What To Do About An Enlarged Prostate?

What To Do About An Enlarged Prostate

Enlarged prostates are common as you age. Men aged 60 and older have a 50/50 chance of having an enlarged prostate and those who are 85 have a 90% chance. Those may be scary stats, but what exactly does having an enlarged prostate mean? Is it something to worry about? And if so, what are the treatment options? Keep reading to learn more about this very common condition and what it may mean for you.

Anatomy Review – function of the prostate

The main function of the prostate glad is to serve as a reproductive organ. It is responsible for producing prostate fluid, which is one of the main components of semen. The prostate gland muscles also help to transport semen into the urethra during ejaculation.  

The prostate gland sits just below the bladder, where the bladder and urethra (the tube that inside the penis that carries urine and semen out of the body) connect. In early life, it’s about the size and shape of a chestnut, and grows to different sizes throughout a man’s life. 

What causes the prostate to get enlarged?

As men age, the prostate gland grows. It’s estimated than as many as 17 million men have an enlarged prostate, or symptoms of Benign Prostate Hyperplasia (BPH). While it’s unclear why the prostate begins to grow, its thought that an excess of certain hormones may be to blame.

Symptoms of an enlarged prostate include the following:

  • A weak or interrupted urinary stream

  • The sudden urgency to urinate

  • Frequent urination

  • An inability to empty the bladder during urination

  • Trouble initiating urine flow, even when you feel like your bladder is full.

Should I worry? 

Even if your prostate becomes enlarged, it may never become an issue for you. The problems start when the prostate begins to constrict or block the urethra. This can compromise the bladder’s ability to effectively empty, causing chronic retention of urine. And, because the bladder still continues to send signals that it needs to empty, urgency and frequency can occur (this is also known as overactive bladder).  If left for too long, the bladder may become distended, making it even harder for it to empty completely. 

For these reasons, it’s important to see your doctor right away if you start experiencing any of the symptoms listed above. Additionally, the symptoms of an enlarged prostate can also mimic those of other conditions, such as bladder cancer or overactive bladder. Your doctor will be able to help diagnose your condition to determine an appropriate treatment.

What’s the treatment for an enlarged prostate?

There are many treatment options for enlarged prostate, depending on your symptoms.

Active surveillance, or “watchful waiting” is a term used to describe the act of monitoring your condition regularly for any changes. This approach is often used for men whose symptoms are mild and not too bothersome. 

There are several medications that are approved for BPH, but most of them fall into two categories: Alpha blockers and inhibitors. Both are effective at treating BPH and sometimes are even prescribed in combination with each other.  

Non-invasive treatment options include things like laser therapy, which decreases the size of the prostate by removing some of the tissue, or laser vaporization, which enlarges the prostate obstruction and opens the urethra.  Transurethral microwave therapy or transurethral needle ablation are other non-invasive treatment options that destroy excess prostate tissue that is causing blockage.

Finally, surgery is also commonly used to help relieve symptoms of an enlarged prostate. The most common form of surgery is transurethral resection of the prostate, or TURP. This surgery requires no incisions, relying instead on a surgical instrument inserted through the tip of your penis and the urethra. Using this tool, the doctor is able to trim excess prostate tissue that may be preventing the flow of urine. 

Other less common surgeries are also used to both trim excess tissue from the prostate, or to decrease pressure on the urethra in order to make urinating easier. You can read more about additional surgical options here.

What Causes Incontinence In Men

What Causes Incontinence In Men?

Bladder leaks can happen to anyone at any age. While we’ve been conditioned to think that mostly older women are affected by the condition, many men suffer from incontinence too. 

There are many conditions that can lead to urinary incontinence in men. But luckily there are also many ways to treat it. Keep reading to learn some of the reasons men develop leaky bladders, how it’s diagnosed, and ways to treat it.

What is urinary incontinence?

Urinary incontinence is the accidental leakage of urine. Many people wrongly assume that developing urinary incontinence is something that just happens as you age. This couldn’t be further from the truth. It can develop in anyone, at anytime. And there are several possible causes for it.

First, let’s start off with learning a bit about how everything works.

The urinary system is composed of two kidneys, two ureters, a bladder, and a urethra. The kidneys remove waste products from the blood and continuously produce urine. The muscular, tube-like ureters move urine from the kidneys to the bladder, where it is stored until it flows out of the body through the urethra. A circular muscle, called the sphincter, controls the activity of the urethra and keeps urine in the bladder until it is time to urinate.

Normally, the bladder wall is relaxed while storing (or filling with) urine and the urethra is closed off by the sphincter. Your pelvic floor muscles also help keep the bladder outlet closed by supporting the urethra.

When the bladder is working correctly, the bladder sends signals to the brain to let you know how full it is, and to the sphincter to tell it to stay closed and prevent the bladder muscle from contracting.

When the bladder is full, you allow the pelvic floor as well as muscles at the outlet of the bladder to relax and open up. As this is happening, the muscle in the wall of the bladder (detrusor muscle) begins to contract and continues contracting until the bladder is completely emptied.

This process of bladder filling and emptying is obviously very complex. When any part of the urinary system or pelvic floor does not work correctly, incontinence can result.

If any of these signals don’t happen or get confused, bladder leakage can happen. 

What causes urinary incontinence in men?

Many things may contribute to bladder leakage in men.

The most common reason men experience incontinence is due to problems with the prostate. As men age, the prostate gland grows. It is estimated that 17 million men have an enlarged prostate, or symptoms of Benign Prostate Hyperplasia (BPH). The prostate gland wraps around the urethra (the bladder outlet), so an enlarged prostate can constrict or block the urethra. This is known as prostatic obstruction.

Prostatic obstruction can compromise the bladder’s ability to effectively empty, causing chronic retention of urine. This contributes to urgency and frequency because the bladder still signals that it needs emptying. If left untreated, the bladder can become distended, worsening its ability to contract and completely empty. It is possible to have prostatic obstruction even if the prostate is not enlarged.

Men may also experience Overactive Bladder (OAB) which is characterized by a sudden and urgent need to urinate, and needing to urinate frequently. This becomes urgency urinary incontinence when you are not able to reach the bathroom before losing control of the bladder.

Additionally, conditions that cause damage to the nerves, such as diabetes can cause bladder problems since it disrupts the normal signaling from the bladder to the brain to help control bladder function. Other conditions, such as stroke, can also cause incontinence, and even some medications or certain foods or drinks can contribute to urinary incontinence. 

How is urinary incontinence in men diagnosed? 

Before your appointment, take note of your symptoms so that you can relay them to your doctor. Symptoms of incontinence to look for are:

  • Diminished or interrupted urine flow

  • An urgent or sudden need to urinate

  • Increased frequency of urination

  • Inability to empty the bladder completely when urinating

  • Difficulty starting the urine flow, even when the bladder feels full

  • Getting up more than once per night to urinate (nocturia)

  • Accidental urine leakage

Talking to your doctor is the first step toward treatment.  At your appointment, your doctor will likely ask for your medical history, give you a complete physical examination, and provide a urine specimen. You may be asked to keep a bladder diary to record your symptoms.  Other tests to examine the bladder and/or prostate may also be necessary. 

Once your doctor has diagnosed your bladder condition, you can work together to decide on a treatment option that best fits your needs and works with your lifestyle.

What treatment options exist for men with urinary incontinence?

The good news is that there are lots of treatments available to men with urinary incontinence.  Your treatment path will depend on what is causing your condition.

For men with an enlarged prostate, your doctor may recommend medications to reduce symptoms and reduce the size of the prostate. Minimally invasive treatments, or even surgery is sometimes done to increase the flow of urine.  

Men with OAB may also be prescribed medications to help calm the bladder.  In cases where medication is not an option or isn’t working, minimally invasive treatments such as InterStim may be used.  This is an implanted device that helps to establish more normal function of the bladder by gently stimulating the sacral nerve. Behavioral modifications can also help with OAB. Changes in your diet, bladder training, and pelvic floor muscles are often used to help control urinary incontinence caused by OAB.

Many men also experience incontinence after prostate cancer surgery. When the prostate gland is removed, damage may occur to nerves, tissues, and the sphincter muscle that can impair the bladder's ability to store urine without leaking. This may last for just a few months during recovery, or longer. Depending on the severity of incontinence, there are several options that may help.  

Performing pelvic muscle exercises (kegels) are an important part of treating incontinence in men. Kegel exercise done before and after surgery can help to recover bladder control and are important for maintaining erectile function.  When done correctly, kegels can strengthen the muscles that support the bladder, causing fewer leaks, and improving bladder and bowel control. (Click here for a men’s guide to doing kegels.)

 If additional help is needed, other surgical options may be available. Your doctor can talk about the pros and cons of the various surgical options available.

Seeking Help Is The First Step

If you’re struggling with urinary incontinence, the most important thing to remember is that help is available. It’s not just a women’s issue – MANY men live with this condition too and there is no need to suffer in silence.  Talk with your doctor to learn the root cause of your bladder leakage and to find a treatment that works for you.