What Are the Signs of Prostate Problems?

Signs of prostate problems can vary, but many are related to changes in urination. As the prostate enlarges, it may begin to press against the urethra, causing symptoms that can affect the ease and frequency of urination. Some of the common signs include:

• Frequent need to urinate: You may find yourself needing to use the bathroom more often, especially at night.
• Difficulty starting urination: Starting the urine stream may become harder, often requiring more effort or time.
• Weak or interrupted urine flow: The urine stream may be weaker than usual or stop and start several times.
• Urgency to urinate: A sudden, intense need to urinate can make it difficult to wait.
• Incomplete bladder emptying: You might feel that your bladder isn’t fully empty, even after urinating.

In some cases, urine may dribble after finishing or there might be mild discomfort or pain when urinating. It’s also possible to experience blood in the urine, though this is less common. If you notice these symptoms, consult a healthcare professional to understand their cause and explore possible treatment options.

What Causes an Enlarged Prostate?

An enlarged prostate, also known as benign prostatic hyperplasia (BPH), is a common part of aging for many men. Although the exact cause isn’t fully understood, changes in hormone levels over time are believed to play a role. As men age, testosterone levels gradually decline, while levels of other hormones, like estrogen and dihydrotestosterone (DHT), may remain the same or increase. This shift may encourage the growth of prostate cells, leading to an increase in the prostate’s size.

The prostate goes through two main growth phases in life: one during puberty and another starting around the age of 25 and continuing gradually. In some men, this growth becomes significant enough to press on the urethra, causing symptoms associated with BPH.

While hormone changes are a common factor, each individual’s experience with prostate enlargement is unique. Not all men will develop noticeable BPH symptoms and the severity of an enlarged prostate can vary widely.

Can an Enlarged Prostate Cause Pain in the Urethra?

An enlarged prostate or BPH can sometimes cause discomfort or a sensation of pressure around the urethra. As the prostate grows, it may press against the urethra, which can make urination feel more challenging and, in some cases, uncomfortable.

While BPH typically affects the flow of urine, leading to symptoms like difficulty starting urination, a weak stream or the need to urinate frequently, direct pain in the urethra is not always common. However, some men may feel discomfort due to the strain placed on the urinary system as the bladder works harder to push urine through a narrowed urethra.

What Is the Treatment for an Enlarged Prostate?

Enlarged prostate treatment options vary depending on the severity of symptoms and how much they affect daily life. Treatments range from nonsurgical options like medications and lifestyle adjustments to more involved surgical procedures for those who need them. Here’s a look at the different approaches available. 

For many men, non-surgical treatments are the first line of care. These approaches may effectively relieve symptoms without the need for invasive procedures.

• Medications: Several medications can help alleviate BPH symptoms:
  • Alpha-blockers help relax the muscles in the prostate and bladder neck, improving urine flow. They can work relatively quickly but don’t reduce prostate size. Commonly used alpha-blockers include tamsulosin, terazosin and alfuzosin.
  • 5-alpha reductase inhibitors may block a hormone involved in prostate growth, which can help gradually shrink the prostate over time and reduce urinary symptoms.
  • Combination therapy: Some men may benefit from a combination of an alpha-blocker and a 5-alpha reductase inhibitor.
• Lifestyle adjustments: Simple lifestyle changes may also help manage mild symptoms. Reducing caffeine and alcohol, staying active and practicing bladder training techniques may support better urinary health. Monitoring symptoms with routine check-ups may be enough for those with mild or moderate issues.

If symptoms persist despite non-surgical treatments, minimally invasive options might be considered:

• Prostatic urethral lift (PUL): This procedure uses implants to hold back the enlarged prostate tissue, opening the urethra and improving urine flow.
• Water vapor therapy: This treatment involves injecting steam into the prostate tissue, which causes it to shrink over time as cells are naturally absorbed by the body.
• Temporary implanted prostatic devices (TIPD): These devices are placed in the urethra temporarily to help relieve prostate obstruction.

Surgical intervention is usually considered when BPH symptoms are severe, persistent or leading to complications such as urinary retention, frequent urinary tract infections, bladder stones or kidney damage. BPH surgery may also be recommended when medications and minimally invasive treatments are not enough to provide relief.

• Enlarged prostate surgery, TURP removes prostate tissue through a resectoscope inserted through the urethra.
• Laser therapy: Laser techniques, such as Holmium Laser Enucleation of the Prostate (HoLEP) or Thulium Laser Enucleation, use lasers to remove excess prostate tissue.
• Simple prostatectomy: For very large prostates, a simple prostatectomy, which removes the inner part of the prostate, may be necessary.

  An appropriate treatment plan for an enlarged prostate depends on several factors, including symptom severity, prostate size and overall health. Working with a healthcare provider to understand the benefits, risks and potential side effects of each option can help in making a well-informed decision.