Needing to urinate often? Experiencing change in flow or getting up at night several times to go to the toilet?

If so, you could be experiencing prostatic symptoms caused by ageing.

“The prostate normally and naturally tends to enlarge as we get older,” Dr Mark Rowe says. “It increases in size every year, from the age of 40 onwards, by 1% to 2%. It’s part of the normal ageing process and to do with the function of the prostate.”

What exactly is the prostate?

“It’s a small, walnut-sized gland near the back passage, and the waterworks tube (the urethra) goes from the bladder to the penis through it. It makes special proteins and special liquid that forms part of semen.

“Because the waterworks tube goes through the middle of it, as the prostate starts to enlarge, it can cause urination problems, so a change in how you are passing urine is always a clue that your prostate may be enlarged.”

For most men, it is part of normal ageing, but sometimes it could be a sign of something more serious, he says.

“That’s why if you notice a change in your usual pattern of passing urine, you should go to the doctor and be checked out.”

The prostate enlarging due to ageing is called Benign Prostatic Hyperplasia (BPH).

“It is a benign (non-cancerous) condition and for some men it may cause only minor symptoms.”

Symptoms of enlargement

These are the symptoms of prostate enlargement:

  • • Peeing more often.
  • • Having to get up at night to urinate.
  • • Change in the stream, eg difficulty starting, weak flow, dribbling at end or having to pee again soon after.
  • • Weak stream: slow flow or stop/start pattern.
  • • Leaking or urge incontinence (not getting to bathroom in time).
  • • Urine retention (unable to urinate at all – rare).
  • But why do some men get symptoms and others don’t?

    “It’s not known why this happens,” he says. “Genetic factors and dietary ones, such as eating too little fruit and too much meat, may be involved, along with obesity. Obesity is often associated with more severe BPH symptoms.

    “Symptoms can vary widely and men can decide to have treatment or not, depending on how much it’s affecting their quality of life. As you can see from table one, after a certain age, it would be unusual not to have symptoms of an enlarged prostate.”

    Watchful watching

    For men who have mild symptoms, they may decide that treatment is not necessary, but you should have a check-up.

    “When you see your doctor about it, he will do a blood test called the PSA test, which is a measure of the prostate function.

    “The normal range is between zero to four. It’s not a definitive test, but a raised PSA level may indicate that there is something seriously wrong with the prostate – but not always.

    “A rectal examination may also be done so that the smooth surface of the prostate can be felt for lumps and bumps. The doctor will also get a sense of how enlarged the prostate is. If there are concerns, you can be referred to a specialist called a urologist.”

    Brave the examination

    Some men may put off going to the doctor because of fear and/or embarrassment around the whole issue of rectal examination. What would Dr Rowe say to this?

    “I would encourage men to get over this natural shyness and ‘sticking your head in the sand’ scenario.

    “Knowledge is power. Just as you get your tractor serviced, you should look after your body. For farmers, surely the greatest investment you can make is in your own health and wellbeing. You can’t farm if you’re not well.

    “We have to get over thinking that we’ll appear weak or inadequate if we discuss certain topics. The reality is that we’re all human and our prostate is just one of the things that we have to discuss.”

    Lifestyle improvements

    While no active treatment may be your choice if your quality of life is not affected too much, herbal remedies, medication and surgery are treatment options if it is. Lifestyle measures may also be useful. These include:

  • • Restricting fluids in the evening time, but do make sure that you drink enough during the day to stay hydrated (your urine should be clear in colour) and avoid thirst.
  • • Avoiding known irritants of the urinary tract, like alcohol, coffee and spicy foods.
  • • Having your medications reviewed. Some medications, like antihistamines, some anti-depressants, cough bottles and diuretics, may aggravate symptoms – discuss this with your doctor.
  • • Avoiding heavy meals at night.
  • • Taking regular exercise and eating healthily – cooked tomatoes are very rich in a substance called lycopene and are very powerful anti-cancer agents, particularly for the prostate. Vegetables like cabbage and kale are good for the prostate as well.
  • Types of prostate disorder

    There are three main types of prostate disorders:

  • 1. Benign enlargement of the prostate gland (BPH).
  • 2. Prostatitis.
  • 3. Prostate cancer.
  • Prostatitis

    Prostatitis is usually associated with younger men and often involves discomfort and burning when urinating.

    “The prostate is prone to become inflamed and sometimes infected as it is connected to the processes of both sex and urination,” Dr Rowe says.

    “Prostatitis is common and at least half of all men will develop symptoms of this condition at some point in their lives.

    “It is not contagious and is not considered to be a sexually transmitted disease, but needs to be checked out. It can be caused by bacterial infections, viral infections, sexually transmitted infections, inflammation of the urinary tract and other conditions, including stress. Symptoms include discomfort when urinating, pain in the groin area, fever and sometimes a pus-like discharge. Treatment usually involves antibiotics or anti-inflammatory medication.”

    Prostate cancer

    Prostate cancer is a disease of ageing. Of men in their 80s or 90s, the vast majority would have some evidence of cancer cells if they were analysed. Prostate cancer can be successfully treated but a small percentage can be aggressive.

    “The whole thing is prevention is better than cure, knowledge is power and early detection is key. The bottom line is, know your own body and how it works. If you notice any changes, don’t put off getting them checked out.”

    Men don't know enough about their prostates

    There isn’t enough awareness among men in general about the prostate, according to Dr Rowe.

    “In the UK, it’s been shown that maybe only one third of men know what the prostate is and what it does,” he says.

    “Everyone should know how their body works because knowledge is power. I call it health IQ. If you have an awareness of how your body works and what’s normal for you and, therefore, not normal, you can make informed decisions and choices in terms of your long-term health.

    “If you know how things should work, at least you can do something about it when you appreciate the difference.”

    Note: If you are urinating more often and you’re middle-aged, it may not be prostate trouble. Your doctor will probably want to test you for diabetes or kidney function, Dr Rowe adds.

    Information

  • • Want to assess whether or not you have prostatism (symptoms that result from enlargement of the prostate gland)? There is a scoring system, developed by the American Urological Association, in Dr Rowe’s book. Pages 150-153. For more information, see www.doctormarkrowe.com
  • • The Men’s Health Book is in bookshops or available from www.orpenpress.com. The ebook is €10 and hard copy is €20.
  • • For information about prostate cancer, see http://www.cancer.ie/cancer-information/prostate-cancer
  • Movember

    Fancy raising funds and awareness for prostate and testicular cancer and mental health?

    During November each year, the Movember campaign is responsible for the sprouting of millions of moustaches around the world. Movember is an independent global charity aiming to have an everlasting impact on the face of men’s health.Mo Bros start at the 1 November with a clean-shaven face and are sponsored by friends and family to grow a moustache. Mo Sistas help by supporting and raising awareness and funds also. Register at here