Prostatism refers to a collection of symptoms usually caused by a benign (non-cancerous) enlargement of the prostate gland (benign prostatic hyperplasia, BPH). In order to understand this condition it is helpful to know the position of the prostate.
The prostate gland sits at the base of a man's bladder surrounding the top of the urethra, which conveys urine from the bladder to the outside. The prostate is not essential for life and merely secretes some fluid into the semen and helps squeeze the sperm as they move down the urethra during intercourse.
Benign prostatic hyperplasia (BPH) is one of the most common problems to affect men from middle age onwards. The gland increases in size from around about the age of 40 and by retirement age nearly half of all men will be getting some symptoms from their enlarged prostate. Indeed, about 80% of men over the age of 70 will be affected. Prostatism may thus be regarded as a normal part of old age. However, the impact of this problem should not be underestimated: the day-to-day life of many men is considerably disrupted by it.
Given its position around the urethra, an enlarged prostate gland can 'squeeze' this tube and interfere with the flow of urine out of the bladder. Symptoms can result from this obstruction as well as from the irritation of the bladder lining from the retained urine.
Typical obstructive symptoms include hesitancy (having to wait for a while before the urine flow commences), a poor urinary stream and a general reduced ability to efficiently empty the bladder – needing to stop and start and feeling as though the bladder has not fully been emptied, often followed by a little dribbling of urine after finishing.
Irritative symptoms include needing to pass urine more frequently, both during the day and through the night and also a sensation of urgency in which there is an overwhelming need to quickly go to the toilet because of a difficulty holding the urine in.
Because the prostate tends to enlarge slowly over the years, symptoms initially are often quite mild. In fact up to 80% of men find their symptoms either do not progress or even regress with time! The other 20% however gradually develop more pronounced symptoms which occasionally can even lead to the acute inability to pass urine at all. A condition termed 'acute urinary retention' which requires urgent insertion of a catheter into the bladder to relieve the obstruction and associated pain.
Many men accept mild symptoms of prostatism as simply just another feature of advancing years and for many of those whose lives are not unduly disrupted by this condition, there is no specific need for any treatment. However, when symptoms are bothersome it is sensible to discuss these with your doctor as effective treatments are available. Although many men undergo operations to relieve the problem of BPH, developments in medication now offer a non-surgical alternative.
As symptoms of prostatism are occasionally associated with cancer of the prostate and also because BPH itself, in its more severe form, can cause damage to the kidneys from the accumulation of urine in the bladder, your doctor will want to examine you and perform some blood tests. Assuming there is no evidence of any sinister problem, several options can then be discussed.
If a man is only mildly affected, this may be the most suitable option. As mentioned above, symptoms from BPH do not necessarily progress: in one study only about 20% of men become more affected over a 5 year period, about 50% stayed the same and the remainder actually improved without any specific treatment.
Alpha-blockers.
Alpha-blocking drugs (eg prazosin, Hypovase, doxazosin, Cardura) relax the muscle of the prostate gland thereby allowing urine to flow more freely out of the bladder at micturition. It is necessary to take the medication for 6 weeks for the full benefit to become apparent and the dose can be gradually increased for maximum benefit. Alpha-blockers are also used in the treatment of raised blood pressure (hypertension), dizziness may therefore be a side-effect of this medication if the blood pressure is reduced too much.
5 Alpha-reductase inhibitors (finasteride, Proscar)
This medication interferes with conversion of the hormone testosterone to dihydrotestosterone. Over a course of several months this tends to cause an enlarged prostate gland to shrink and symptoms of prostatism to improve. It is important to persevere with this medication as it can take up to 6 months for the full benefit to be realised. Although it is unusual to get side-effects with finasteride, impotence and a reduced sex drive are occasionally seen.
If medication does not control symptoms, if the flow of urine out of the bladder becomes completely blocked or damage to the kidneys develops as a consequence of chronic obstruction, surgery may be necessary. Indeed many men opt for this rather than taking medication regularly.
The most common operation is a 'Trans-Urethral Resection of the Prostate' (TURP). This is performed using a special telescope passed into the penis and along the urethra into the prostate gland where chips of the prostate tissue can be removed thus relieving the obstruction to the passage of urine. The majority of men get a good result with this procedure, although not all symptoms settle in everybody and some develop complications including impotence in approximately 10% and incontinence in 1%.
After the operation it is wise to avoid driving and sex for 2 weeks. During this time the urine may well contain blood and it may take up to 6 weeks for the frequency of passing urine to reduce to less than it was before the operation. About half of all men after a TURP develop "retrograde ejaculation" in which, during sex, the semen ejaculates backwards into the bladder before being passed out later in the urine. Apart from reducing fertility, which is not usually an issue at this time of life, a man may notice his urine to be cloudy as a consequence (although this is of no significance).
Although BPH can cause a variety of symptoms, passing blood or pain require further investigation and you should make an appointment to see a doctor.
Disclaimer: This page is for informational purposes only and should not be considered as medical advice or substituted for professional advice. Always consult your doctor with your questions and concerns.
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