Enlarged prostate?

An enlarged prostate, also known as benign prostatic hyperplasia (BPH) or benign prostatic hypertrophy, is a common problem encountered in the older man. Estimates of how many males suffer from an enlarged prostate vary:

• 40% of men over the age of 50 show signs of prostate enlargement
• By the age of 70, about 80% of men have an enlarged prostate

Whatever the exact figure is, it is clear that symptoms of an enlarged prostate are common in men over the age of 50.

The prostate is part of the male reproductive system. The prostate gland lies at the base of the bladder, surrounding the urethra - the tube that carries urine from the bladder when you urinate.

A healthy prostate is about the size of a chestnut. As a man gets older, there is a tendency for the prostate to enlarge. Although we know quite a bit about the biochemistry affecting prostate cells, we don't really know why prostate enlargement occurs - why some men suffer an enlarged prostate and others don't.

However, what is clear is that as the prostate gland enlarges, it presses against the bottom of the bladder (irritative symptoms) as well as squeezing the urethra in a way which interferes with urination (obstructive symptoms). This is the reason an enlarged prostate can give rise to difficulty in urination as well as trouble in control of bladder and sexual function.

Symptoms of an enlarged prostate, in general, affect men from the age of 50 onwards. So, if you are in your 30's or early 40's, though not totally unknown, it is unlikely you will have a significantly enlarged prostate.

The following information may help you understand the symptoms of an enlarged prostate and what to look out.

Men with an enlarged prostate may often experience one or more of the following symptoms:
Irritative symptoms of an enlarged prostate:

• a need to pass water frequently
• having to get up a few times during the night to urinate
• a feeling you can't get to the toilet in time (known descriptively as 'urgency')
• feeling that you can't empty your bladder completely
• loss of libido

Obstructive symptoms of an enlarged prostate:

• poor urine flow or weak stream
• difficulty getting started when needing to urinate
• stopping and starting, rather than a steady stream
• dribbling at the end of urination

This is an example of a commonly used questionnaire to assess the signs and symptoms of an enlarged prostate. This questionnaire should not replace a consultation or professional diagnosis of BPH / prostate enlargement by a doctor or healthcare professional. Always consult your doctor first.

Click here for the questionnaire: BPH Screening Tool¹

• Quick and simple – only 7 questions.
• Once questions have been answered, click on submit to receive your BPH Score.

1. Barry, M.J., et al., The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association. J Urol, 1992. 148(5): p. 1549-57; discussion 1564.

If you are experiencing symptoms of an enlarged prostate or think you have an enlarged prostate gland, the first thing you should do is to see your doctor to have the diagnosis confirmed. This step may involve an internal examination to feel your prostate gland, but it is important to overcome the embarrassment factor as it is vital to rule out more serious conditions such as prostate cancer.

Should an enlarged prostate be detected, your GP may take blood samples for laboratory testing to ascertain PSA (Prostate Specific Antigen) levels. This will provide further information and help in the diagnosis of an enlarged prostate.

When the diagnosis of an enlarged prostate is confirmed, your doctor will be in a position to discuss the treatment options available to you. In general, these are likely to be:

• Watchful waiting. Not everyone with an enlarged prostate requires treatment. Some men experience very few or no symptoms, and the option to 'watch and see what happens', also known as 'watchful waiting' can be a sensible choice.
• Drug medication. These medicines treat an enlarged prostate and are available on prescription from your doctor or at the pharmacy counter after you have spoken to a pharmacist. Your doctor will be the best person to discuss which pharmaceutical BPH treatment is best for you and what the side-effects could be.
• Surgery. For some men, an operation to remove part of the enlarged gland may be recommended. This may be the treatment of choice if you suffer severe symptoms of an enlarged prostate and of course, involves a referral to an urologist at your local hospital.
• Herbal remedies. A number of herbal remedies have been used traditionally to help treat symptoms of an enlarged prostate. Across the world, the most commonly used herb is Saw palmetto - it is also the herb which has been researched the most. Prostasan or Prostate formula may be chosen by:

1. Men with mild to moderate symptoms of an enlarged prostate who have been advised by their doctor to 'watch and wait', or
2. Men who prefer to use natural treatments such as herbal remedies to treat their enlarged prostate