Back To CoursePathophysiology Textbook
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As Little Red Riding Hood found out, big eyes are good for seeing, big ears are good for hearing, and big teeth could get her eaten. But some big things are good for nothing. One of these things affects a considerable proportion of men as they age. It's a non-cancerous enlargement of the prostate gland called benign prostatic hyperplasia (BPH).
The prostate gland is something only men have, so the ladies out there don't need to fear this lesson's big bad wolf. But some men are more likely to get BPH than others - men that:
Men with an enlarged prostate may have a combination of the following signs and symptoms:
The reason these signs occur is because the bladder that holds your urine has a tube it connects to, called the urethra, which empties the bladder's urine out into the toilet bowl. The urethra runs through the prostate gland on its way out of the bladder. If the prostate gland enlarges with age as a result of changes caused by the hormones testosterone and DHT, the prostate squeezes down on the urethra, thereby making it more difficult to urinate.
The urethra is just like a straw, and if you put a straw in your mouth and squeeze it almost shut, it's going to be very difficult to expel any air out. You must consider that as a consequence of this, the bladder now has a difficult time expelling urine out as its muscles contract in order to do so. As a result, the bladder wall becomes thickened - like your muscles thicken when they have to work out really hard.
The bladder wall also become irritable, just like you'd become pretty irritable if you couldn't expel any air out through the straw despite trying really hard. This increased irritability of the bladder due to BPH is thought to contribute to the frequent urge to urinate. After a while, you would tire of trying to blow air out of a partially closed straw, and so the bladder also tires and weakens after some time due to BPH.
This ends up causing an inability to fully empty the bladder because the bladder is weak. Such a problem - the inability to fully empty the bladder - is a great way to predispose a person to a urinary tract infection and bladder stones because diminished urine flow is a huge component of these two problems. This is why men with BPH are predisposed to urinary tract infections and bladder stones.
Furthermore, in serious cases of BPH, men can develop kidney disease. This is because as urine backs up in the urinary system, the kidneys stop making urine since they think it has nowhere to go, and they start to shut down as a consequence of this. Essentially, the person has reduced kidney function.
So, the point here is that the prostate gland isn't the sole player involved in all of the signs and symptoms we discussed before. There's a whole domino effect going on here, and thus, BPH should be diagnosed and treated ASAP.
Speaking of diagnoses and treatments, let's get to that then, shall we? Diagnostic options for BPH include:
Let me explain why, so that you don't think I'm just trying to make you feel uncomfortable and forcing you into getting a rectal exam. A doctor is trained to differentiate (that is to say, tell apart) by touch the stereotypical differences between cancer and benign hyperplasia. In BPH, the prostate is big, smooth, and symmetrical, meaning the enlargement is the same on both sides. However, if the doctor's finger detects hardened areas, asymmetry, lumps, or bumps, then this can be a big clue for cancer, and further testing would be necessary.
Other tests are used on top of the two important things I described above to rule things in or out as a potential diagnosis or complication of BPH. These tests include urine flow tests, ultrasound, and urinalysis. So, let's say that BPH is diagnosed after all those tests. What next? Treatment, of course! Drugs can be used, such as:
In cases where medication doesn't work, then surgery is another way to go. The most common of these procedures is known as TURP (transurethral resection of the prostate), a procedure where a doctor takes an instrument, inserts it into the urethra, and removes part of the prostate. While surgeries such as these cause the greatest symptomatic relief, they also pose dangers for complications such as infection, bleeding, permanent incontinence, and permanent erectile dysfunction (aka impotence).
'Permanent' is luckily not a word that describes our lesson, though, since we're about to end it with a quick review of benign prostatic hyperplasia (BPH), a non-cancerous enlargement of the prostate gland. Men under 40 rarely have to worry about BPH, but most men will have this problem by age 85. BPH causes signs and symptoms like:
BPH begins following hormonal changes involving testosterone and DHT, but it also involves the bladder - detrimentally so. The gland enlargement and bladder's subsequent weakened state predisposes people with BPH to urinary tract infections, bladder stones, and kidney disease.
This is why if you have any symptoms of the above it's best to see a doctor right away for a digital rectal examination and a test for PSA, or prostate-specific antigen, to help diagnose BPH. Once it's diagnosed, treatment can include drugs like alpha-adrenergic blockers and five alpha reductase inhibitors, or surgery such as transurethral resection of the prostate (TURP), the most common surgical treatment for BPH.
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Back To CoursePathophysiology Textbook
20 chapters | 274 lessons