A review of the 2nd instalment of our 4 part series on Benign Prostatic Hyperplasia (BPH), this week - Diagnosis

Benign Prostatic Hyperplasia (BPH)

Part 2: Diagnosis

This is the second of my 4-part series in BPH, a common condition as men gets older; last week I discussed causes, signs, and symptoms. To establish a correct diagnosis of BPH, the process largely involves eliminating other conditions that may show similar symptoms, which may include: -

• Urethral stricture
• Overactive Bladder
• Pelvic floor issues
• Prostate Cancer

Many believe that there is some correlation between an enlarged prostate and prostate cancer. There is no relation in terms of the condition itself, the risk for prostate cancer is the same irrespective of whether BPH is present or not.

The GP will ask general questions relating to lifestyle, quality of life and more specific questions relating to the symptoms the patient has. Following this discussion, it is likely the GP will conduct a physical examination which will include a digital rectal exam. Inserting a finger into the rectum and feeling the prostate through the rectum wall will give the doctor information of the size, shape and feel of the prostate.

It is also likely that the GP will ask for a urine test to identify possible infections and a blood test. The blood test will help identify any kidney issues and give a PSA (prostate-specific antigen) score which will help benchmark / rule out any potential prostate cancer issues. If there is any concern regarding cancer, the GP will refer to urology straight away. Once all the relevant information has been collated, the GP will either be able to offer a diagnosis, or if further clarity is needed, recommend further tests. These are more likely to be in a hospital setting.

Once BPH has been diagnosed, then depending on personal factors such as prostate size, age, general health along with severity of symptoms or more often, impact on quality of life, a course of action will be taken.

If the symptoms are mild or not that bothersome, the term “Watchful Waiting” may be introduced to monitor and manage a patient’s symptoms using regular screening (quarterly usually) of previously benchmarked results.

With mild symptoms, some simple lifestyle changes may help manage and alleviate them. These may include: -

• Advice regarding diet and exercise, especially if obesity is an issue which can affect BPH. Specific exercises may be given to help with breathing, relaxation, and muscle control (pelvic floor).
• Minimising consumption of carbonated drinks, alcohol, caffeine, and artificial sweeteners will reduce risk of bladder irritation.
• Where nocturia (Increased frequency in urination both day and night) is an issue - reducing fluid intake in the evening and nothing two hours prior to bedtime may help you avoid night-time toilet visits.
• Be prepared – if embarking on a long journey or not sure about toilet access – be prepared by going before leaving
• Double voiding – waiting for a few minutes when you have “finished” before trying to go again. This will help those who have difficulty in emptying their bladder.
• Increasing fibre intake can help promote more regular bowel movements. Constipation can put pressure on the bladder and aggravate symptoms.
• The doctor or pharmacist can review current medication regimen to ensure there is adverse impact on urinary symptoms as some drugs exacerbate symptoms.

To be continued next week...I discuss treatment.

For comprehensive and free health advice and information call in to Whelehans Pharmacies, log on to www.whelehans.ie or dial 04493 34591 (Pearse St) or 04493 10266 (Clonmore).