The prostate gland is a male reproductive organ. Many men experience changes as they age, which may be due to inflammation or enlargement of the prostate gland. An enlarged prostate gland, however, does not always cause urinary problems. Troublesome urinary symptoms are rarely symptoms of prostate cancer.
The prostate gland is found at the base of the bladder. The urethra is a thin tube that allows the passage of urine out of the penis. It runs through the prostate gland. Fluid produced by this gland helps to protect and feed sperm, which come from the seminal vesicles via the ejaculatory ducts into the urethra.
The prostate undergoes two main growth spurts. The first is fuelled by sex hormones made by the testicles during puberty. This prompts the gland to reach an average weight of 20 grams in adulthood. For reasons that are unclear, the second growth spurt begins when men are in their 30s. The prostate continues to enlarge with age to an average weight of 40 grams in men in their 70s.
Many men experience urinary symptoms as they age, which may be caused by inflammation of the prostate gland (prostatitis). In the older male, symptoms may be the result of a blockage in the tubes due to a benign (non-cancerous) enlargement of the prostate gland (benign prostatic hyperplasia, or BPH). The most common symptom is difficulty emptying your bladder.
Urinary symptoms may become sufficiently difficult that they require treatment.
Not all urinary symptoms are due to changes to the prostate. Also, some men have enlarged prostates and yet experience few, if any, symptoms.
Urinary symptoms commonly experienced include:
- • The need to urinate frequently during the night
- • Urinating more often during the day
- • Urinary urgency – the urge to urinate can be so strong and sudden that you may not reach the toilet in time
- • The urine stream is slow to start
- • Urine dribbling some time after finishing urination
- • A sensation that the bladder isn’t fully emptied after urination
- • Lack of force to the urine flow, which makes directing the stream difficult
- • The sensation of needing to go again soon after urinating.
Although these symptoms often do not need treatment, you should see your doctor if they are causing particular difficulty, as they can be successfully treated.
Urinary symptoms that should be followed up
See your doctor if you experience:
- • Being unable to urinate
- • Painful urination
- • Any blood in the urine at all
- • Any discharge from the penis
- • Continuous or severe urinary incontinence (you can’t hold your urine).
Bacteria sometimes cause prostatitis (inflammation of the prostate). More commonly, the underlying cause is uncertain. You should consult your doctor promptly if you experience:
- • Fever
- • Lower back pain
- • Pain in the groin
- • Urgent and frequent urination.
Treatment with antibiotics is essential for acute bacterial prostatitis. Admission to hospital is often necessary and, as with chronic (ongoing) prostatitis, specific antibacterial drugs are required for a long time.
BPH causes enlargement of the prostate, which may cause troublesome symptoms. BPH is more common as men get older.
The urethra passes through the prostate gland, so men may have problems urinating if the enlarged gland restricts the flow of urine. If the flow stops completely, a catheter is required to empty the bladder. It is rare for this form of acute urinary retention to cause kidney damage.
An enlarged prostate doesn’t always cause urinary problems. Studies indicate that the size of a man’s prostate gland has little influence on the type or severity of his urination problems. BPH is just one possible cause of urinary symptoms.
Another cause of urinary symptoms can be changes to the muscles that are part of the urinary system, which may cause bladder contractions or stop the bladder from contracting.
If you are troubled by urination problems, you should see a doctor – no matter what your age. If your doctor agrees that your symptoms need further evaluation and treatment, you may need to undergo a few tests. These may include:
- • Physical examination – including rectal examination to check the size and shape of your prostate gland
- • A urine check – to ensure the prostate is not infected
- • A flow rate check – to estimate the speed with which you pass urine
- • An ultrasound examination – to assess if the bladder is emptying completely and to examine your kidneys
- • Urodynamics – a series of tests on the bladder to see how your urinary system is functioning may be recommended in some circumstances.
If your urination problems are simple and don’t bother you very much, steps you can take at home include:
- • Minimise drinks such as coffee, caffeinated soft drinks and alcohol, especially before bedtime, if getting up at night to pass urine is disturbing your sleep.
- • Try ‘urethral stripping’ or ‘milking’ your urethra empty after you finish urinating if dribbling is a problem. You do this by running your finger from behind your scrotum to the tip of your penis to help press the last dribbles out. If you wait a little while after passing urine for the last drops to fall before replacing your penis in your underpants, it may also lessen the likelihood of dribbling.
- • Learn pelvic floor and bladder retraining exercises as they may help to ease some urinary symptoms. See your doctor for advice.
If your urinary problems are caused by infection or enlargement of the prostate gland, treatment may include:
- • A long course of antibacterial medication (for bacterial prostatitis) – because infection is difficult to get rid of, the antibacterial medication will need to be taken for many weeks.
- • Medications to improve urine flow and other symptoms (for obstruction caused by an enlarged prostate).
- • Surgical procedures (for blockage caused by an enlarged prostate) such as transurethral resection of the prostate (TURP), transurethral incision of the prostate (TUIP), laser resection of the prostate, and for very large glands, open (enucleative) prostatectomy. This last procedure involves removing the enlarged prostatic tissue around the urethra and leaving the remaining prostate behind. The type of surgery required depends on the size of the prostate and the condition of the urethra.
- • A number of other procedures have been devised and promoted to reduce urinary symptoms. Talk to your doctor about your options.
Medications for prostate gland and urinary problems
Your doctor may suggest various medications to help ease your urinary problems, including:
- • Medications to reduce the tone of the muscles of the urethra and prostate to minimise any constriction to urine flow caused when these muscles contract.
- • Medications to reduce the size of the prostate gland. These drugs work by blocking the action of male hormones produced by the prostate gland.
- • Medications to relax the bladder, making unwanted contractions less likely and thus reducing the symptoms of urgency and frequency of urination.
- • The over-the-counter preparation ‘saw palmetto’ (Serenoa repens) is sometimes recommended. This may help some men, especially if frequent urination at night is a problem, although studies have not shown improvement in urinary flow measures, or prostate size, in men with BPH taking saw palmetto.
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