Your prostate and what can go wrong
What and where is the prostate and what does it do?
The prostate is an organ found only in men. It is the size and shape of a plum and is found just below the bladder. It is a gland which discharges fluid believed to nourish sperm. When a man has an orgasm it is believed that the prostate releases some of this fluid. When you pass water your urine flows from the bladder along a tube (urethra) and out through the penis. As the prostate sits just below the bladder the urethra has to pass through it before reaching the penis.
What can go wrong with the prostate?
The enlarged prostate
As a man gets older, usually from the age of 40, the prostate grows. This is due to natural hormonal changes connected to ageing and happens to all men. The amount of enlargement varies from man to man. In most men this causes no difficulties. However in some men the enlarged prostate interferes with the passing of urine.
If the enlarging prostate begins to choke the urethra, it sometimes becomes more difficult for urine to pass through. It can increase many times its normal size. If this happens the bladder muscles must work harder to force urine through the narrowed urethra.
This leads to the bladder becoming thicker and more sensitive, and makes it more difficult to empty itself completely. The urine left in the bladder can lead to infection.
The medical term for an enlarged prostate is Benign Prostatic Hyperplasia (BPH). This very common condition is not connected with cancer. BPH affects around 75 per cent of men over the age of 75. Beyond the age of 40 about 10 per cent of men will eventually require an operation.
Location of the prostate
Prostatitis Prostatitis has nothing to do with prostate enlargement. It is an inflammation of the prostate and is an uncommon condition which may be the result of an infection. Prostatitis causes similar symptoms to an enlarged prostate but may be accompanied by fever, chills or pain. This is treated by antibiotics rather than surgery.
Prostate Cancer Small areas of dormant prostate cancer are found in about 10 per cent of men over 60 years old, though more active cancer occurs in a very small minority (see page 20).
What may be the signs of prostate trouble?
• Difficulty in passing water. Urine flow is slow to begin and may take several minutes. Straining produces only a small improvement.
• A spasm or sudden urge to urinate, which can be difficult to control. The urge to urinate appears more often.
• You may notice yourself visiting the toilet more often.
• The bladder may overflow causing leakage of urine.
• The bladder can be triggered by, for example, the sound of running water, and may cause a leakage before you reach the toilet, and dribbling afterwards.
• Traces of blood in the urine can be related to prostate trouble, though this is more often a sign of trouble elsewhere in the system. You must consult your GP at the first opportunity if this happens.
If you suspect you may have prostate trouble then you should consult your GP to discuss your symptoms. If your symptoms are not too bad, only a physical examination, reassurance and information may be necessary. However your GP may decide that you should visit a surgeon specialising in these disorders.
Sudden Inability to Urinate
Some men find that they are suddenly unable to urinate at all even though they feel the urge to do so. This is because the bladder muscles have been straining to push urine through the narrowing passage. Having too much to drink can suddenly overstretch the bladder, making its muscle unable to function. This is not a dangerous situation but is painful. You will need to visit your GP or hospital Accident and Emergency department in order to have the urine drained away. This is done by inserting a thin tube (called a catheter) gently up through the penis into the bladder. In our survey, only a small minority of patients reported that this caused anything more than brief discomfort.
Catheters and Waiting
Nowadays, some GPs will insert a catheter to avoid emergency admission to hospital. Your doctor may then send you directly to hospital with your catheter in, or arrange an urgent outpatient appointment with a surgeon. This should be within a few days. Most will be admitted directly for an operation. You may be sent home with your catheter in place if your general health suggests that emergency surgery should be postponed, or because your hospital cannot offer a bed immediately. You should be admitted within 6 weeks if this is the case.
Problems with urinating that are not related to your prostate
There are many other problems with urinating besides those caused by prostate enlargement, particularly in younger men (25-55 year olds). For example, at the neck of the bladder, just above the prostate, is a muscular ring which can tighten. This can restrict the flow of urine as may any narrowing of the urethra, caused by for example, an over-tight foreskin, stone or growth in the bladder.
At this stage YOU and your GP may agree that your symptoms are mild enough just to be watched. If, however, your GP is concerned about your condition you will be referred to a specialist. If you have agreed that this is best, you will be asked to see a surgeon in a hospital outpatient clinic.
