Enlarged prostate

The prostate is a chestnut-sized gland that surrounds the first part of the urethra in men. It often grows larger with age. Because it lies right around the outlet of the bladder, the enlargement shows itself when passing urine, not as pain.

This is a non-cancerous, benign enlargement. It is not a precursor of prostate cancer and does not develop into it. Prostate cancer is a separate disease which, in its early stages, can cause similar symptoms or none at all, and that is exactly why these symptoms call for an examination rather than being put down to age.

How it shows

The stream is weaker and thinner, it takes longer to start, the flow stops and starts, dribbles at the end, and the bladder feels as if it has not emptied completely. This is joined by a more frequent urge to pass urine, an urgent need that cannot be put off, and getting up at night.

The symptoms develop slowly, often over several years. Many men adapt their daily life without noticing: they go to the toilet once more before setting off, avoid long meetings, do not drink in the evening. These adjustments are often a better indicator of how severe the symptoms are than a description of the symptoms themselves.

The size of the prostate and the severity of symptoms do not go hand in hand. A large prostate may cause no trouble, while a moderately enlarged one can greatly obstruct the flow.

What affects the course

The main factors are age and the action of male sex hormones. Heredity, excess body weight, diabetes and too little exercise also play a part. Sexual activity does not cause enlargement of the prostate and does not affect it.

Certain medicines can make the symptoms markedly worse. These include decongestant cold sprays and tablets, older antihistamines and medicines with an anticholinergic effect, for example some medicines for overactive bladder, for cramps and for sleep.

A worsening often follows drinking larger amounts in the evening, alcohol, coffee and cold. If things have got worse within a few days, a new factor is often to blame rather than the condition itself.

When it can no longer wait until next week

If you cannot pass urine despite a strong urge and pain in the lower abdomen, this is acute urinary retention. It is an emergency that needs immediate treatment, as the bladder must be relieved; seek emergency medical help and do not wait until morning.

You also need emergency help if you have a high fever with chills and pain in the lower back, or heavy bleeding from the urinary tract with clots. If this is accompanied by confusion, marked weakness or a drop in blood pressure, call 112.

Blood in the urine, even once and without pain, is not a sign worth just keeping an eye on. Book an examination, even if it does not happen again in the meantime.

What happens at the urology clinic

The examination begins with a conversation about your symptoms, which the urologist usually also assesses with a questionnaire, as this allows comparison over time. Details that are easy to overlook matter: how much and when you drink, how many times you get up at night, which medicines you take.

This is followed by a clinical examination with a digital rectal examination of the prostate, together with a laboratory PSA test and a urine test. Depending on the urologist's judgement, an ultrasound of the urinary tract, a urine flow measurement and a measurement of the urine left in the bladder after passing urine are also carried out.

A raised PSA is not a diagnosis. The value is also raised by an enlarged prostate, inflammation, a recent procedure or a catheter. The result is read together with the clinical examination and with how the values change over time.

Treatment options

When symptoms are mild, treatment is often not needed. Monitoring is agreed, along with measures that actually work: less fluid two to three hours before bed, less alcohol and coffee, a review of the list of medicines that make symptoms worse, and enough time on the toilet.

For more pronounced symptoms, there are medicines that relax the muscles in the prostate and the neck of the bladder, and medicines that shrink the prostate over time. The first work within a few days, the second only after a few months, so expectations about timing are an important part of the plan.

Surgical treatment is considered for repeated urinary retention, recurrent infections, bladder stones, bleeding, or when medicines do not help. Talk to the urologist about what the procedure involves and where it is carried out.