Prostate

The prostate surrounds the urethra like a ring, which is necessary for delivering seminal fluid during ejaculation. However, as the prostate enlarges, it can press against the urethra and irritate the bladder, causing urinary symptoms. 

Many people worry that an enlarged prostate may indicate prostate cancer, but this is not typically the case. Although an enlarged prostate can be associated with prostate cancer, it is usually a condition known as benign prostate hyperplasia (BPH), which is non-cancerous. 

Other factors, such as decreased muscle strength in the bladder and pelvic floor, can also contribute to urinary issues. A weakened bladder may make it harder to empty completely, leading to irritation and urinary tract infections. 

Not all men with an enlarged prostate experience symptoms. If the prostate grows outward without compressing the urethra, symptoms may be minimal. However, if the glandular tissue expands inward, the urethra may become constricted, causing urinary problems. 

Common symptoms include: 

• Difficulty starting urination 
• Longer time needed to urinate 
• Weak or interrupted urine flow 
• Burning sensation when urinating 
• Dribbling after urination 
• Frequent feeling of a full bladder 
• Increased urgency to urinate 
• Disturbed sleep due to nighttime urination 
• Trouble holding urine 

Other conditions, such as bladder infections, diabetes, obesity, or constipation, can also cause these symptoms. It is important to see a doctor for a proper diagnosis. 

Urinary problems arise when an enlarged prostate compresses the urethra, obstructing urine flow, or pushes against the bladder, causing discomfort. A doctor may conduct a rectal examination to feel if the prostate is enlarged or if the texture has changed. Blood tests to check the PSA (prostate-specific antigen) levels can also help identify whether further investigation is needed, as high PSA levels may indicate conditions like prostatitis or, in rare cases, prostate cancer. 

A urologist can perform additional tests, such as an ultrasound or MRI, to further evaluate the prostate and bladder function, including measuring urine flow and retention. 

Prostate enlargement is a natural part of aging, and the exact cause remains unknown, making it difficult to prevent. However, if urinary symptoms arise, there are several treatment options available.  

For mild symptoms, a wait-and-see approach may be recommended, involving regular monitoring of the PSA levels and prostate size, known as "vigilant waiting." If symptoms become bothersome, treatment options include medication or surgery.   

Medication

The first-line treatment for prostate symptoms often involves alpha 1 blockers, which relax the muscles in the urethra and prostate, making it easier to urinate. Examples include alfuzosin, doxazosin, and tamsulosin. If symptoms do not improve within six weeks, alternative treatments may be needed. 

Another option is 5-alpha reductase inhibitors, which help reduce prostate size and relieve urinary symptoms. These may be used in combination with alpha 1 blockers. Side effects can include erectile dysfunction or reduced libido. 

Operation

If medication does not alleviate symptoms, surgery may be necessary. This often involves inserting an instrument into the urethra to remove prostate tissue through burning, lasering, or evaporation, creating more space for urine flow. Recovery may take a few weeks, with full benefits often noticeable after three months. 

While prostate surgery does not typically cause erectile dysfunction, a "dry orgasm" may occur, where no semen is ejaculated. This happens because the seminal fluid redirects to the bladder instead of exiting through the urethra, affecting fertility. If you plan to have children, discuss this with your doctor before surgery. 

Alternative treatments

In addition to conventional medications, several natural remedies are believed to benefit prostate health, including: 

• Saw palmetto 
• Prunus africana 
• African potato 
• Tomato 
• Pumpkin seed oil 
• Nettle 

There are also products that combine some of these ingredients. 

Lifestyle changes

A healthy lifestyle cannot stop prostate growth, but it can reduce the impact of symptoms and help prevent other conditions that exacerbate urinary problems, such as obesity, diabetes, and constipation. 

Tips for a healthier lifestyle: 

• Drink at least 1.5 to 2 litres of water daily to avoid dehydration, which increases the risk of bladder infections. 
• Avoid drinking fluids two hours before bedtime to reduce nighttime urination. 
• Eat a diet rich in vegetables, fruit, and fibre to prevent constipation. 
• Maintain a healthy weight, as excess weight can contribute to urinary problems. 
• Exercise regularly to improve fitness and resistance, and prevent obesity. 
• Strengthen pelvic floor muscles to reduce urinary incontinence. 
• Limit alcohol and caffeine intake, as they can irritate the bladder. 
• Do not delay urination for too long. 

Treatments for an enlarged prostate – Prostaat.nl. (z.d.). Consulted on 19 April 2019, from https://www.prostaat.nl/behandelingen/behandelingen-vergrote-prostaat/

Debruyne, Prof. Dr F. (z.d.). Enlarged prostate – causes and treatment | Andros Mannenkliniek. Consulted on 19 April 2019, from https://www.andros.nl/prostaatklachten/vergrote-prostaat/

I’m having peeing problems | Home doctor. (z.d.). Consulted on 19 April 2019, from https://www.thuisarts.nl/plasklachten-bij-mannen/ik-heb-plasklachten 

Can I prevent an enlarged prostate? | Andros Mannenkliniek. (2017, 25 September). Consulted on 19 April 2019, from https://www.andros.nl/artsenblog/vergrote-prostaat/vergrote-prostaat-voorkomen/ 

Medicines for an enlarged prostate (BPH) – Prostaat.nl. (z.d.). Consulted on 19 April 2019, from https://www.prostaat.nl/medicatie/medicijnen-vergrote-prostaat-bph/

Enlarged prostate (BPH) – Prostaat.nl. (z.d.). Consulted on 19 April 2019, from https://www.prostaat.nl/aandoeningen/vergrote-prostaat-bph/

Mictio complaints in men – Pharmacotherapeutic Compass (z.d.). Consulted on 19 April 2019, from https://www.farmacotherapeutischkompas.nl/bladeren/indicatieteksten/mictieklachten_bij_mannen