How an Enlarged Prostate Affects Your Bladder
If you're a man older than 60, you should know what an enlarged prostate can do to your bladder. About half of all men at this age will have bladder symptoms because of an enlarged prostate. By age 85, almost all men will have these symptoms.
The healthy prostate is a gland the size of a walnut. It sits just beneath the bladder. Its job is to produce the fluid that comes out during an ejaculation. The tube that empties urine through the penis (the urethra) passes right through the prostate. Urinary problems can develop if the prostate enlarges, compresses the bladder, and starts to squeeze down on the urethra.
Benign prostatic hyperplasia (BPH) is the name of the condition that develops when a man's prostate enlarges as he ages. Researchers do not know exactly why this happens. It may have something to do with hormone changes. Men who are overweight, don't exercise, and have a family history of BPH may have a higher risk.
BPH can block the flow of urine and cause it to back up into the bladder. Signs of that include:
- Needing to urinate more often
- Getting up frequently at night to urinate
- Having a weak stream or dribbling flow of urine
- Having trouble starting or stopping urination
- Having to go urgently
- Feeling like the bladder is still full after urinating
If you have any of these symptoms, but they are mild, you don’t have to do anything. Your doctor might do some tests to find out how enlarged your bladder is and to rule out cancer or serious inflammation. The doctor also may do a finger exam of your prostate through your rectum. That's called a digital rectal exam. If everything checks out, a wait-and-see approach should be fine. If your symptoms are bothersome or getting worse, options range from medicines to minimally invasive procedures and surgery. The drugs used to treat BPH require a prescription. No studies have shown that over-the-counter treatments work for BPH.
Treatment options include:
- Alpha blockers. These are oral drugs that relax the muscles around the prostate. That improves urine flow. They don’t shrink your prostate. Side effects can include headache, dizziness, and problems with ejaculation.
- 5-alpha-reductase inhibitors. If you have significant prostate enlargement, your doctor may suggest one of these drugs. They are also oral. They cause the prostate to shrink. Side effects can include erectile dysfunction and problems with ejaculation.
- Minimally invasive procedures. Several different procedures can shrink the prostate. First, the doctor puts a scope, probe or catheter into the penis and through the urethra to reach the prostate gland. Then, transurethral microwave therapy sends microwave energy through the tube to shrink the gland. Transurethral needle ablation uses radio frequency energy. Laser therapy uses vaporizing energy.
- Transurethral surgery. Transurethral resection of the prostate (TURP) is the most common surgery for BPH. However, surgery is usually not suggested unless nothing else has worked. TURP involves inserting a scope through the penis. The doctor puts an electrical loop through the scope and uses it to cut away tissue in the center of the prostate gland. This surgery is more effective than all other procedures except total removal of the prostate gland. Complication rates are low. But, they are known to include incontinence and erectile dysfunction.
- Open surgery. Someone with an extremely enlarged prostate may need to have the center of the gland removed through an incision in the lower belly. This surgery greatly improves urine flow. It often requires a brief hospital stay. One possible complication is bleeding.
If you have bladder symptoms, talk with your doctor. Your doctor will run tests to determine if you have an enlarged prostate. If you and your doctor decide to watch and wait instead of pursuing treatment there are a few things to keep in mind. Reducing stress, exercising regularly, and avoiding alcohol or caffeinated beverages later in the day can help avoid some symptoms of an enlarged prostate. Also, make sure to take the time to empty your bladder completely, especially if you are going to be away from a bathroom for a while.