Enlarged prostate

An enlarged prostate means an increase in the volume of the prostate gland. While the reason is still unknown, this benign prostate hypertrophy usually occurs with aging. The prostate bulge compresses the urethra just below the bladder neck, giving the typical obstructive symptoms. Most people believe that frequent and urgent urination, and poor urine flow, are unavoidable signs of aging. However, when there is any impact on daily activities and on quality of life, we should consider an active treatment. It usually includes some lifestyle modification, medication, or surgery. While in some cultures the treatment relies on empiric beliefs, it is better to avoid not scientifically supported medications.

Symptoms Explained

The enlarged prostate symptoms occur because of obstruction of the urethra just below the bladder neck. The prostate gland surrounds the urethra and compresses it while enlarging. The early sign is the poor or weak stream. Soon the bladder capacity decreases, and urination becomes frequent and urgent during the day and at night. The dysuria may indicate a concurrent urinary tract infection whose prostate enlarged patient is more exposed. 

Complications

Gross haematuria is a less common symptom, and it is a sign of complication (bladder stones, vein varicosities of the bladder neck). Acute urinary retention is when the patient cannot urinate because of advanced and severe obstruction along with a hypotonic bladder. In this case, the main symptom is severe lower abdominal pain and tenderness, as general symptoms like nausea, swelling, chills, and possible fever.

Quality of life of patients with an enlarged prostate

Patients usually have their daily activities interrupted by frequent urination (business meetings, demanding activities, etc.). Work performance and social interaction may be heavily affected even because of tiredness after insufficient night rest (waking up to urinate several times). The water intake restriction is typical among patients to minimize the symptoms.

Treatment

We can manage mild symptoms with some diet and lifestyle modifications with significant improvement in life quality. The treatment indication must take into consideration the risk of progression toward the complicated stages of the disease. According to this, we may prescribe mono or combined medication therapy. We recommend surgery in case of medical treatment failure. The urologist and the patient must discuss all the possible options selected based on prostate volume and comorbidities.

External resources

Patient’s section of the European Association of Urology