The prostate is a walnut-sized gland that is part of the male sex organs. With increasing age, the prostate enlarges, which presses on the urethra and triggers various symptoms. Prostate enlargement that is not of pathological origin is also known as benign prostatic hyperplasia or prostatic adenoma.
What is an enlarged prostate?
An enlarged prostate is a benign enlargement of the prostate as a result of increasing proliferation of cell material. Hyperplasia is to be distinguished from hypertrophy (growth in cell size), even if the terms are sometimes used synchronously in the case of prostate enlargement. See gradphysics for Kniest Dysplasia in English.
Enlarged prostate involves an increase in the number of stromal and epithelial cells, resulting in the formation of large, relatively discrete nodules in the area of the prostate surrounding the urethra. If large enough, the nodules press on the urethra, causing obstruction to the normal flow of urine.
Enlarged prostate leads to symptomatic urinary retention such as frequent urination, dysuria (painful urination), and an increased risk of urinary tract infections. Despite the symptoms that cause discomfort, an enlarged prostate does not lead to cancer or an increased risk of cancer.
The increasing tissue growth of the prostate begins around the age of 30. An estimated 50% of men by the age of 50 have histological evidence of prostate enlargement. By the age of 80, 40-50% of all men have clinically significant prostate enlargement.
The cause of prostate enlargement has not yet been clarified, so risk factors can hardly be named. However, it is believed that the increasingly higher proportion of estrogen promotes a growth stimulus of female tissue parts in the posterior urethra. Another thesis assumes that an enlarged prostate results from a reduced production of dihydrotestosterone (DHT) with age.
Other studies assume that an enlarged prostate could be predisposed. Thus, later in life, certain cells are activated that signal other cells in the gland to grow or become more sensitive to hormones.
Symptoms, Ailments & Signs
An enlarged prostate primarily affects urination. The most common symptom is the urge to urinate frequently at night. In addition, with an enlarged prostate, there is often a sudden and strong urge to urinate.
At the same time, urination also becomes more difficult: the stream of urine is weaker and those affected by an enlarged prostate often have the feeling that the bladder is not completely empty. In fact, men with an enlarged prostate very often have residual urine in the bladder, which promotes the occurrence of bladder and urethral infections. In very rare cases, there is complete urinary retention and thus a risk to the kidneys.
The urination itself often takes longer than usual for those affected. Occasionally, those affected have great difficulty even starting to urinate. Urine often continues to drip after urinating or there are symptoms of incontinence. Sometimes there can be a reduced amount of ejaculation or temporary problems with an erection.
The symptoms that can occur as part of a benign prostate enlargement are not necessarily dependent on the extent of the enlargement. Some men have no or very few symptoms despite a greatly enlarged prostate.
Diagnosis & History
In the irritation stage of an enlarged prostate, the first symptoms appear relating to the frequency of urination and bladder function. The second stage of prostate enlargement is characterized by incomplete urinary retention and incipient organ failure.
In the untreated final stage, the bladder function fails completely, which would result in urine poisoning. Additional complications such as urinary tract infections and even kidney damage are possible. For a complete diagnosis of an enlarged prostate, a rectal urological examination is first necessary.
A protein-based PSA blood test or rectal ultrasound can be done to rule out cancer as a cause of prostate enlargement. If there is a suspicion, a biopsy of suspect tissue is taken for a microscopic examination. During cystoscopy, the doctor inserts a small tube through the opening of the urethra into the penis under local anesthesia. The inside of the urethra and bladder can be examined to determine the extent of prostate enlargement.
Changes in the prostate that are not treated promptly can be associated with a number of complications. Benign enlargements can also block the flow of urine. As urine accumulates in the bladder, the risk of bladder stones, urinary tract infections, and a number of more serious complications increases significantly.
Due to the permanently increased filling of the bladder and the associated increased pressure when urinating, after some time there is a reactive growth of the bladder wall muscles. Excessive muscle growth can cause the bladder wall to lose elasticity. In addition, the accumulation of collagen in the tissue increases, which can result in the formation of pseudodiverticula, i.e. small bulges in the bladder wall.
Urinary retention can cause urine to get into the renal pelvis via the ureters. If this is the case over a longer period of time, the kidneys are damaged, and in severe cases it can lead to kidney failure. In addition, there is a risk of uremia.
Certain metabolic by-products such as creatinine, uric acid or urea must be excreted via the kidneys in the urine. If this does not happen or not to a sufficient extent because the kidneys are damaged, these substances accumulate in the body, which leads to symptoms of poisoning. Typical symptoms are nausea, vomiting and severe itching. Untreated uremia can be fatal.
When should you go to the doctor?
Because an enlarged prostate can indicate another serious condition, it should always be evaluated by a doctor. Only early diagnosis and treatment can prevent further symptoms and complications. The earlier the disease is diagnosed and treated, the higher the probability of a positive course of the disease.
The doctor should be consulted for prostate enlargement if the affected person has to go to the toilet very often at night without having drunk much. Erection problems can also indicate prostate enlargement and should be examined by a doctor if they occur regularly and without any particular reason. Patients often show incontinence, which can also damage the kidneys. The symptoms of prostate enlargement can vary in intensity and significantly limit the life of the affected person.
The diagnosis of prostate enlargement can be made by a urologist. In the further treatment, however, the involvement of other specialists is necessary. Whether the life expectancy of the affected person is reduced as a result of the prostate enlargement depends heavily on the exact cause of the disease, so that no general prediction is possible.
Treatment & Therapy
Treatment measures should be taken as soon as the first symptoms appear in order to curb the progression of the prostate enlargement. Most of these minimally invasive treatments apply heat to the affected tissue that is pressing on the bladder.
If symptoms are severe and heat treatment is unsuccessful, surgery should be considered. In addition to naturopathic medicinal plant teas made from stinging nettle, willowherb or aspen buds, an enlarged prostate can also be treated with medication.
The natural hormones finasteride and dutasteride prevent prostate enlargement. So-called alpha blockers such as terazosin, doxazosin, tamsulosin or alfuzosin can treat symptoms of prostate enlargement.
However, side effects such as dizziness, tiredness and lightheadedness are to be expected. The symptoms of an enlarged prostate can be alleviated with red light and sitz baths or warm, moist wraps. In order to counteract the accumulation of blood in the prostate, regular sexual intercourse or masturbation is also an effective therapy.
An enlarged prostate is part of the aging process in men. In principle, a light diet rich in vitamins and carbohydrates that is low in protein is recommended for prevention. Fat, meat and beer should be abandoned in favor of non-carbonated drinks and fruit. A valuable alternative to chips are the pumpkin seeds, which inhibit the growth of proliferating prostate tissue. Sitting for too long, hypothermia or violent suppression of the urge to urinate should also be avoided.
In the case of prostate enlargement due to the formation of a carcinoma, surgical treatment is usually required and the affected tissue is removed. This also happens in some cases of benign prostate enlargement. After such treatment, regular examinations by the attending physician are of great importance. The possible occurrence of further tumors after the treatment should be recognized at an early stage.
In the case of a previous operation, aftercare of the wound must also be carried out. The doctor treating you makes sure that the wound does not become infected and that there is little scarring. If there is severe scarring, an additional operation can be performed. Disease and treatment of the prostate can also lead to impaired sexual function and incontinence.
This can lead to psychological problems in the patient. Therapy and a course of treatment, which is often covered by statutory health insurance, are therefore advisable in order to make the patient’s situation easier. Self-help groups and other advice centers at the clinics can also be used. Any incontinence that may occur can be improved with special pelvic floor exercises.
You can do that yourself
The enlargement of the prostate is a mostly benign clinical picture that is not always operated on immediately, but is also accessible to the patient to help himself. Some measures with which the patient can help himself in everyday life are compiled below.
The first step is to make the urge to urinate, which most patients perceive as a recurring symptom, more bearable. This often succeeds when patients drink the recommended amount, but not before certain occasions, such as going to bed or a social obligation, in order to be relieved of the urge to urinate as best as possible for these times.
Another way of self-help is to avoid diuretic drinks. Dehydrating drinks should also be avoided. Coffee, tea and alcohol in particular are on the list of unfavorable drinks. After urinating, it is advisable to try again after a short break to empty the bladder. Subsequent urine is then also removed and the interval before the next urination is significantly extended. Bladder training is also very useful.
It is also used, for example, in the irritable bladder in order to train the bladder so that it can tolerate larger amounts of filling. In this way it is also possible to better control the urge to urinate. This is also made possible by over-the-counter medicines, such as those with pumpkin extracts.