Men’s health is a topic of great importance and becoming more frequently spoken about day-to-day. Spotting changes in someone else’s lifestyle isn’t always easy, but there are things we can keep an eye on to help support the men in our lives. We spoke with Consultant Urological Surgeon at St Joseph’s Hospital, Mr Adam Cox, who has a subspecialist interest in treating diseases of the prostate, about how to spot signs and symptoms of an enlarged prostate, and what to do next.
“Men and those born biologically male have a prostate. It grows to about the size of a walnut in their 20s and then by their 40s it can start to grow or enlarge, which may cause problems when passing urine.” The prostate is located inside the pelvis, just below the bladder and in front of the back passage. This can’t be seen or physically examined from outside the body due to its positioning, which highlights the need to watch for signs of change in daily routine.
“The symptoms of an enlarged prostate (called benign prostate enlargement, BPE) are very common in men over 50. Studies have reported that approximately half of men aged 51 to 60 have BPE, which jumps to 70% among men aged 60 to 69 and around 80% in men over 70 years.” Why a man’s prostate grows, to what size, and how quickly it grows is due to their genetics, family history, and the hormonal changes that occur in the ageing male.
While some men who have BPE do not experience disabling symptoms, for many it causes problems with urination. These can include any combination of the following:
- Increased frequency of urination
- Increased urge to urinate that is difficult to put off
- Urge incontinence, or the involuntary loss of urine
- Increased frequency of urination at night which disrupts sleep
- Bedwetting
- Urinary hesitancy, or difficulty starting urination
- Weak urinary stream
- Need to strain muscles to begin the flow of urine
- Urinary stream that starts and stops one or more times
- Inability to completely empty bladder of urine
- Flow of urine slows to a dribble toward end of urination
“In some cases, BPE can lead to acute urinary retention, the painful inability to urinate accompanied by swelling in the lower abdomen due to a full bladder, or chronic urine retention, the failure to empty the bladder fully but maintained ability to pass urine. Chronic urine retention can lead to bladder stone formation, urinary tract infections (UTIs), and damage to the kidneys if not treated promptly.”
Early detection, diagnosis and treatment of prostate problems is key to improving the quality of life for those affected and their loved ones. “Most men suffering with BPE tend to accept its symptoms as a normal part of ageing, usually either reluctant to seek advice if they feel embarrassed about their symptoms or fearful of an intimate clinical examination. They may be unaware that there is help available to help improve their quality of life and therefore hesitate to be seen.”
Fortunately, there are effective ways to treat the symptoms of BPE that usually begin with lifestyle changes, progressing to medication prescribed by doctors and lastly surgical interventions.
“Lifestyle changes recommended for men with symptoms of BPE include weight loss, reduction of caffeine, alcohol, and fizzy/energy drinks and limiting drinks before bed.”
If after 4-6 weeks of adopting these lifestyle modifications, there is no clear improvement, patients should see their GP, according to Mr Cox. Patients suffering with bothersome urinary symptoms and any of the following symptoms should see their GP urgently to rule out more serious health concerns:
- Visible blood in the urine with/without passage of clots
- Lower abdominal pain
- Bedwetting
- Loss of appetite or weight loss
- Unrelenting pain, especially back pain with/without pins and needles or weakness in one or both legs
- Swollen leg(s)
“Medication to reduce the size of the prostate and relax your bladder may be recommended by your GP if BPE symptoms are sufficiently bothersome or severe. After a medical assessment, their GP may wish to refer onto a Consultant Urologist. Surgery is usually only recommended for moderate to severe symptoms that have not responded to medicine, urine retention that doesn’t improve with medication, or urine retention that causes kidney damage, recurrent UTIs or bladder stone formation.”
It is well known how difficult it is for some men to talk about their health. “If you are someone who is close to a man you recognise or suspect as having bothersome urinary symptoms due to BPE, you may be worried about bringing it up in conversation for fear of causing embarrassment, or you may be concerned about having misread the signs. When discussing personal or intimate functions with loved ones, you should explain that you have their best interests at heart and that it’s much better to get symptoms checked out as early as possible.” Supporting loved ones can be done is a series of ways; attending appointments, providing transport, encouraging them to speak to men of a similar age about their symptoms or simply showing you are there for support when needed.
Support for those affected by BPE can be found at Prostate Cymru or Prostate Cancer UK. Mr Adam Cox holds clinics at St Joseph’s Hospital.
For more information, please visit: www.stjosephshospital.co.uk, call on 01633 820 300 or email: hello@stjosephshospital.co.uk.
