Enlarged prostate (benign prostatic hyperplasia)

Enlarged prostate (benign prostatic hyperplasia)

Virtually no man who lives long enough can avoid it: benign enlargement of the prostate. Benign prostatic hyperplasia or benign prostate enlargement begins as early as the age of 30 and slowly progresses. Symptoms and complaints only develop decades (decades) later. Shaped like a chestnut, the prostate lies under the bladder and encloses the urethra like a fist. Before puberty, she was small and largely inactive, reaching her average size by about 20 years of age.

Cause of an enlarged prostate

The trigger for an enlargement of the prostate gland is a hormonal imbalance: From the age of 50, the male sex hormone testosterone is increasingly converted into the breakdown product dihydrotestosterone (DHT) in the prostate, which presumably stimulates tissue restructuring and thus, prostate enlargement.

 

Consequences of prostate enlargement

From the age of 40 to 50, the prostate tissue changes. The muscle and connective tissue layers around the urethra multiply, and the benign tumour can grow into the bladder. One speaks of a benign prostatic hyperplasia (BPH) or a prostate adenoma. The enlargement of the prostate constricts the urethra like a fist slowly squeezing a straw.

The consequences are easy to imagine – the urine can no longer flow freely, and the pressure when urinating increases; to apply this, the muscle pulls in the bladder (bar bladder) increase. These, in turn, narrow the openings of the ureter, and the urine backs up into the kidneys.

After urinating, a residue of urine remains in the bladder (residual urine), which increases the risk of cystitis. If the prostate is so large that the bladder outlet no longer opens, painful urinary retention occurs.

Who is affected by prostatic hyperplasia?

BPH is ubiquitous in older men, so it’s uncharmingly called an older man’s disease.

It is assumed that microscopic changes in the prostate can be detected in about 50 per cent of men over the age of 50. The enlargement can already be felt in half of them. Seventy per cent of people in their seventies are already affected, and 90 per cent of those in their 80s.

 

What are the symptoms of an enlarged prostate?

Whether and how severe symptoms occur varies greatly. Some men have no symptoms despite enlarged prostate tissue; others show apparent symptoms without detectable enlargement.

Typical signs of an enlarged prostate are:

  • Dripping and thus damp laundry, the feeling of residual urine
  • weakened stream of urine, frequent urge to urinate with small amounts of urine
  • Difficulty starting or interruption of the stream when urinating

By the way, Even if the prostate and its secretions take on essential functions during sexual intercourse, BHP does not mean that impotence is necessarily associated with it.

It’s not always prostate problems.

Many men think they have a prostate problem because they have to go to the bathroom at night. False alarms are not uncommon because very few men are woken up by the urge to urinate but go to the toilet because they are awake anyway. The reason? The structure of sleep changes with age – if you are not ill, you wake up four to five times a night.

Apart from that, the capacity of the urinary bladder also decreases with age, independently of BPH, which results in more frequent urination.

How is the diagnosis made?

To diagnose, the doctor will first collect the medical history (including the medication taken ) and ask precisely about the symptoms and the frequency of urination during the day and night. A standardized questionnaire is often used for this purpose.

A palpation of the prostate follows this via the rectum, often coupled with an ultrasound  – both via the rectum and the abdominal wall. This way, the kidneys and bladder can be assessed simultaneously, and the residual urine can be determined.

For this purpose, the blood and urine are examined to rule out malignant changes.

Depending on your needs, further tests follow, such as a cystoscopy (cystoscopy) or an X-ray examination (excretion urogram). When measuring the urine stream, the doctor checks its strength.

 

Treatment of benign prostate enlargement

The treatment depends on the symptoms and the examination findings, especially the measurement of the urinary stream. If the symptoms are mild, “watchful waiting” (wait and see and check regularly) is indicated – in about one-third of men, these improve spontaneously over time. In the second third, the prostate problems remain constant; in the rest, they progressively worsen.

Treatment with over-the-counter and herbal supplements

In the case of mild symptoms, herbal medicines with few side effects, available over the counter in pharmacies, have their place. These include extracts of nettle root, saw palmetto fruit, pumpkin seeds and rye pollen.

The plant extracts have a decongestant and anti-inflammatory effect but do not prevent the prostate from growing. However, they can postpone an operation to remove excess prostate tissue.

Taking tip: The preparations do not work immediately, but it must take several weeks to achieve an effect. In any case, regular checks by the urologist are essential.

Treatment with prescription drugs

If the symptoms are apparent, the doctor will prescribe alpha-blockers (with the active ingredients doxazosin, prazosin, terazosin or tamsulosin). These have a relaxing effect on the bladder, neck, urethra, and muscles of the prostate, thus making it easier to urinate. Your advantage: the effect starts immediately. The main side effects of the medication are circulatory disorders and dizziness.

If the prostate tissue is significantly enlarged, finasteride is used. This intervenes in the hormone metabolism of the prostate gland: it prevents the conversion of the hormone testosterone into dihydrotestosterone. The symptoms are significantly improved after at least six months of use; however, only about half of the men respond to the therapy.

 

surgery of the prostate

Suppose the medication no longer works, and the symptoms become very distressing. In that case, an operation is unavoidable – in the case of urinary retention, overflow bladder, kidney congestion and damage, it is necessary. The aim is to remove the proliferating tissue while the actual prostate capsule remains intact. You can imagine it like an orange: the flesh is peeled off, and the skin remains.

There are several surgical methods, and the specialist must decide which is suitable. Transurethral resection (TURP), in which the tissue is planed away using an electrical loop inserted through the urethra, is ubiquitous. A more recent method is the more gentle vaporization of the prostate tissue using a laser in the green light range ( green light laser ).

An operation should be carried out in large specialist clinics to keep the risks low. Nevertheless, BPH surgery is now a routine procedure.

What can I do myself if I have prostatic hyperplasia?

Some studies suggest a link between diet and prostate enlargement. Certain secondary plant substances, in particular, are said to be able to prevent enlargement (polyphenols, for example, in grapes, pomegranates, spices) or even prostate cancer (phytoestrogens, for instance in spinachbroccoli, soybeans and carotenoids, for example, in carrotstomatoes, green vegetables ). 

If you are already suffering from minor symptoms, the following tips can alleviate them:

  • Wear comfortable underwear made from natural fibres.
  • Give in to the frequent urge to urinate – otherwise, there is a risk that the bladder will be overfilled and overstretched, thereby increasing the symptoms.
  • Ensure you have regular bowel movements – this will not put additional pressure on the urinary tract.
  • Don’t sit for too long, but stand and walk occasionally.

Enlargement and cancer – increased risk?

According to current knowledge, there is no direct connection between the development of a benign enlargement and a malignant cancerous tumour of the prostate. As a rule, soft growth originates from the prostate gland’s inner parts, while the prostate cancer’s germ cell is located in the outer lobules of the gland.

However, both diseases can occur coincidentally simultaneously or one after the other. Although prostate cancer is much less common than benign BPH, early detection and investigation by the doctor are of great importance.

It is, therefore, essential to have regular annual medical check-ups from the age of 45. In this way, early damage can be detected in good time. The statutory health insurance companies cover the costs.

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