What is a prostate?
The prostate gland (or, simply, prostate) is a walnut-shaped organ found just underneath the bladder in men. It's normally about 4cm wide and 3cm thick.3 It produces a milky fluid, which, together with sperm and other secretions, makes up semen. The urethra is the tube that carries urine from the bladder out through the penis, and runs through the middle of the prostate.
What can go wrong with the prostate gland?
The three main things that can go wrong are:
BPH - benign prostatic hyperplasia, a simple enlargement of the prostate, Prostatitis - inflammation or infection of the prostate, Prostate cancer
What is BPH?
BPH stands for benign prostatic hyperplasia. It is an overgrowth of the cells in the prostate gland. As the prostate gets bigger, it starts to obstruct the urethra because it is near to the bladder. This is what causes the symptoms of BPH, such as needing to go to the toilet often or taking a while to get started. These urinary symptoms can have an extremely negative impact on a man's quality of life.
What are the symptoms of BPH?
He will probably have what doctors call lower urinary tract symptoms or LUTS.The symptoms:
- Poor stream - The flow of urine is weaker, and it takes longer to empty your bladder
- Hesitancy - You may have to wait at the toilet for a while before urine starts to flow
- Dribbling - Towards the end of passing urine, the flow becomes a slow dribble
- Poor emptying - You may have a feeling of not quite emptying your bladder
- Frequency (passing urine more often than normal). This can be most irritating if it happens at night. Getting up several times a night is a common symptom and is called 'nocturia'
- Urgency. This means you have to get to the toilet quickly when you 'need to go'.
- He may seem to take a long time when he goes to the loo and have to go frequently, sometimes running off in the middle of something.
Can these symptoms be caused by anything else?
Although BPH is the most common cause of these symptoms in men over the age of 40, a number of conditions can also cause similar symptoms. The only way to be sure that your partner has BPH and not another condition is to get advice from a healthcare professional.
How common is BPH?
The prostate gets larger in most men as they get older and, overall, one in four (25%) of men over the age of 40 can expect to suffer from the symptoms of BPH.1 Your partner's chance of having BPH also increases with age.
Does it have any other names?
Yes, you might also hear it being called benign prostatic hypertrophy, benign prostatic obstruction or just enlarged prostate (EP). It can also be referred to by the symptoms it causes – LUTS or lower urinary tract symptoms.
What can my partner do to make the symptoms better?
The symptoms may be improved by him taking his recommended prescription medications regularly. Also, pelvic floor exercises, altering fluid intake and changes to his diet may also help.
Can BPH be treated?
Yes, in most cases BPH can easily be treated - it is not a condition your partner has to put up with. There are over the counter and prescription medicines he can take that can relieve the symptoms or slow the enlargement of the prostate. If these don't work, there are other options that he can discuss with a healthcare professional.
What should he take with him to the pharmacist?
Providing the following information will help you partner's pharmacist assess his condition more accurately and thoroughly. As an aide memoir, he should try to remember MAPS:
- Medications: have a complete list of all medications he takes. That should include prescription items, over-the-counter products, alternative therapies and herbal remedies.
- Allergies: provide a full list of everything he is allergic to.
- Personal: he should not be embarrassed to disclose personal information. BPH is very common and its symptoms will come as no surprise to a pharmacist but he can ask to talk to him/her in a private area of the pharmacy if required.
- Share: be prepared to discuss his family medical history.
What should he take with him to his doctor?
It may help his doctor if he took a urine sample with him when he visits his doctor. If he has kept an online diary he might also want to print this off and take it with him to help his doctor assess the severity of his symptoms.
Why does BPH happen?
Doctors don't know why some men get BPH symptoms and others don't. It is related to ageing, with older men more likely to have it, but even some younger men over about 40 have urinary symptoms due to BPH. BPH may also be linked to the amount of testosterone you have in your body.9 Some doctors think that as you get older, prostate cells become more sensitive to a hormone called dihydrotestosterone, which is related to testosterone. There may also be genetic, environmental and dietary links.
Can my partner prevent it?
There is no evidence to suggest that BPH can be prevented, but eating a balanced diet, low in saturated fats, and taking regular physical activity will increase his chances of staying generally healthy. Some doctors believe that high levels of physical activity could help to prevent BPH. However, it is important to remember that BPH itself is not a life-threatening condition and occurs in most men as they get older.
Can it affect sex?
It might. Some men with BPH may also have problems with sex. You may not be able to get or keep an erection, or you may experience pain or notice a reduced amount of semen when you ejaculate.10 These symptoms may well improve by treating the BPH. However, some medicines can cause a reduction in the amount of semen when ejaculation occurs. This is caused by the bladder neck relaxing, causing the semen to go up into the bladder.31 This will not cause you any harm and, in fact, can be a sign that the medicine is working.
Will having sex make the BPH worse?No, there is no evidence to suggest that having sex will have any impact on your partner's BPH.
Can my partner live without a prostate gland?
Yes, although it's not common to have your prostate gland completely removed due to BPH that has not responded to medicines. The more common operation is to remove part of the prostate gland.
Does having BPH mean my partner is more likely to have prostate cancer?
There is no greater risk of prostate cancer in men with lower urinary tract symptoms (LUTS) than in men without symptoms.
Should I encourage him to reduce the amount of fluid he drinks to try to reduce the number of times he has to pee?
Men with LUTS should in fact drink more fluid as this will prevent infection caused by urine not being moved through the bladder. However, many men will find that restricting their fluid intake at specific times of the day can help – such as not drinking too much just before bed.
If the prostate is located just under the bladder, why is it examined via the rectum?
The prostate is in close proximity to the rectum (back passage). A doctor can feel by putting pressure on the inside wall of the rectum with a gloved finger due to its close proximity to the rectum.
What happens if he does nothing?
It is essential that your partner speaks to a healthcare professional if he thinks he might be suffering from BPH. Although in some men nothing will happen if they do not treat the condition, many find that their symptoms get worse and affect quality of life more and more.
I think my partner may have the symptoms of BPH - what should I do?
If you think your partner is suffering from the symptoms of BPH, you should encourage him to see a healthcare professional for advice. The earlier the treatment, the earlier the symptom relief.
I think my partner may have the symptoms of BPH but don't know how to talk to him about it.
It can be a difficult topic to talk about but it's important that he's aware of how you feel. Start by explaining that you are worried about him and that you've been doing some research. If it is affecting your life too, you may want to explain how this makes you feel and the reason you've brought up the subject now. As the conversation continues, you can reassure him that his symptoms are very common and can be easily treatable. Knowing this, he may feel happier going to discuss it with his doctor.
Are there any good ways to broach the subject?
You'll know your partner best so it's worth giving some thought to what will work with him. However, some good ways that other people have used are to use friends as examples or compare his health with yours. For example, you could mention how important it is to go for smear tests and breast checks. Leaving information lying around can help bring the topic into conversation too.
My partner may have the symptoms of BPH but refuses to do anything about it. What can I do?
Whilst you can't force someone to go to the doctor, it may help to present him with some of the facts. For example, you could print some of the pages from this website. If he understands how common and easily treatable BPH is, he may be encouraged to make an appointment. It is also important to ensure he understands how it is affecting you. You can explain that you are getting worried about him and it would reassure you if he sought help. And you could explain that you're finding it increasingly harder to deal with the disruptions – such as him getting up a lot during the night. If you think it will work with your partner, you can always ask him to go to the doctor for your peace of mind, or he may be the type of man that will respond to an appointment being booked for him.
Should I go with him to visit the doctor?
This is very much up to you and your partner to decide. It shouldn't be a problem if you want to go to the appointment together.
Is there anything I can do to help relieve the symptoms?
Take a look at the 'top tips' page. Here, there are a number of recommendations that you may be able to help implement or advise your partner to do.
Is there any chance I could catch BPH from my partner?
BPH is a condition relating to the prostate gland. Only men have a prostate gland so if you are female you will not be suffering from BPH. If you have bothersome urinary symptoms, please visit a doctor for advice.
I've heard treatment is now available from pharmacy – is this true?
Yes – your partner can now visit his pharmacist who will be happy to offer friendly advice and discuss his treatment options. A pharmacist will ask him to complete a Symptom-Check Questionnaire. This will help them to identify any symptoms of a more serious nature. If they identify any alarming symptoms they will immediately refer your partner to a doctor. If they deem him suitable for treatment, they can supply him with some OTC treatment or they might recommend lifestyle advice. If he is given an OTC treatment he will still be advised to visit his doctor to exclude any serious underlying conditions but he will be able to purchase the OTC treatment for up to six weeks. Once he has visited a doctor, he will then be able to continue purchasing OTC treatment as long as he does not experience any significant changes or new symptoms.
The opportunity to speak with a pharmacist will help to increase awareness and understanding of BPH. In addition, the pharmacy is an ideal place for your partner to discuss his symptoms as it is more informal than a doctor's surgery and many pharmacists have a private consultation room and are experienced in dealing with sensitive issues like this.