Part of the male reproductive system, the prostate makes most of the essential fluid in the semen. This walnut-shaped gland has two or more sections, or lobes, surrounded by an outer layer of tissue and is in front of the rectum, just under the bladder. It surrounds the urethra at the neck of the bladder, where the urethra joins the bladder. The urethra carries both urine and semen out through the penis.
Prostate glands gradually increase in size with age. If they get too large they can interfere in proper drainage of urine, which is common in men after the age of 50, and more likely as the aging process continues.
Prostatitis, or inflammation of the prostate, is the most common prostate-related problem in men under 50. For men over the age of 50 it is prostate enlargement, also known as Benign Prostatic Hyperplasia. Prostate cancer is another health concern for men over 50, although it can occur earlier if there is a strong family history of the disease.
Prostatitis is not contagious and the symptoms are similar to those of benign prostatic hyperplasia or urethritis (inflammation of urethra).
There are three types of prostatitis, or inflammation of the prostate:
Acute infectious prostatitis
This comes on suddenly and the symptoms may be severe and include painful and frequent urination, a decreasing urinary stream and urinary retention, fever and chills and low back pain. It can be caused by a virus or bacteria.
Chronic infectious prostatitis
This is a longer-lasting form of prostatitis and can be caused by bacteria, and worsened by nicotine, caffeine, stress and alcohol. Symptoms can include frequent urination, pain in the low back or lower abdomen and recurring bladder infections.
This is the most common form of prostatitis. As it is not caused by a bacteria, antibiotics will be of no effect. The symptoms may be worsened by irregular sexual activity since infrequent ejaculation can cause the ducts to become blocked, and by stress, which cause the pelvis muscles to tighten and become painful. Increased pressure during urination can cause urine to back up into the ducts, leading to a form of chemical prostatitis.
What causes prostatitis?
Prostatitis is sometimes caused by bacteria, but there are other possible causes. You will need to visit a urologist to confirm whether you have prostatitis and to rule out other causes of urinary symptoms, such as kidney stones.
How is prostatitis treated?
If your prostatitis is caused by bacteria, then your doctor can prescribe an antibiotic to help fight the infection. If you have recurring infections, there might be a defect in your prostate that allows bacteria to grow. This defect can normally be corrected surgically.
If you have non-bacterial prostatitis, you might be given a drug to relax the prostate’s muscle tissue. Your doctor might also advise you to take warm baths or make dietary changes.
BHP refers to a situation where your prostate is enlarged but not cancerous. It is also known by the names Benign Prostatic Obstruction or Benign Prostatic Hypertrophy. When the prostate grows larger, it presses against the urethra and pinches it. The bladder wall also becomes thicker and eventually, the bladder can weaken and lose the ability to be fully emptied. This urinary retention, together with the narrowing of the urethra, are responsible for many of the symptoms associated with benign prostatic hyperplasia.
What are the symptoms of BPH?
Symptoms of BPH include
An urge to urinate even though you have just finished
An urgent and frequent need to urinate
trouble beginning to urinate
a weak urine stream
small amounts of blood in your urine
What causes BPH?
While the causes of benign prostatic hyperplasia are not clear-cut, it is age-related. Benign Prostatic Hyperplasia affects about half of all men between the ages of 51 and 60 and up to 90% of men over the age of 80.
How is BPH treated?
If your symptoms don’t bother you too much, you could just continue to have regular check-ups to ensure the condition is not worsening. However, if the condition is more serious, you might be given medication to relax or shrink the prostate. Another option is the surgical removal of part of the prostate.
Can I ignore my BPH symptoms?
Painful or frequent urination, particularly when it is accompanied by blood in the urine, can be a sign of bladder cancer, so it is important to go to a doctor to rule out his possibility
When should I see a doctor for urinary symptoms?
Common signs to watch for are a weak or interrupted urine flow, difficulty in passing urine, urgency or frequency, pain during urination or ejaculation, or having to get up during the night to urinate.
What steps can I take to help prevent prostate problems?
The following factors appear to contribute to keeping your prostate healthy: reduced intake of meat, dairy sugar and starch; moderate exercise; and regular ejaculation.
Around 40% of men over the age of 60 suffer from troublesome urinary symptoms, some of which significantly impact on their quality of life. The risk of developing these symptoms increases with age and is usually due to Benign Prostatic Hyperplasia (BPH). Since the urethra (waterpipe) passes through the prostate, when this gland enlarges, the flow of urine is blocked. To get around this, the bladder muscle works harder than usual so it can force the urine out. This development can cause some or all of these symptoms:
Frequent visits to the toilet as it is difficult to empty the bladder completely
A sense of urgency when needing to urinate, and inability to hold it in
Getting up frequently during the night to pass urine
Difficulty in starting to urinate, and needing to strain
A weak urine stream
Pauses in urine flow
Tests for enlarged prostate & urination issues in Dubai
Your urologist might recommend these tests to identify or determine the cause if you are having difficulty urinating:
Urine flow test: This test uses a special device to measure the speed of your flow (it is placed in the bathroom so you have privacy). After the flow test, a bladder scan might be performed to assess the amount of urine you have left in your bladder.
PSA test: This blood test measures the amount of prostate-specific antigens (PSA) in your urine. PSA is a natural protein that seeps from the prostate into the bloodstream and the levels are elevated if you have an infection or a urinary catheter, or sometimes for no particular reason. Elevated levels might also be normal for you.
Transrectal ultrasound and biopsy (prostate biopsies): If you have a high PSA reading that is unexplained, we will recommend this scan to check for the presence of prostate cancer. A narrow, lubricated tube will be inserted through the rectum under local anesthetic to allow us to measure the prostate and to take biopsies for analysis.
Flexible cystoscopy: This is an outpatient test, performed under local anesthetic, where a narrow flexible telescope is passed down the urethra into the bladder.
Rigid cystoscopy: This is similar to the flexible cystoscopy except it is done under general anesthetic and the telescope used is wider and rigid. It allows us to do any other necessary procedures at the same time, for example, taking a biopsy from the bladder.
Videourodynamics: This examines the functioning of the bladder – what happens as it fills and empties. It is performed in the spinal X-ray department and involves passing very small tubes into the bladder and back passage under local anesthetic and slowly filling the bladder with fluid while the pressure in your bladder is measured. Once the bladder is full, you are asked to pass the fluid out around the tube.
Treatment for lower urinary tract issues
Lifestyle changes: Sometimes simple lifestyle tweaks are enough to improve your symptoms. Drink plenty of water and, to help reduce symptoms of urinary frequency and urgency, avoid chocolate and caffeinated items such as tea and coffee, as well as alcohol. Also try not to pass urine just for the sake of it, instead, try to increase the amount of time between relieving yourself. However, it is best not to try to hold it in at night as this might keep you awake.
Water tablets: Be sure to take these if the urologist has given you some.
Medication: Your urologist might prescribe tablets to help relax or shrink the prostate, or both.
Surgery: If your symptoms are severe and medication hasn’t helped, your urologist may recommend a procedure called a trans-urethral resection of the prostate (TURP). With this technique, the central part of the prostate that is obstructing the passage of urine is removed. It also involves passing a rigid telescope through the urethra and into the bladder. The hospital stay is usually a day or two.
Our Men’s Health Team
Dr Shawket Alkhayal
Consultant Urologist & Andrologist
Dubai Health Care City