Prostate problems: Carry on living

All men over 50 experience enlargement of the prostate, but with proper care they can easily live a normal and healthy life

old couple on vacationA year ago Mr Shah turned 60 and there was a big party to celebrate the occasion. All were jubilant except Mr Shah, who was secretly dreading the occasion.

Over the last 3 – 4 years, he was experiencing peculiar urinary problems that he felt awkward to reveal to his family. Recently, his problems had worsened and his life almost revolved around the bathroom.

When Mr Shah got the urge to urinate, he could not hold it for even 10 seconds. And sometimes a few drops would spill into his underwear by the time he reached the bathroom. During the day, he felt like going to the bathroom every two hours. What was worse, he had to go every hour at night too, which disturbed his sleep and left him feeling exhausted the next day.

The stream of his urine too was much weaker than before and he had to exert a lot of force to urinate. His urine would take much longer to start and the stream would start and stop and then start again and stop again. Once he finished urinating, he often lacked the satisfaction of having emptied the bladder. Though being a social person all his life he had confined himself to his home for fear that there may be no bathroom where he went.

He had discussed these issues with friends, who were also the same age and were having similar problems. But they all presumed that it was due to ageing and told him that he would have to live with it.

Unfortunately, Mr Shah’s problems were not because of ageing. He had an enlarged prostate.

Prostate and its functions

The prostate gland is a lemon-sized gland at the mouth of the urinary bladder. It is present only in men. The gland grows in size till a boy reaches adulthood. The function of the gland is to produce semen. It is hence a reproductive gland. As the prostate is placed near the urinary tract, a man’s semen comes out from the same tract as urine.

What causes the problems?

The normal weight of the prostate gland is about 25g in an adult man. However, as a man crosses the age of 50, two changes occur in the prostate. Firstly, the size of the prostate starts increasing, and as it grows, it puts pressure on the opening of the urinary bladder, blocking it.

Once the opening of the bladder is either partially or totally blocked, the man has to really strain hard to push urine through this opening.

Secondly, the prostate also becomes harder, which irritates the bladder. A blocked and irritated bladder produces many symptoms in a man like in the case of Mr Shah. In medical terms, this condition is called BEP or benign enlargement of prostate.

Can you deal with it?

This condition is completely and easily treatable and most often without surgery. A visit to your urologist is all that is needed.

Checkup: The urologist will first take a history of your symptoms and assess your overall health. You will undergo a checkup that includes examination of the prostate. This simple examination scares a lot of men but can actually save your life.

The urologist will ask you to lie down comfortably and then insert a gloved, lubricated finger gently into the anus to feel your prostate. It takes about five seconds and is completely painless. The urologist can tell if your prostate is enlarged and sometimes even detect any cancer in the gland.

Investigations: Next, you will need to undergo a sonography of the prostate and a urine test. The urologist will also request a PSA blood test to rule out prostate cancer.

Once these investigations are complete, the urologist will plan the treatment. The treatment depends upon the severity of symptoms, the size of the gland and findings of the sonography.

Management: If you’re lucky and the symptoms are not severe, then a single medicine taken daily can cure you completely of all symptoms. This tablet has no side effects.

However, it needs to be taken lifelong. There are many new, highly effective medicines available today and your urologist will decide the one that is best for you.

If your symptoms are severe or the sonography reveals other indicators like bladder stones, swelling of the kidneys or inability to empty the bladder completely, surgery is recommended. For such patients, medicines may not work well and it is better to go ahead with surgery.

Surgery is usually performed endoscopically to remove the obstructing part of the prostate. It takes about one hour, is painless and requires you to spend a 2 – 3 days in the hospital. Returning to normalcy takes a week or two.

All men have some enlargement of their prostates after 50 years of age. It is recommended that after 50, all men must visit their urologists once a year because in prostate enlargement as well as prostate cancer, as there may not be any symptoms early in the disease.

It is mandatory to undergo a prostate examination and a PSA test, which is inexpensive and is performed at most pathology labs. You may also undergo sonography.

As for Mr Shah, he visited his urologist, who after investigations advised a daily medication. Within two weeks, most of Mr Shah’s symptoms disappeared. Today, he is a carefree man who does not hesitate to go anywhere. What’s more? He has educated all his friends and they too have found relief, after suffering for years.

Do you have an enlarged prostate?

Here are the symptoms you should look for.

  • Strain in urinating.
  • Delays in urine to start.
  • Weak flow.
  • A tendency of the urine to stop and start.
  • A feeling that you have not emptied your bladder.
  • Inability to hold urine till you reach the bathroom.
  • Frequent visits to the bathroom in particular at night.
  • Dribbling of urine after just urinating.
Dr Anup Ramani is a urologist who specialises in cancer of the kidney, prostate and urinary bladder. He was a consultant urologist in the USA for six years and has recently returned to India. He practices urology in Mumbai at Lilavati, Breach Candy and Saifee hospitals and Welcare hospital in Dubai.


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