The prostate gland is a male reproductive organ situated deep in the pelvis that can be the source of much trouble to the aging male. Mysterious to many, its purpose is to produce prostate fluid, a milky liquid that is a nutrient and energy vehicle for sperm.
Similar to the breast, the prostate consists of many glands that manufacture fluid and ducts that convey the fluid.
At the time of sexual climax, prostate muscle fibers squeeze the prostate fluid into the ducts to drain into the urethral channel, where it mixes with secretions from the other male reproductive organs to form semen. The prostate gland completely envelops the urethral channel, enabling its many ducts to drain into the urethra.
Problems Affecting The Prostate Gland
However, this necessary anatomical relationship between the prostate and the urethra can potentially be the source of many issues for the aging male, one of which is growth of the prostate gland. The prostate is actually one of the few organs that actually gets bigger with time when there is generally shrinkage and loss of tissue mass elsewhere.
Prostate growth is influenced by three factors — aging, genetics and the male hormone testosterone.
In young adults the prostate gland is about the size of a walnut. Prostate enlargement with aging is highly variable with some men having minimal enlargement and others with prostates the size of large Florida grapefruits!
The problem is that as the prostate enlarges, it often — but not always — squeezes the sector of the urethra that runs through it, making urination difficult and resulting in a number of annoying symptoms and sleep disturbance.
It is similar to a hand squeezing a garden hose that affects the flow through the hose. The situation can be anything from a tolerable nuisance to one that has a huge impact on one’s daily activities and quality of life.
Benign Prostate Hyperplasia (BPH)
This condition of prostate enlargement is known as BPH — benign prostate hyperplasia — one of the most common plagues of aging males.
Although larger prostates tend to cause more “crimping” of urine flow than smaller prostates, the relationship is imprecise and a small prostate can, in fact, cause more symptoms than a large prostate, much as a small hand squeezing a garden hose tightly may affect flow more than a larger hand squeezing gently.
The factors of concern are exactly where in the prostate the enlargement is and how tight the squeeze is. An additional factor is that the prostate contains muscle and the symptoms may result depending upon the muscle tone of the prostate.
Symptoms Relating to BPH
Symptoms that develop as a result of BPH are often “obstructive” as the prostate becomes “welded shut like a lug nut,” as one of my patients aptly described.
These symptoms include
- a weak stream that is slow to start,
- a stopping and starting quality stream,
- prolonged time to empty,
- incomplete emptying and at times,
- a stream that is virtually a gravity drip with no force.
Another of my patients described the stop and start quality of urination as “peeing in chapters.” Many men have to urinate a second or third time to try to empty completely, known as double and triple voiding. There may be dribbling after urination is completed, known as post-void dribbling.
Characteristically, the symptoms of BPH are worse during sleep hours.
Other common symptoms of BPH are known as “irritative” and include urgency to urinate requiring hurrying to the bathroom with frequent urinating both day and night and at times urinary leakage that occurs before one arrives to the bathroom.
As a result of these symptoms, some men have to plan their activities based around the availability of bathrooms, sit in an aisle seat on airplanes and avoid engaging in activities that provide no bathroom access.
One symptom in particular, sleep-time urination— a.k.a. nocturia — is particularly irksome because it is sleep-disruptive and the resultant fatigue can make for a very unpleasant existence.
Other Problems Arising Out Of BPH
At times, a man with BPH cannot urinate at all and ends up in the emergency room for relief of the problem by the placement of a catheter, a tube that goes in the penis to drain the bladder and bypass the blockage. BPH can be responsible for other symptoms including
- blood in the urine,
- urinary infections,
- bladder stone formation, and on occasion,
- kidney failure.
When a man experiences symptoms of BPH, he should consult with a urologist, the medical specialist that treats the urinary and genital systems. It is important to identify other conditions that can mimic BPH, including urinary infections, prostate cancer, urethral stricture (scar tissue causing obstruction) and under-active bladder (a weak bladder muscle that does not squeeze adequately to empty the bladder).
Clinical Analysis Of BPH
A basic evaluation will include a physical examination of the abdomen, groin and prostate, a urine analysis test, a PSA blood test and other tests depending on the particular circumstances. Not all men with BPH need to be treated; in fact, many can be observed if the symptoms are tolerable. There are very effective medications for BPH and surgery is used when appropriate.
There are three types of medications used to manage BPH:
- those that relax the muscle tone of the prostate;
- others that shrink the enlarged prostate gland; and
- Cialis, which can be used daily to treat both erectile dysfunction and BPH.
There are numerous surgical means of alleviating obstruction and currently the most popular procedure uses laser energy to vaporize a channel through the obstructed prostate gland.
Recall the factors that drive prostate growth: aging, genetics and testosterone. We certainly can’t do anything about the aging process, as it is quite desirable to live a long and healthy life. We can’t do a thing about our inherited genes. Having adequate levels of testosterone is actually quite desirable in terms of our general health.
Tips On Maintaining Prostate Health
So what can we do to maintain prostate health? The short answer is that a healthy lifestyle can lessen one’s risk of BPH. Furthermore, the following tips must be followed to minimize risk.
- Maintaining a physically active existence with regular exercise. This can help increase blood flow to the pelvis, which reduces inflammation and is prostate-healthy.
- Exercise can also be effective by reducing the tone of the sympathetic nervous system, alleviating higher prostate smooth muscle tone and improving the symptoms of BPH.
- Maintaining a healthy weight and avoiding abdominal obesity will minimize inflammatory chemicals that can worsen BPH.
- Vegetables are highly anti-inflammatory and consumption of those that are high in lutein, including kale, spinach, broccoli and peas are recommended.
- Vegetables that are high in beta-carotene like carrots, sweet potatoes and spinach; lycopenes including tomatoes and tomato products can also lower the risk of BPH.
Bottom Line: BPH is a common problem, oftentimes negatively impacting one’s quality of life. There are medications as well as surgery that can help with this issue; however, a healthy lifestyle that includes exercise, avoidance of obesity, and a diet rich in vegetables can actually help lower the risk for developing bothersome prostate symptoms.