If you’re a man over age 50, and you notice you’re making urgent, frequent trips to the bathroom—even though you have difficulty urinating when you get there—you are not alone.
You are likely burdened by an enlarged prostate, a condition that causes blockage of the flow of urine. This occurs when rapidly multiplying prostate cells create the enlargement, putting pressure on the urethra, the tube-like structure through which urine and semen exit the body.
This pressure causes the muscle to contract, creating an urgent need to urinate. Eventually, the bladder muscle cannot overcome the challenge of the pressure caused by the enlarged prostate, and fails to completely empty the urine.
The condition goes by several names. In addition to enlarged prostate, it is more formally called benign (noncancerous) prostate hyperplasia or BPH. It is part of a second phase of the prostate growth period. The first occurs in early puberty. The second begins in the mid-20s, and continues throughout life. Thus, as a man ages, his prostate may grow to the point of BPH.
The condition is common. By their 50s, about half of men have BPH, and by their 70s and 80s, that number jumps to 90 percent. And as many men know, it can make life quite miserable. It can also lead to bladder infection or damage, and eventually even kidney damage.
Signs of an Enlarged Prostate
Signs of BPH include:
- Frequent urination – This includes numerous trips to the bathroom especially at night (nocturia). It also entails the urgency: a rush to get to the toilet, with the possibility of urine leakage before getting there.
- Difficulty urinating – Despite the urgency to go, it can be hard to start urinating. In addition, the urine stream may be slow or weak. There may also be a dribbling of urine.
- Difficulty emptying the bladder – The urgency may be accompanied by the feeling that the bladder has not fully emptied. This feeling may be exacerbated by straining to urinate.
- Bloody urine, incontinence or sexual dysfunction
- Progression of symptoms – This can include bladder infection or bladder stones; kidney damage; and urinary tube blockage, preventing the ability to urinate at all. This is a medical emergency requiring immediate treatment.
A person with BPH may or may not experience any of these symptoms, even disproportionate to the level of the problem. That is, severe BPH may result in mild or no symptoms, and mild BPH in greater symptoms. BPH symptoms can also indicate other medical problems. These are all reasons why men with these symptoms should visit their doctor.
Treatment options vary according to the level of BPH, the level of symptoms, one’s age and overall health. Some men can experience easing of symptoms and can even get by with merely having symptoms monitored.
For those who have mild to moderate symptoms that can benefit from treatment, there are several types of medications that are commonly prescribed. These include:
- Alpha blockers – This category of medicines helps make urination easier by relaxing muscles in the bladder and prostate.
- 5-alpha reductase inhibitors – These medications prevent hormonal effects that cause the prostate to grow, thus they shrink the prostate.
- Combination drug therapy – The top two categories of medications might be used simultaneously.
- Cialis (tadalafil) – While not routinely used for BPH alone, this erectile dysfunction medication may also treat an enlarged prostate.
Minimally invasive techniques
A number of outpatient, minimally invasive techniques are used to treat BPH. These include:
- Transurethral microwave thermotherapy (TUMT) – In this treatment, microwaves use heat to destroy problematic prostate tissue.
- Transurethral needle ablation (TUNA) – High-frequency radio waves are used to burn a specific region of the prostate.
- Water-induced thermotherapy – This technique uses hot water to target and destroy a desired area of prostate tissue.
The preferred surgical method for BPH is transurethral resection of the prostate (TURP). This is removal of the prostate tissue that is obstructing the urethra. TURP consists of widening the urethra through incisions in the bladder and prostate.
Laser surgery utilizes ablation (melting) or enucleation (cutting) to remove prostate tissue. GreenLight™ Laser (also known as PVP, or photosensitive vaporization of the prostate) combines high-powered laser light with fiber optics in order to quickly and accurately vaporize the excess of prostate cells.
Other open surgeries may be required for particularly complicated cases of BPH.