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By Dr Brigid Monda
Many men are blissfully unaware of how their bodies work and how to recognise the signs of danger. A good case in point is the prostate gland, which a number of men are unaware is part of their genetic makeup, the few who do, do not have a clue where it is located or what its function is. That is until it enlarges.
The prostate gland lies in front of the rectum and just below the urinary bladder. It is wrapped around the urethra — the tube through which urine flows out from the bladder.
A healthy prostate gland is surrounded by a capsule, weighs around 20g, is the size and shape of a large walnut, secretes a thin, milky, alkaline fluid which makes up about 70 per cent of semen and contains substances that give semen its characteristic smell. This fluid also contains nutrients that enable sperms to keep healthy and survive their ‘hazardous’ journey through the female reproductive tract as well as enzymes, which increase semen fluidity so sperm can swim in it. It makes the vaginal canal less acidic, protects against infection, contains prostaglandins — hormone-like chemicals which make the cervix ‘pout’ slightly so that sperm can swim through more easily — and causes the female tract to contract so as to ‘suck’ sperm higher up towards the egg thus intensifying a woman’s orgasm.
The prostate also directs semen outwards during ejaculation so that it does not reflux up into the bladder by closing off the bladder neck during sexual climax.
how BPH develops
When the prostate gland enlarges, it causes Benign Prostatic Hyperplasia (BPH). This affects more than 96 per cent of men over the age of 40 and is as common a part of ageing as greying hair. Traditionally associated with elderly men, the gland begins to enlarge in their mid 40s and can grow to the size of a grapefruit. As life expectancy rises, so does the occurrence of BPH with more than half of men in their 60s and as many as 90 per cent in their 70s and 80s showing symptoms. It is the commonest type of tumour in mature men but is neither cancerous nor predisposing factor for prostate cancer. The only other animals known to develop BPH with age are dogs and lions. It does not develop in eunuchs.
The cause of BPH is not well understood but two factors contribute to its formation — ageing and hormones.
Because the prostate is wrapped around the urethra, this design flaw means that if the gland enlarges, it obstructs the urethra like a clamp on a hosepipe. The result is an obstruction of urinary outflow and incomplete emptying of the bladder.
As the prostate enlarges, the capsule surrounding it stops it from expanding, causing the gland to grow inwards and press against the urethra. The bladder wall becomes thicker and irritable because it has to push against this resistance to get the urine out. It contracts continuously even when it contains small amounts of urine, causing more frequent urination. Eventually, it becomes weak and loses the ability to empty itself. The man will always have an urgent need to urinate, rarely passing a rest room without stopping to use it and yet the feeling to pass urine persists because the bladder always feels full.
Risks of infection
Because urine remains ‘trapped’ in the bladder, it increases the risk of infection. The bladder’s capacity is reduced due to the enlarged prostate compressing it. The urine stream in a young man can be about a quarter of an inch wide whereas that of a man who has BPH is much less than this and is hesitant, interrupted and weak causing dribbling.
The man may require several seconds trying to find the right button to push to start urinating. He may also have pain or burning sensation during urination because the urethra is irritated or if an infection may have set in due to the incomplete bladder emptying.
If left untreated, BPH can cause urine retention and strain on the bladder and predispose to urinary tract and prostate infections, bladder or kidney damage, bladder stones and urinary incontinence.
Sometimes a man may not know he has any obstruction until he suddenly finds himself unable to urinate at all. This may be triggered by overindulging in alcohol or taking over-the-counter cold or allergy medicines which contain a decongestant drug whose side effect is to prevent the bladder from opening, relaxing and allowing urine to empty. BPH, however, is rarely life threatening because the prostate enlarges very slowly and it also does not impair sexual function.
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