Enlarged Prostate: A Common Problem in Older Men

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You have more frequent urges to urinate, but then you get a hesitant, weak stream or dribbling. You may have trouble getting a solid night’s sleep and may dread being more than a few steps from a toilet, waiting in line for the men’s room, or seeing the “fasten seat belt” sign illuminated in an airplane. These are the experiences commonly reported by older men who have an enlarged prostate, also known as benign prostatic hyperplasia (BPH). A few men develop urinary tract infections or “acute urinary retention,” an inability to urinate at all that requires urgent medical care.

BPH is a noncancerous proliferation of cells in the prostate. The prostate, a walnut-sized gland below the bladder and in front of the rectum, is important in sexual function, providing much of the seminal fluid that carries sperm.

The gland grows slowly as men age, pressing on the bladder and part of the urethra. In some men, this enlargement begins to cause symptoms by mid-life. Half of all men have trouble urinating by age 60, and the rate rises to 9 out of 10 by age 70. By age 80, about 20 to 30 percent of men require some form of treatment for BPH.

BPH is called “benign” because the enlargement is not harmful in itself. It is not cancer, nor does it lead to cancer (“hyperplasia” simply means an increased number of normal cells). Of course, BPH may not seem so benign if you have it. But at least it does not affect sexual function (though some of the treatments do).

No one knows what causes prostate enlargement. Some studies have pointed to a connection with being overweight. In fact, losing weight if you need to may lessen symptoms. Some studies suggest that consuming lots of fruits and vegetables and minimizing red meat intake may reduce the risk. One study found that aspirin and other nonsteroidal anti-inflammatory drugs may also reduce the risk of BPH, but other findings contradict this idea. The normal drop in testosterone levels that comes with aging may have something to do with BPH, but this does not mean that testosterone supplementation will help. Indeed, it might make matters worse.

If you have symptoms, see your doctor. A medical evaluation can determine whether it is BPH or some other condition. No biopsy is needed to diagnose it. If you have mild BPH, it may be manageable with practical lifestyle measures, such as cutting down on fluids, especially alcoholic beverages, in the evening to decrease the need to urinate during the night and avoiding over-the-counter cold or allergy drugs and sleep aids that contain antihistamines or decongestants because they may worsen symptoms. If these and other lifestyle measures are not effective, a variety of treatment options are available.

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