With the age span increasing new problems will occur in an elderly men. The prostate becomes enlarged as the man aged. Many old patients will not admit it but you can see the stains of urine on their trousers. Recently there was an elderly man whose bladder was distended as a result of enlarged prostate blocking his passage of urine. He was catheterised in the clinic and referred to the hospital for removal of his prostate.
Benign Prostatic Hyperplasia or BPH is a common condition where older men over fifty years of age have enlargement of the prostate.
The prostate is a gland present only in males which produces the secretions nourishing the sperms in the semen.It is a walnut size gland encircling the lower urinary outlet of the bladder.
With age, the prostate gland enlarges and squeezes the bladder outlet and the urinary passage like a clamp. An enlarged prostate gland can obstruct the urethra and block urinary flow resulting in damage to the bladder and kidneys.
The cause of the enlarged prostate gland is usually due to age and the prolonged exposure to the male hormones from puberty causing hyperplasia(overgrowth) of the prostatic cells.
The symptoms of BPH varies from person to person.
Sometimes an enlarged prostate may cause little or no problem while a smaller prostate may may compress the the neck of the bladder giving to problems in passing urine.
Symptoms:
1. difficulty in starting urination
2. straining at urination to produce a weak flow of urine
3. dribbling of the urine after urination
4. feeling of incomplete emptying of bladder even after urination.
5. nocturia -getting up at night more frequently to pass urine
6. frequency of urination
7. interrupted urine flow
8. urgent need to pass urine immediately with uncontrolled leakage(incontinence)
Signs:
1.physical examination
A rectal examination may show the enlargement of the prostate
2.urine examination to exclude infections
3.blood tests to check on kidney function
4.an ultrasound to have a better look at the prostate and also any damage to kidneys
5.a urine flow test(Uroflow) to see how fast you can pass urine
6. a blood test for prostatic specific antigen(PSA) to exclude prosate cancer
7. Cystoscopy - a lighted tube to examine the inside of the bladder especially to find where the blockage is or if there is blood in the urine
8.Urodynamics test - to measure the voiding pressure(pressure in the bladder)
Prolonged blockage of the urine by BPH can cause serious Complications:
1.Acute retention of urine( sudden inability to pass urine ) with enlargement of the bladder and abdominal pain
2. Urine leakage or incontinence
3. recurring urine infections
4. bladder stone formation
5. blood in the urine
BPH sufferers may be referred to an Urologist for review. As long as Prostate Cancer has been ruled out, treatment depends on the severity of the BPH.
In mild BPH,there is no significant blockage of the bladder. Symptoms are usually not bothersome. Treatment is by an
1.adjustment of fluid intake
2.regular exercise,
3.proper diet with less red meat , more vegetables and fruits.
In moderate BPH, if the blockage is not severe but the symptoms are bothersome, treatment include the above as well as
4. medications to relax the bladder outlet or help shrink the the prostate, to improve the flow of urine.
In Severe BPH. if the blockage is severe and the person is unable to empty bladder completely,
5.catheterisation and drainage of the urine may be necessary in acute retention of the urine
6.Surgery may be necessary.
This operation called TURP or Trans Urethral Resection of the Prostate removes the obstructing part of the prostate using a resectoscope inserted via the urinary tract. Recovery usually takes 3-4 days.
TURP is usually safe and low risk. Less than 10 % may have some bleeding and infection. Less than 1% may have loss of urinary control.
Less than 4% will have impotence or erectile dysfunction problems.
7. Antibiotics may be given for urinary infections
1.Changing Fluid Intake
You may need to increase or reduce your fluid intake, or change the timing of fluid intake to gain more control over the bladder. Restricting intake of alcohol and coffees can also help by reducing the amount of urine.
2.Bladder training and peri -uretharal muscle exercises
This involves training your bladder to control the urge to void.
3.Maintain a healthy weight.
4.Avoid constipation by including sufficient amounts of fibre and fluids in your diet.
Very good prognosis after treatment.
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