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Prostate: your enlarged prostate

What causes 'trouble with the waterworks'?

This is usually caused by enlargement of the prostate gland. Nearly every man over 45 years of age has some degree of this enlargement, which is called benign hypertrophy. Some drugs cause trouble, especially when an enlarged prostate is present. These drugs include alcohol, some drugs used to treat depression, Parkinson's disease, irregular beats of the heart and over-the-counter ephedrine-like compounds for coughs and colds.

How common is the problem?

Although enlargement of the prostate is common in men over 45, it rarely causes trouble before 50. By the age of 60 at least 50 per cent of men will have 'waterworks trouble'. Serious urinary trouble affects 1 in 10 elderly men.

What are the symptoms?

• frequency of urine
• an urge to urinate without much warning
• waking at night with this urge
• difficulty starting and sluggish stream, especially first thing in the morning
• a tendency to dribble after urinating, with wetting of pants
• a need to urinate a second time after only 20 minutes
• The symptoms vary somewhat, but pain is a rare problem.

What is the prostate gland?

It is a brownish gland about the size of a walnut that surrounds the opening of the bladder and the first 2.5 cm (1 inch) of the urethra (the tube passing from the bladder to the penis).

What does it do?

It has nothing to do with the passing of urine but has a minor fertility function. From puberty it produces substances that form part of the seminal fluid (semen) and seem to help keep the sperm alive.

What are the risks?

Hypertrophy of the prostate is not dangerous, but it tends to squeeze the urethra and makes it difficult for the urine to pass through. This can cause the symptoms of dribbling and poor stream.

More serious problems include:

• infection of urine
• sudden blockage (called acute retention of urine)
• slow blockage (called chronic retention of urine)
• A catheter will usually be necessary to relieve a severe obstruction.

What will your doctor do?

Your doctor will perform a rectal examination with a gloved finger to feel the prostate and then may refer you to a urologist for special tests. Cancer of the prostate has to be excluded. The doctor will check what drugs you are taking to make sure these are not aggravating the problem.

What is the treatment?

Non-surgical

At least 1 in 3 mild cases will not require an operation. Although we cannot cure or shrink an enlarged prostate, you can learn to live with it for some time.

• Avoid or cut down alcohol, especially with and after an evening meal.
• Keep dry (avoid fluids) for at least 3 hours before retiring.
• Get up immediately at night when you wake up with the urge to go.
• Visit the toilet when you need to (do not hang on) and wait a while to make sure you empty your bladder completely.
• Fortunately there are now drugs that can improve the flow of urine in many patients. Your doctor will prescribe them if appropriate.

Surgical

This is eventually required for most prostate problems. About 1 in 10 men will need a prostatectomy. This usually is done through the penis, using an instrument about as wide as a pencil. The operation is called a trans-urethral resection (TUR). Sometimes a cut in the abdomen will be necessary to remove the prostate.

Copyright 1995: John Murtagh, Professor of General Practice
Monash University, Melbourne, Australia