Prostate enlargement symptoms are mainly urinary complaints. The prostate or prostate is located below and behind the urinary bladder, around the upper part of the urethra and against the rectum wall. The urethra runs from the bladder to the end of your genitals. When the prostate enlarges, it can pinch the urethra, causing urinary complaints. The prostate is about the size of a chestnut and is part of the male reproductive organs. The organ produces a fluid to keep the sperm cells alive and to transport them out during ejaculation, called ‘seminal fluid’. Complaints that may arise with prostate enlargement include: a weak urine stream, problems starting to urinate, especially at night or when the bladder is full, dripping urine after urination and the feeling that the bladder is not completely empty. . You can counteract prostate enlargement to some extent.
- What is a prostate enlargement?
- Benign enlargement
- Urinary complaints due to prostate enlargement
- Symptoms of an enlarged prostate
- Phenomena
- International Prostate Symptom Score
- Complications of prostate enlargement?
- Examination and diagnosis
- Prostate enlargement treatment
- No treatment
- Medication
- Surgery
- Laser treatment
- Herbs (Serenoa repens)
- Peeing while sitting
- Preventing prostate enlargement
- An enlarged prostate and prostate cancer
- How can an enlarged prostate affect your life?
What is a prostate enlargement?
Benign enlargement
From the age of 50, the prostate gland gradually becomes larger, this is a normal phenomenon. At the age of 70, 4 out of 5 men have an enlarged prostate. Benign prostate enlargement is also called Benign Prostate Hyperplasia (BPH). The prostate grows larger due to an increase in the number of cells, this is called ‘hyperplasia’. The exact cause of this increase is not (yet) known. In some cases, the prostate becomes larger or stiffer as a result of inflammation or a malignant tumor.Prostate enlargement / Source: Akcmdu9, Wikimedia Commons (CC BY-SA-3.0)
Urinary complaints due to prostate enlargement
As the prostate enlarges, it can push the urethra just below the bladder. This narrowing of the urethra can cause some men with an enlarged prostate to have problems urinating. Prostate enlargement is the most common health problem in men over 60 years of age. BHP is a benign condition (not cancer) in older men.
Symptoms of an enlarged prostate
Phenomena
About 1 in 3 men aged 50 and older develop complaints as a result of prostate enlargement. These complaints consist of:
- A weak stream during urination. The urine stream not only becomes less powerful, but may also be interrupted. All in all, it takes longer to completely empty the bladder.
- Problems starting to urinate, i.e. it takes a while before the urine starts to flow when you urinate
- Dripping after urination, which causes you to lose some droplets of urine shortly after urinating.
- Frequent urination, especially at night, you often have to get out of bed to urinate.
- Urgency, sometimes one has to rush to get to the toilet on time.
- Unconsciously losing small amounts of urine, which is called ‘incontinence’.
In the beginning, the symptoms are often quite mild and can gradually worsen as the years go by.
International Prostate Symptom Score
The GP can use a questionnaire with scores to quantify the severity of the urinary complaints and the discomfort experienced by the patient. The most widely used and studied is the International Prostate Symptom Score (IPPS), a seven-item questionnaire developed and validated by the American Urological Association and recommended in the guidelines of the Dutch Association for Urology (NVU). People are always asked about the frequency in which the complaints occur. IPSS is useful for assessing the severity of symptoms and monitoring their course with or without treatment.Complete the following questionnaire, where:
- < stands for ‘less than’; and
- > stands for ‘more than’.
| How often in the past month have you… | Never | < 1 in 5 | < half | ± half | > half | Almost always |
| the feeling that your bladder was not empty after you urinated? | 0 | 1 | 2 | 3 | 4 | 5 |
| that you had to urinate again within 2 hours after urinating? | 0 | 1 | 2 | 3 | 4 | 5 |
| that while urinating you noticed that the stream stopped and started again several times? | 0 | 1 | 2 | 3 | 4 | 5 |
| difficulty delaying urination? | 0 | 1 | 2 | 3 | 4 | 5 |
| a weak urine stream? | 0 | 1 | 2 | 3 | 4 | 5 |
| that you had to strain to get the urine stream going? | 0 | 1 | 2 | 3 | 4 | 5 |
| How often in the past month have you had to… | Never | 1x | 2x | 3x | 4x | 5x |
| getting out of bed to pee on average per night? | 0 | 1 | 2 | 3 | 4 | 5 |
The answers are scored on a six-point scale (0-5 points) and can now be added up to a total score. The following classification by severity is generally used:
- 0 to 7 points – no or minor complaints;
- 8 to 19 points – moderate complaints;
- 20 to 35 points – severe complaints.
Complications of prostate enlargement?
The urine drainage can suddenly become blocked, making it impossible to urinate. This is called ‘acute urinary retention’, which is a medical emergency that requires immediate treatment. ‘Chronic urinary retention’ can also occur: an accumulation of urine in the bladder for a longer period of time because one can no longer urinate completely empty. The amount of urine remaining in the bladder increases. This can lead to inflammation or unwanted urine loss. Prostate stones can also develop as a result of prostate enlargement.
Examination and diagnosis
The prostate can be examined by means of a rectal examination. The doctor inserts a gloved finger through the rectum to examine the prostate and allow the doctor to estimate the approximate size of the prostate. Urine and blood can also be examined. This is to rule out inflammation, cancer or kidney problems. It is important that other possible causes of an enlarged prostate, such as cancer, are ruled out before treating the patient for benign prostate enlargement. In case of serious complaints and complications, the GP can refer the patient to a specialist in the hospital for further tests and examinations.
Prostate enlargement treatment
No treatment
In many cases, prostate enlargement does not cause any damage or complications and does not require treatment. Whether treatment is initiated depends on the severity of the complaints. If symptoms are mild or moderate, regular monitoring may be performed to assess whether the prostate is growing further and whether the symptoms are worsening. The complaints do not always get worse and can even disappear spontaneously. If the complaints become more serious, there are roughly three treatments available.Medication for prostate enlargement / Source: Jarmoluk, Pixabay
Medication
There are two types of medicines that can reduce the symptoms:
- Alpha-1 blockers. These help relax the muscle fibers in the prostate and prostate capsule, so that the patient has to urinate less often.
- 5-alpha reductase inhibitors. These medications affect male hormone balance and reduce prostate volume, sometimes by as much as 30%. Reduced sexual desire and impotence may occur in 1 in 20 patients.
Surgery
In case of serious complaints and complications and when medication does not provide sufficient relief, surgical intervention may be considered. The most commonly performed operation is the so-called ‘Trans Urethral Resection of the Prostate’ (TURP), in which part of the prostate is peeled off through the urethra. Several new treatment methods have also been developed in recent years. TUMT is the most commonly used of the new methods. TUMT stands for ‘trans urethral microwave thermotherapy’ and is also called ‘heat treatment’ or ‘thermotherapy’. A special catheter is inserted into the urethra and prostate tissue is heated through this tube using microwaves. Due to the heating, part of this tissue shrivels and space is created again.
Laser treatment
A new, modern treatment method for prostate enlargements is laser treatment with the GreenLight laser . The procedure is virtually bloodless, which reduces the hospital stay from two to four days to one night. The treatment takes place in the operating room and during the procedure the urologist inserts a viewing tube, a so-called scope, into the urethra. A laser wire, a fiber, then passes through this tube, to which the laser machine is connected. The urologist then activates the laser, sending a bright green laser light through the tube that vaporizes the extra tissue from the enlarged prostate. This procedure returns the prostate to its normal size. The treatment takes about one to one and a half hours. Afterwards you will receive a bladder catheter, which will be removed after one day.
Herbs (Serenoa repens)
Several plant-based drugs have been proposed for the treatment of prostate enlargement, although their mechanism of action is unclear. Serenoa repens is the best studied. Several studies show a beneficial effect on the symptoms of nocturnal urination, urine flow rate and residual volume. Prostate size is not affected.
Peeing while sitting
Men with a benign enlarged prostate can better sit down when urinating. As a result, there appears to be a more powerful stream, while the urination time seems to become shorter and the bladder is emptied better in this way, which means that they run less risk of bladder infections. When you sit, the muscles in your legs and pelvis are more relaxed, making it easier to empty your bladder. This is evident from a study of the scientific literature in this area. Researchers from the LUMC published the results on July 22, 2014 in the scientific journal PLOS ONE. Medications that reduce muscle tension around the bladder can provide relief. But this research shows that the effect of urinating while sitting is almost as great. However, it is not recommended to stop taking medications. A combination of medication and sitting while urinating probably works best.Healthy food combats prostate complaints / Source: Oleksandra Naumenko/Shutterstock
Preventing prostate enlargement
You can never completely prevent prostate complaints and the prostate becomes larger as you get older, but there are measures that can contribute to the condition of your prostate. Eat lots of fruit and vegetables and exercise daily. Men who are regularly physically active have a much smaller chance of prostate problems than men who lead an inactive lifestyle.
An enlarged prostate and prostate cancer
Men with an enlarged prostate do not have an increased risk of prostate cancer. These two problems usually start in different parts of the prostate. Men can have an enlarged prostate and prostate cancer at the same time. Localized prostate cancer (i.e. cancer that has not spread beyond the prostate) usually does not cause symptoms when urinating. If you are concerned about prostate cancer, make an appointment with your doctor.
How can an enlarged prostate affect your life?
Having an enlarged prostate affects men in different ways. Some men have only mild symptoms and do not require treatment. Other men feel like they have to stay close to a toilet because they keep having to pee. This can really interfere with your daily life, such as working, driving, being outdoors and attending social events. If you often have to get out of bed at night to urinate, this can seriously disrupt your sleep, making you less rested during the day and sometimes even just tired. Some men with prostate enlargement notice that their symptoms decrease over time without treatment. But for most men (without treatment) the symptoms remain more or less the same or gradually get worse.
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