How Is Enlarged Prostate Treated
Treatments for enlarged prostate include:
Lifestyle changes: These can include reducing liquid intake, bladder training , abstaining from alcohol and caffeinated beverages and regularly exercising the pelvic muscles.
Medication: A class of medication called Alpha Blockers works to relax muscle fibers in the prostate and bladder. This relaxation allows for increased urine flow and less frequent urination. A second class of medication, called Alpha Reductase Inhibitors, works to block the hormones that cause the prostate to swell. Many patients will take a combination of these two types of medication.
Minimally invasive procedures: Our specialists are trained in two minimally invasive procedures that can help remove or reduce the obstructing prostate tissue:
Surgery: For severe cases of a very enlarged prostate, surgical removal of the prostatecalled transurethral resection of the prostate may be the recommended course of action. Patients will decide with their doctor if aggressive treatment is warranted, depending on the size of the prostate and severity of symptoms.
Sign : Stop And Start Urination
Typically, the flow of urine should be smooth and steady. But when the prostate is too big, urine could come out in interrupted spurts. You urinate a little and then it stops, even though you know theres more.
We know how bothersome this is. Be careful not to force out the remaining urine as you might strain the various muscles in the pelvic area.
Diagnosing Benign Prostate Enlargement
You might have several different tests to find out if you have an enlarged prostate.
A GP may do some of these tests, such as a urine test, but others might need to be done at a hospital.
Some tests may be needed to rule out other conditions that cause similar symptoms to BPE, such as prostate cancer.
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Medications For Enlarged Prostate
There are two main classes of pharmaceuticals that work to alleviate enlarged prostate symptoms: alpha blockers and alpha reductase inhibitors
Alpha Blockers. Alpha blockers relax the smooth muscle around the bladder neck and within the urethra.
Inhibitors. Inhibitors stop the conversion of the male hormone testosterone to DHT to reduce the prostate’s size, eliminating blockage.
Dont be surprised if your physician prescribes a combination of the two medications, as they have been shown to work more effectively together than alone. The downside is that combination therapy may increase the likelihood of experiencing side effects from the medications. Be sure to work with your doctor to assess the benefits and costs before starting on combination therapy.
Watchful Waiting With An Enlarged Prostate
When the symptoms of an enlarged prostate gland are mild, with low scores on the BPH Impact Index , it may be best to wait before starting any treatment — what’s known as “watchful waiting.”
With regular checkups once a year or more often, doctors can watch for early problems and signs that the condition is posing a health risk or a major inconvenience. That’s where the BPH Index is especially helpful, Westney tells WebMD. “It lets us know how high the symptom score is â¦ when to start treatment.”
The “driving force in treatment,” she explains, is whether the symptoms are affecting your quality of life — and whether a blockage is causing serious complications, such as inability to urinate, blood in the urine, bladder stones, kidney failure, or other bladder problems.
A few questions to ask yourself:
- How severe are your symptoms?
- Do symptoms prevent you from doing things you enjoy?
- Do they seriously affect your quality of life?
- Are they getting worse?
- Are you ready to accept some small risks to get rid of your symptoms?
- Do you know the risks associated with each treatment?
- Is it time to do something?
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What Is The Prostate
The prostate is a walnut-sized gland that rests just below the bladder. It surrounds the urethra, the tube that carries urine from the bladder out of the body. The prostate plays a critical role in the male reproductive system by helping to nourish sperm and direct it from the testicles when a man ejaculates.
Symptoms Of Overactive Bladder
A few symptoms might indicate that you have OAB:
- When you feel the urge to urinate, you may also leak a small amount of urine. This is called urge incontinence.
- You have to use the bathroom more often than you normally do or more than eight times in 24 hours.
- You need to urinate more than once during the night in the absence of contributing factors such as caffeine, alcohol, or excessive fluid intake at night. This is called nocturia.
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Not Sure What To Do Next
If you are still concerned about your prostate problems, why not use healthdirects online Symptom Checker to get advice on when to seek medical attention.
The Symptom Checker guides you to the next appropriate healthcare steps, whether its self care, talking to a health professional, going to a hospital or calling triple zero .
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How Is Bph Treated
In some cases, in particular where symptoms are mild, BPH requires no treatment. At the opposite extreme, some men require immediate intervention if they cannot urinate at all or if kidney/bladder damage has occurred. When treatment is necessary, many men will simply require daily medication. If this fails to completely treat the symptoms, or if there are signs of damage from BPH, the doctor may recommend minimally invasive endoscopic surgery . Or, in some cases, traditional surgery may be recommended.
- Drug treatment: The FDA has approved several drugs to relieve common symptoms associated with an enlarged prostate, including drugs that inhibit the production of the hormone DHT and drugs that relax the smooth muscle of the prostate and bladder neck to improve urine flow.
For surgery, there are many procedures to choose from, and the choice depends largely on your specific prostate anatomy, and surgeon preference and training. These procedures all have a common goal of widening the urethral channel as it passes through the prostate. Procedures include the following:
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Three Stages Of An Enlarged Prostate
It is difficult to tell how many men actually have an enlarged prostate since most men do not have any noticeable symptoms. It is believed there are three stages.
The first is known as the microscopic stage where small areas of the prostate are enlarged but can only be seen through a microscope. Symptoms are rare at this stage, and only one in four men will ever develop symptoms.
The macroscopic stage shows larger areas under a microscope, and can be felt by McIver Clinic during a rectal exam.
The symptomatic stage is noted by changes in urinary habits. There is decreased blood flow to the prostate and there can be additional symptoms related to inflammation of the prostate, an infection, or even prostate cancer.
What Should I Watch Out For
Symptoms of BPH fall into 2 categories. Those caused by pressure on your urethra are called obstructive. The others start in your bladder.
Some of the obstructive symptoms include:
- Trouble starting to urinate
- You have to stop and restart several times
- Pee dribbles out at the end
If BPH causes changes in your bladder, it may include these signs:
- You suddenly feel a strong need to urinate. Doctors call this âurgency.â
- You have to pee more than 8 times a day. This is called âfrequency.â
- Even after you go, you feel as though your bladder is not empty.
- You wake up often in the night to relieve yourself. This is called ânocturia.â
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How Is Bph Diagnosed And Evaluated
Early diagnosis of BPH is important because if left untreated it can lead to urinary tract infections, bladder or kidney damage, bladder stones and incontinence. Distinguishing BPH from more serious diseases like prostate cancer is important.
Tests vary from patient to patient, but the following are the most common:
Using Medication To Reduce Symptoms
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Do I Need Treatment If I Have An Enlarged Prostate
This all depends on how bothersome your symptoms are. Usually, treatment for BPH is not medically mandatory.
What I mean by this is that just having an enlarged prostate is not a medical concern. Its not like diabetes in that if you dont take your insulin that you will have disastrous medical results.
However, the urinary symptoms can really put a stress on your quality of life and that is why many men will find relief with treatment. Many of my patients will tell me how their bladder will dominate their thought process when they are at work or a restaurant or a movie and with treatment this can really help you to getting back an enjoying more those aspects of your life.
There is some theory that if an enlarged prostate is left untreated that it could affect your bladder function as you get older, but this is more controversial, which is why I will usually focus on peoples symptoms the most when deciding to start treatment.
There are however certain instances were treatment is really really warrant. These are if the enlarged prostate is resulting in recurrent UTIs, blood in the urine, or blocking the urine flow that it affects your overall kidney function
Symptoms Of Benign Prostate Enlargement
The prostate is a small gland, located in the pelvis, between the penis and bladder.
If the prostate becomes enlarged, it can place pressure on the bladder and the urethra, which is the tube that urine passes through.
This can affect how you pee and may cause:
- difficulty starting to pee
- a frequent need to pee
- difficulty fully emptying your bladder
In some men, the symptoms are mild and do not need treatment. In others, they can be very troublesome.
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When To Contact A Medical Professional
- Less urine than usual
- Back, side, or abdominal pain
- Blood or pus in your urine
Also call if:
- Your bladder does not feel completely empty after you urinate.
- You take medicines that may cause urinary problems, such as diuretics, antihistamines, antidepressants, or sedatives. DO NOT stop or change your medicines without talking to your provider.
- You have tried self-care steps for 2 months and symptoms have not improved.
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Surgical Treatment For Enlarged Prostate
Transurethral resection of the prostate . In this surgery, the inner portion of the prostate is removed. Used 90% of the time, this is the most commonly used surgical procedure for BPH.
Open prostatectomy .The surgeon makes an incision and removes the enlarged tissue from the prostate.
Laser surgery –Laser surgery uses laser energy to destroy prostate tissue and shrink the prostate.
Transurethral incision of the prostate .This surgery does not involve removing prostate tissue. A few small cuts are made in the prostate gland to reduce the prostate’s pressure on the urethra, making urination easier.
Understanding An Enlarged Prostate
The small prostate gland plays a significant role in your reproductive system, producing seminal fluid, which is a large component of semen. But it also helps with hormone production and the regulation of urine flow.
Medical researchers still dont understand why some men experience an enlarged prostate or benign prostatic hyperplasia . But they do know that at least 50% of men are diagnosed by the time they reach 60, with 90% of men having BPH by age 80, which is highly correlated to aging.
In addition to age, other risk factors linked to BPH include
- Being obese
- Having heart disease
- A family history of BPH
Recent studies have also revealed additional biological factors may influence who develops BPH, including cellular changes in the testes and elevated testosterone.
Whats An Alpha Blocker And How Does It Work
The most common one that people have heard about in my practice is called Flomax or tamsulosin. Other examples of this class of medications include Tamsulosin , sildosin , doxazosin, terazosin, alfuzosin
These work by relaxing the prostatic urethra and opening of the bladder.
It typically takes about 7-10 days to notice if there is symptom improvement. So the urologist will typically see you back in 2-4 weeks and see if it is making a difference.
It does work better on an empty stomach.
Tell your doc if you have a sulfa allergy as some of the brands, like tamsulosin, may cause you to have an allergic reaction.
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What Kind Of Symptoms Would Lead Me To Think That I Have An Enlarged Prostate
So when you come to the urologists office, he/she will typically give you this questionnaire below. This questionnaire really gets to the heart of what symptoms suggest that you are dealing with an enlarged. prostate.
So these questions really focus on how an enlarged prostate can cause bothersome urination.
If you notice that your urine stream is slow or that you have to rush to the bathroom, or that you are straining to urinate, then you are likely suffering from an enlarged prostate.
As a urologist, we will count up these numbers and studies have shown that this can help us evaluate how bad your enlarged prostate is for you. Additionally, this can also help guide us to see how effective your treatment is.
What I mean by this is that when you come back to the office after starting medication or having surgery, we can see what your symptom score is and track to see if we have improved your symptoms of an enlarged prostate.
Blood In Urine/bladder Stones
A number of factors associated with enlarged prostate can cause blood in the urine: Enlarged veins in the prostate can rupture, or if youre forcing hard to urinate, that can also rupture veins. Blood in the urine can also be a sign of a UTI. Urine retention in your bladder can also cause bladder stones. These occur when urine becomes concentrated and crystallizes. They can be very painful and can further block the flow of urine. However, its unlikely that bladder stones would be the first noticeable symptom of an enlarged prostate, Dr. Linehan says.
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What An Enlarged Prostate Gland Feels Like
The symptoms that come with an enlarged prostate vary from man to man, but they usually start out mild and get worse over time. Here are a few of the signs you might notice.
- An urgent need to urinate
- Frequent need to urinate
- The need to urinate frequently through the night
- A weak urine stream
- Urination that starts and stops
- Trouble starting to urinate
- Trouble emptying your bladder completely
While these are the most common signs of BPH and are more annoying than medically problematic, a few symptoms require immediate attention, including the inability to urinate and blood in your urine.
Talk To Me About The Roto Rooter
The most tried and true management of surgery for an enlarged prostate is a transurethral resection of the prostate, or TURP. This is where the urologist will offer the roto rooter or clean out or core out of the prostate.
The best way to think of this is to pretend the prostate is an orange. We take out the fruit but leave the peel on the outside.The next question I get is why not just take the whole thing out? The reason for that is that the risks are higher for when the whole prostate is taken out as is done for prostate cancer. Our focus is on the part of the prostate that is blocking your urine flow, which is why we dont need to remove the whole thing.
This is done in the operating room. You are put to sleep.
A scope is inserted into the penis and a device is used to scrape or resect the part of the prostate that is blocking your flow. This usually takes 1-2 hours and oftentimes you will stay overnight in the hospital.
When you wake up, you will have a catheter coming out the penis and usually continuous bladder irrigation will be done overnight. This is where fluids will run constantly through the catheter into the bladder to help lessen the risk of bleeding and blockage of the catheter. Most of the time you will be able to go home the next day. There are differences in when your urologist will feel comfortable taking the catheter out.
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