The prostate is a small walnut shaped gland in men which is responsible for the production of the seminal fluid that carries forward the sperm cells during ejaculation. The prostate surrounds the urethra which is the channel through which the urine flows out of the body from the bladder. As a man ages, the prostate cells begin to multiply with each passing year, resulting in a gradual growth in size of the prostate. As the prostate becomes larger, it begins to put pressure on the urethra and narrows down the channel. When the urethra narrows down, the bladder has to contract with greater force to push the urine out of the body. Over time, this regular, increased contraction of the bladder makes the bladder muscles stronger, thicker and extra sensitive and the bladder begins to contract even when there is minimal amount of urine accumulated in it, giving rise to the need for frequent urination. Simultaneously, in spite of its increased efforts, the bladder is not able to overcome the impact of the narrowed size of the urethra and so the bladder is unable to empty itself out completely causing discomfort to the body. This condition is known as Benign Prostatic Hyperplasia (BPH) or what is commonly known as an enlarged prostate.
Urologists in Delhi and elsewhere have still not been able to pinpoint the exact causes which give rise to an enlarged prostate but experience has shown that prostate begins to enlarge after men cross the age of forty and almost all men over the age of eighty suffer from the effects of an enlarged prostate. There is research underway to assess whether Benign Prostatic Hyperplasia (Enlarged Prostate) is a directly an outcome of a mans prolonged exposure to male hormones such as testosterone.
The main symptoms of an enlarged prostrate all of which may or may not be experienced by all men are:
1. Feeling strong and sudden urges to urinate.
3. Needing to urinate more than twice in the night.
4. Experiencing a slow start to the urination process.
5. Having a weak urine stream.
6. Having to strain while urinating.
7. Experiencing pain during urination or passing blood in the urine.
8. Dribbling at the end of the urinating process.
9. Incomplete emptying of the bladder leading to repeated need for urination.
10. Urine retention or the complete inability to urinate.
The treatment for enlarged prostate is dependent upon the age of the patient, overall health and medical condition, the severity of the symptoms and of course the size of the prostate.
Since it is not a life-threatening condition and does not turn cancerous, as a first step towards the treatment for enlarged prostate, urologists in Delhi are of the opinion that Self-Care with an annual examination is the best way forward. This is generally recommended as a standalone measure for younger men whose symptoms of an enlarged prostrate are lower in intensity. Self-Care typically includes the following changes to be made in the lifestyle and adhered to with discipline and dedication:
1. Besides making it a point to urinate whenever the call arises, a habit should be made to go the bathroom at regular intervals even if there is no need felt for urination.
2. Fluid intake should be regularized throughout the day at fixed intervals. There should be no instances of excessive intake of fluids at one go and at the same time there should not be prolonged intervals where no liquid is taken. The last intake of fluid should be two hours before bed time.
3. Stimulants such as tea and coffee should preferably be avoided. Also coffee and alcohol should be completely avoided after dinner even if it is two hours before bed time.
4. Over-the-counter drugs for the common cold and sinus problems should not be taken at all. This is because these drugs contain chemicals which aggravate the symptoms of an enlarged prostate.
5. Exercising regularly especially in the cold weather is a must, as it has been found that cold weather and inertia tend to make the symptoms worse. Pelvis strengthening exercises are compulsory which may be learnt from a physiotherapist.
6. Practice ways and means to reduce stress. Since the onset of Benign Prostatic Hyperplasia (BPH) usually begins when a man enters his forties and it is also the time when his career is at the peak, hence stress levels are higher , this point is especially important. Mediate, do yoga, read, watch movies, paint whatever, but it is important to have a tension-free mind because stress, tension and fears tend to cause muscles all over the body to tense and this is not good for those with an enlarged prostate.
Prescription of drugs alongside Self-Care is done by an urologist in Delhi for the treatment of enlarged prostate where it is found that the symptoms have increased in intensity but are not so severe as to warrant surgery. Two categories of drugs are typically prescribed:
1. Alpha 1 Blockers These are a genre of medicines which are typically prescribed for managing blood pressure, but their relaxant nature helps to ease the muscles of the bladder and allow for easier urination.
2. Alpha Reductase Inhibitors This category of drugs lowers the level of hormones produced by the prostate, slows down the multiplication of cells and reduces the size of the prostate. These medications need to be taken continuously for a period of three to six months before the benefits are actually perceived.
The final frontier in the treatment of enlarged prostate is surgery, both invasive and non-invasive. Let us understand the various surgical methods which could be recommended:
1. TURP (Transurethral Resection of the Prostate) As on date, this procedure is still considered to be the most effective one for reducing the symptoms of an enlarged prostate with the fastest recovery time. TURP involves the insertion of an endoscope and removing those sections of the prostrate which are blocking the urethra. This eases the pressure on the urethra thus increasing the flow of urine and eliminating the other symptoms.
2. TUIP (Transurethral Incision of the Prostrate) The procedure is similar to that of the TURP but it is used for treating men whose enlarged prostates are smaller in size. In this procedure too, an endoscope is inserted but here a small opening is created in the prostate tissue to enlarge the bladder outlet and reduce the pressure on the urethra. This makes the process of urination much easier.
3. Simple Prostatectomy This is a more complex invasive surgery through which large portions of the prostate are completely removed. This procedure is resorted to only in extreme cases.
Of late, there is been a growing interest in the use of laser technology as a means of a blood-less surgery for the treatment of enlarged prostate. The most breakthrough and successful method using laser technology is HoLEP (Transurethral Holmium Laser Enucleation of the Prostate). The methodology of the HoLEP involves the use of high energy laser to remove those bits of prostate tissue which are weighing down and blocking the urethra. The recovery time and post-surgery discomfort is much less as compared to the traditional surgical methods mentioned earlier. Since this is a novel technology, very few urologists in Delhi have the experience and expertise to conduct this procedure.
Patients seeking treatment for enlarged prostate could review the information provided above and then seek out an experienced and able urologist in Delhi for further advice and guidance.
Visit Dr Rajesh Taneja: www.drrajeshtaneja.com