urine than usual
3. Pain in the back, side, or abdomen
4. Blood or pus in the urine
5. Inability to empty the bladder even after you urinate

Contact your provider if your symptoms do not improve even after trying self-care and lifestyle changes for two months.