What and where is the prostate gland?
The prostate is a walnut-sized gland found only in males. It sits below the bladder and wraps around the urethra.
Its purpose is to produce the milky fluid that nourishes sperm and helps make up semen.
Why does the prostate gland ?
The reason why this happens is unknown, but it seems to be a fairly inevitable part of ageing. Over time, the gland slowly becomes bigger, increasing to the size of a lemon. According to the Harvard Medical School, half of all 60-year-old men will have an enlarged prostate, and by the time they’re 85, that number has risen to 90%.
The medical term for this is Benign (non-cancerous) Prostatic Hyperplasia or BPH.
Of course, in some cases, the enlargement is caused by cancer, so if you do have symptoms, make sure you make an appointment with your doctor and have it investigated.
How does an enlarged prostate affect urinary continence?
As you can see in the diagram, the gradual increase in the size of the gland squeezes and constricts the urethra, the tube that drains urine from the bladder to outside the body. The enlargement can also put additional pressure on the bladder
Symptoms on an enlarged prostate
It’s important to know that for many men, an enlarged prostate has no impact on their health or continence. But for those who do experience issues, the most common are:
- Difficulty starting and maintaining the stream of urine
- A weak or slow stream
- Frequent urination during the night also called Nocturia
- Frequent urination during the day – more than eight times
- Not always feeling like your bladder is empty, even if you’ve just been to the toilet
- Having to go back to the bathroom shortly after you’ve just been
- A sudden and urgent need to empty your bladder, also known as urge incontinence – when you may or may not make it to a bathroom in time
- Urine retention which can lead to a type of overflow incontinence known as after dribble Burning or pain when passing urine or visible blood may be signs of infection caused by retention
Should I seek help for an enlarged prostate or just put up with it as part of ageing?
It’s well documented that men can be reluctant to see a doctor, but there are two strong arguments to have this condition investigated:
- The enlargement may be cancer, and that must be diagnosed and treated
- Retention of urine in the bladder can cause an infection which can then travel to the kidneys, making you very unwell
- A total blockage can be life-threatening. If you find you are unable to urinate at all, head straight to your nearest emergency room where a catheter will be inserted to drain the bladder
- Kidney damage caused by the constant pressure or retained urine
- Impact on lifestyle
- Urinary incontinence can have a significant emotional effect on men. Read more about that in this article.
- It can be down-right annoying, inconvenient, exhausting (especially if you have to get up several times throughout the night) and embarrassing – which can all impact your work, sport, social and sex life
How is an enlarged prostate diagnosed?
Your doctor may:
- Enquire about your general health, including erectile function, lifestyle habits (diet, activity, alcohol consumption, mental health, etc.)
- Ask about your symptoms
- Conduct a physical examination, including checking the size of your prostate gland via the rectum
- Take a urine sample to check for infection
- Run general health checks for diabetes, cholesterol levels, etc.
- Refer you for an ultrasound or urodynamics tests to discover exactly how your urinary system is functioning
Just keep in mind that doctors have seen and heard it all before, so you should feel able to share everything that’s going on in the same way you’d talk to your mechanic about how your car is running.
This article, Questions for the Doctor might be useful in preparing for your appointment.
Treatment for an enlarged prostate
Your doctor will advise you on the best course of action for your circumstances, which could include:
- Lifestyle changes such as
- Losing weight
- Exercising more
- Addressing persistent constipation
- Ceasing smoking
- Reducing food and drinks that can irritate the bladder such as alcohol, caffeine and carbonated beverages
- Pelvic floor exercises, which specifically target the sling of muscle that supports the bladder, colon, urethra and rectum, as well as playing an essential role in bladder and bowel control.
- Bladder retraining
- ‘Watch and wait’, which suggests no immediate issue but required ongoing monitoring for any further changes. This is often in conjunction with some of the approaches above
- Medications which can:
- Reduce the size of the prostate by blocking the male hormone produced by the gland
- Reduce the muscle tone (stiffness) of the urethra
- Relax the bladder to reduce urgent contractions
- Improve the issue of frequent nighttime voiding
- Non-surgical procedures, including the use of heat or steam to reduce the size of the prostate. This is a relatively new treatment explained in this short video from the Mayo Clinic website
- Surgery. Your doctor will discuss the type of surgical options relevant for your condition. You can read more about that, including questions to ask if your considering surgery in this article
Prostate surgery and incontinence
Damage from prostate surgery can have a negative impact on continence, usually through nerve injury. An anaesthetic can also cause a condition called Post-Operative Urinary Retention (POUR), which is the inability to pass urine. You can read more about that here. Both of these are typically temporary and resolve themselves over time.
If you’ve had prostate cancer, in addition to surgery, radiotherapy can also contribute to incontinence by irritating the bladder and causing it to contract more than usual. For more information, read this article titled Prostate Cancer and Male Urinary Incontinence. Once you’ve fully recovered from treatment, your urinary function should return to normal, but if issues persist, discuss it with your doctor.
Living with incontinence
Using an absorbent, disposable product is also a good solution, long or short term. These products are soft, discreet and comfortable as well as being specifically designed to quickly absorb and lock-away urine to keep you dry and odour-free.
Using such products for the first time can be very disconcerting for men, but they quickly discover how effective they are and soon don’t even notice they’re wearing them. Read more about using absorbent products, including when to change and the correct way to dispose of used ones here
The TENA for Men range of products includes anatomically designed Shields and Guards that fit snugly into the front of briefs and offer ideal protection for dribbles. The men’s range also includes Men’s Pants. However, to find the best product for your needs, check out the TENA Product Finder Tool,where you can also order free samples.
Asaleo Care makes no warranties or representations regarding the completeness or accuracy of the information. This information should be used only as a guide and should not be relied upon as a substitute for professional, medical or other health professional advice.