Dealing with an enlarged prostate

There is always a debate about whether size matters. Well, for the prostate it definitely does! This male reproductive organ grows throughout life, paradoxically, much to the dismay of many a man!

It tends to add to the list of challenges that older persons have deal with which are associated with ageing. What can we do about it?

The purpose of the prostate is to produce and store a liquid that makes up 20-30 per cent of the semen. This liquid helps sperms to survive longer and move faster in the female genital so that they can complete the task that they have set out to accomplish. The prostate surrounds the outlet of the bladder, so as it grows, it obstructs the outflow of urine form the bladder.

Benign prostatic hyperplasia/ hypertrophy (BPH) is a very common problem in older men. In fact, about 50 per cent of men have it by age sixty and 90 per cent by 85. In 40-50 per cent of these men, the condition will cause symptoms. If the muscles around channel that takes the urine out of the bladder (urethra) in the prostate are contracted, then symptoms are more likely.

In fact, there may be obstruction without an enlarged prostate and vice versa. The symptoms are usually more aggressive in black populations.

The symptoms of an enlarged prostate include slow-flowing urine, increased night-time urination, increased overall frequency of urination, straining to pass urine, a sensation of incomplete bladder emptying, and increased time for urination to start and stop. These symptoms are usually progressive, as the prostate grows larger.

Interventions

Some lifestyle changes that may help include reducing alcohol and caffeine intake, as they increase the production of urine. Also, reduce the intake of fluids close to bed time, and seek to have regular planned time to urinate.

Nutritional and herbal supplements (e.g. saw palmetto) have not been proven reliable in treating this condition, either in relieving the symptoms or slowing down its growth. There are medications available that can relax the muscles of the urethra in the prostate, that give relatively fast relief of the symptoms. Some medications can shrink the prostate over time. Combining them has the better outcome.

Surgery (prostatectomy) may be used to remove the obstruction, and heat may be used to selectively destroy some of the prostate, reducing the size. The heat may be supplied by laser, high-intensity ultrasound, microwaves, radiofrequency energy, and high-voltage electrical energy.