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Common Benign Prostate Problems

Prostate Enlargement

It is common for the prostate gland to become enlarged as a man ages. Doctors call the condition benign prostatic hyperplasia (BPH), or benign prostatic hypertrophy.

As a man matures, the prostate goes through two main periods of growth. The first occurs early in puberty, when the prostate doubles in size. At around age 25, the gland begins to grow again. This second growth phase often results, years later, in BPH.

Though the prostate continues to grow during most of a man's life, the enlargement doesn't usually cause problems until late in life. As the prostate enlarges, the layer of tissue surrounding it stops it from expanding, causing the gland to press against the urethra like a clamp on a garden hose. The bladder wall becomes thicker and irritable. The bladder begins to contract even when it contains small amounts of urine, causing more frequent urination. Eventually, the bladder weakens and loses the ability to empty itself. Urine remains in the bladder. The narrowing of the urethra and partial emptying of the bladder cause many of the problems associated with BPH.

Symptoms of Prostate Enlargement

About 1 in 3 men aged over 50 have some symptoms due to an enlarged prostate. As the prostate enlarges it may press on the urethra just below the bladder and cause symptoms.

Symptoms include one or more of the following.

  • Poor stream. The flow of urine is weaker, and it takes longer to empty your bladder.
  • Hesitancy. You may have to wait at the toilet for a while before urine starts to flow.
  • Dribbling. A bit more urine may trickle out and stain your underpants soon after you finish at the toilet.
  • Frequency. You may pass urine more often than normal. This can be most irritating if it happens at night. Getting up several times a night is a common symptom and is called 'nocturia'.
  • Urgency. You may have to get to the toilet quickly.
  • Poor Emptying. You may have a feeling of not quite emptying your bladder.

Usually the symptoms are mild to begin with. Perhaps a slight reduced urine flow, or having to wait a few seconds to start passing urine. As the years go by, symptoms may become more troublesome. In some men the symptoms become quite severe and complications may develop.

NOTE 1: an enlarged prostate does not always cause symptoms. Also, the severity of the symptoms is not always related to the size of the prostate. It depends on how much it presses on the urethra and lower bladder.

NOTE 2: not all urinary symptoms in men are due to an enlarged prostate. In particular, if you pass blood or have pain it may be due to bladder, kidney, or other prostate conditions. You should see a doctor if these symptoms occur, or if there is a change from your usual prostate symptoms.

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Prostatitis is an inflammation of the prostate gland that is usually caused by a bacterial infection that has spread from another part of the body. Prostatitis can develop suddenly as with acute prostatitis, or gradually build up over an extended period of time as with chronic prostatitis.

Acute prostatitis develops suddenly and is generally caused by a bacterial infection of the prostate brought on by e coli, certain sexually transmitted diseases or sexual contact with an infected person, a urinary tract infection, urethritis, epididymitis, urethral instrumentation, trauma, bladder outlet obstruction, or an infection elsewhere in the body. Acute prostatitis is more common in men aged 20-35, men with multiple sex partners and men who engage in high-risk sexual behaviors.

Symptoms of acute prostatitis may include:

  • Chills
  • Fever associated with lower abdominal discomfort or perineal pain
  • Pain and/or burning with urination, ejaculation, or a bowel movement
  • Urinary retention
  • Blood in the urine and/or semen
  • An increased need to urinate
  • Testicle pain

Unlike acute prostatitis, chronic prostatitis develops gradually, continues for a prolonged period of time, and may have subtler symptoms. Chronic prostatitis will develop from an acute prostatitis bacterial infection that keeps recurring or from a urinary tract infection, urethritis, or epididymitis. Chronic prostatitis is more common in men aged 30 to 50 and is thought to also be associated to hormonal changes of aging and also certain lifestyle influences (excessive alcohol drinking, perineal injury, certain sexual practices).

Symptoms of chronic prostatitis include:

  • A history of recurrent urinary tract infections
  • Lower back, perineal, pelvic floor, or testicular pain
  • Pain and/or burning with urination, ejaculation, or with a bowel movement
  • Blood in the urine
  • Incontinence
  • Abnormal urine color

Like an enlarged prostate, prostatitis is diagnosed through a rectal examination. Unlike the enlarged prostate however, the prostate infected with prostatitis is swollen, warm and very tender to any touch. Prostatitis is typically treated with antibiotics to fight the infection. If antibiotic treatment is unsuccessful, surgery (transurethral resection) may be done. This delicate surgery can cause sterility, impotence, and/or incontinence.

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More dire problems: Prostate Cancer

Prostate cancer is the most common cancer in American men. Any man can develop prostate cancer, but for reasons that are not clearly understood, African-American men are twice as likely as white men to develop it. It is less common in Asian and American Indian men.

A man's risk of developing prostate cancer increases with age, and is most often found in men over the age of 50, and more than 75 percent of tumors are found in men over age 65. A family history of prostate cancer may also increase an individual's risk of developing the disease. Studies suggest that a high-fat diet may increase the risk of prostate cancer, and that a diet rich in vegetables, particularly cruciferous vegetables -- which include broccoli, cabbage, cauliflower, kale, collard and mustard greens, horseradish, kohlrabi, Brussels sprouts, broccoli rabe, radishes, turnip, rutabaga and watercress -- is associated with a reduced risk of prostate cancer.

The incidence rates of prostate cancer have nearly doubled from rates 20 years ago. One possible explanation is that due to the decline in heart disease mortality in recent decades, more men are living to older ages, when prostate cancer risk is highest.

While many men experience no symptoms of prostate cancer before it is discovered, others may notice frequent urination or an inability to urinate, trouble starting or holding back urine, or frequent pain or stiffness in the lower back, hips, or upper thighs. However, these symptoms are also seen with a common, non-cancerous condition called benign prostatic hyperplasia (BPH), which is an enlargement of the prostate gland. It is important to seek medical attention for any of these symptoms to ensure the proper diagnosis and treatment.


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