What is prostate? – The prostate is a small organ (gland) that surrounds the urethra in male. It produces fluid, emptied into the urethra, as part of the fluid that carries sperm during ejaculation. 

When is prostate enlarged?

The prostate is said to be enlarged when it grows bigger than its normal size, which is around 25 grams. The prostate normally increases in size as men get older. However, there is a limit to which this is normal (less than 80 grams).

Prostate enlargement is diagnosed when it grows bigger than the size attributable to age. When this happens, it is called benign prostatic hyperplasia / hypertrophy (BPH). This simply means prostate enlargement that is not cancerous.

What causes prostate enlargement?

The cause of prostate enlargement is not known. However, its growth has been attributed to the effects of male hormone (testosterone) produced by the testes. Age is also a factor as the risk of developing enlarged prostate increases with the age of men.

What are the symptoms of prostate enlargement?

Majority of men with prostate enlargement will not manifest symptoms. Those who present with symptoms may have any or a combination of the following:

1. Consistent frequent urination at night (2 or more times before day break)
2. Frequent urination, in small volumes, during the day
3. Incomplete emptying of urine from the bladder
4. Dribbling of urine after urination
5. Inability to pass urine despite having the urge to do so
6. Delay in initiating urination
7. Poor urine flow / weak urine stream
8. Straining to urinate
9. Painful urination
10. Passing blood in urine

Treatment for prostate enlargement 

Treatment for prostate enlargement depends on the severity of the symptoms as well as other medical problems the patient may have. Treatment options include: lifestyle changes, medical (drug) treatment and surgical treatment.

1. Lifestyle changes – These are applied when the symptoms are mild. They include:

1. Reduction of quantity of water intake per time – This helps to avoid quick filling of the bladder.
2. Avoidance of drinking fluid late into the night – Drinking of fluid should be avoided within 2 hours of going to bed. This allows most of the fluid that has been taken in to be passed out before going to bed.
3. Regular passage of urine – Urine should be passed at the earliest signal of urine in the bladder.
4. Regular exercise – This keeps the body warm, increases insensible water loss and thereby reduces the quantity of urine produced. Cold weather increases urine production due to reduced insensible water loss 

2. Drugs – Drug treatment is directed at reducing the size of the prostate gland so as to allow free urine passage. These include:

1. Reduction of male sex hormone production by the testes (e.g. finasteride) – By reducing hormone production, they help reduce the size of the prostate and subsequently increasing urine flow rate, thereby reducing the symptoms felt by the individual.
2. Smooth muscle relaxation (e.g. alpha-1 blockers) – These relax the muscles around the bladder neck and prostate, thereby allowing free passage of urine.

3. Antibiotics – This helps in treating infection of the prostate (prostatitis) which may have been responsible for or worsened the symptoms of BPH. Symptoms may improve after completing the antibiotic regimen.

4. Surgery – This may be necessary in patients who do not respond to lifestyle changes or drug treatment, as well as those with urinary incontinence, poor kidney function, recurrent urinary infection or worsening inability to empty the bladder. This treatment may restore normal function in a significant number of those who have it.