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The most common symptom of BPH includes having to urinate more, often at night. The reason is that the enlarged prostate gland presses on the urethra, which carries urine out of the body. Because of this pressure, the bladder muscles have to work harder to excrete urine. The bladder eventually may start to contract even when only a small amount of urine is present, creating the urge to urinate more often.
The symptoms of prostate enlargement are called lower urinary tract symptoms (LUTS). See separate leaflet called Lower Urinary Tract Symptoms in Men for more details. LUTS can also be caused by other conditions.
As the prostate enlarges it may cause narrowing of the urethra. This may partially obstruct the flow of urine. This can lead to obstructive symptoms such as:
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.
In men, urine flows from the bladder through the urethra. BPH is a benign (noncancerous) enlargement of the prostate that blocks the flow of urine through the urethra. The prostate cells gradually multiply, creating an enlargement that puts pressure on the urethra -- the "chute" through which urine and exit the body.
As the urethra narrows, the bladder has to contract more forcefully to push urine through the body.
Over time, the bladder muscle may gradually become stronger, thicker, and overly sensitive; it begins to contract even when it contains small amounts of urine, causing a need to urinate frequently. Eventually, the bladder muscle cannot overcome the effect of the narrowed urethra so urine remains in the bladder and it is not completely emptied.
Symptoms of enlarged prostate can include:
A weak or slow urinary stream
A feeling of incomplete bladder emptying
Difficulty starting urination
Urgency to urinate
Getting up frequently at night to urinate
A urinary stream that starts and stops
Straining to urinate
Continued dribbling of urine
Returning to urinate again minutes after finishing
Most men put up with an enlarged prostate for months, even years, before seeing a doctor, says Slawin. "When they're getting up several times a night, and have trouble falling asleep again, that's when they come in," he tells WebMD.
It's not always obvious what's going on, Slawin adds. "When men start having urinary problems, it's hard to know the reason. They should see a doctor when anything changes, because there can be bladder cancer, stones, prostate cancer. BPH is often a diagnosis of exclusion … after we make sure nothing more serious is going on."
Urologists use the BPH Impact Index, a symptom questionnaire developed by the American Urological Association to determine if a man's symptoms from BPH require treatment. "It helps us understand how severe the problem is," says Slawin. Higher scores indicate more severe symptoms.
Prostate growth -- and the trouble it causes -- varies greatly from person to person, says O. Lenaine Westney, MD, division director of urology at The University of Texas Medical School at Houston. "Some people have more growth than others. Some people with very large prostates don't have trouble with voiding. It's a very individual thing."
When the symptoms of an enlarged prostate gland are mild, with low scores on the BPH Impact Index (less than 8), it may be best to wait before starting any treatment what's known as "watchful waiting."
With regular checkups once a year or more often, doctors can watch for early problems and signs that the condition is posing a health risk or a major inconvenience. That's where the BPH Index is especially helpful, Westney tells WebMD. "It lets us know how high the symptom score is … when to start treatment."
The "driving force in treatment," she explains, is whether the symptoms are affecting your quality of life and whether a blockage is causing serious complications, such as inability to urinate, blood in the urine, bladder stones, kidney failure, or other bladder problems.
A few questions to ask yourself:
How severe are your symptoms?
Do symptoms prevent you from doing things you enjoy?
Do they seriously affect your quality of life?
Are they getting worse?
Are you ready to accept some small risks to get rid of your symptoms?
Do you know the risks associated with each treatment?
Is it time to do something?
The treatment you choose will be based on how bad your symptoms are and how much they bother you. Your doctor will also take into account other medical problems you may have.
Treatment options include "watchful waiting," lifestyle changes, medicines, or surgery.
If you are over 60, you are more likely to have symptoms. But many men with an enlarged prostate have only minor symptoms. Self-care steps are often enough to make you feel better.
If you have BPH, you should have a yearly exam to monitor your symptoms and see if you need changes in treatment.
For mild symptoms:
* Urinate when you first get the urge. Also, go to the bathroom when you have the chance, even if you don't feel a need to urinate.
* Avoid alcohol and caffeine, especially after dinner.
* Don't drink a lot of fluid all at once. Spread out fluids during the day. Avoid drinking fluids within 2 hours of bedtime.
* Try NOT to take over-the-counter cold and sinus medicines that contain decongestants or antihistamines. These drugs can increase BPH symptoms.
* Keep warm and exercise regularly. Cold weather and lack of physical activity may worsen symptoms.
* Learn and perform Kegel exercises (pelvic strengthening exercises).
* Reduce stress. Nervousness and tension can lead to more frequent urination.
A range of treatments can relieve enlarged prostate symptoms -- medications, minimally-invasive office procedures, and surgery. The best one for you depends on your symptoms, how severe they are, and whether you have other medical conditions.
The size of your prostate gland, your age, and your overall health will also factor into treatment decisions. What's best for a man in his 50s might not be optimal for an 80-year-old. An older man may want immediate symptom relief through drugs or surgery, whereas a younger man may lean toward a minimally invasive treatment. According to the American Urological Association, surgery often does the best job of relieving symptoms, but it also has more risks than other treatments.
Consider the options carefully with your doctor, says Westney. "We can start with medications, and if there's no improvement, we look at minimally invasive therapy to reduce a portion of the prostate," she tells WebMD. "These procedures are very effective, and side effects are very rare."
If symptoms are really bothersome -- or if you have complications like urine retention -- it may be best to bypass medication. The minimally invasive treatments have benefits over surgery, like quick recovery time; however, you may need a second procedure later on. There is also less risk of serious side effects like long-term incontinence or erection problems -- which can occur rarely with surgery.
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Groin pain and swelling could be a red flag for men and potentially indicate many different conditions. It is important to know what these conditions are since they can range from kidney stones to cancers, and to be able to identify when something is wrong. Not only can this be worrisome to any man experiencing abnormal swelling or pain, but depending on the extent of the pain and symptoms could be reason to see your doctor.
The most common cause for pain or swelling in the groin – the area between the abdomen and thigh – is a hernia. This type of hernia is more specifically called an inguinal hernia, and it occurs when part of the small intestine bulges through a weak area in the lower abdominal muscles. Inguinal hernias present as bulging in the groin, and can often be confused with swelling. Even a small hernia will cause intermittent pain, which is pain that comes and goes. However, more severe hernias can cause unbearable pain for sufferers to the point of incapacitation. This symptom is not something to ignore. Hernias left untreated may become strangulated when blood flow to the intestine is cut off, leading to death of the bowel tissue. Such a complication is life-threatening and requires emergency surgery.
Another common cause of swelling in the groin area are swollen lymph nodes. Most often we do not notice these glands, but when they are swollen, or enlarged, they become evident to us. Lymph nodes are important part of the immune system and are located regionally throughout the body. The groin has a uniquely high concentration of lymph nodes and as part of the immune system lymph nodes reflect abnormalities in that area. Therefore, you could be experiencing swelling of nodes from a urinary tract infection, or some other type of infection your body is fighting off.
The lymphatic system removes infections and other toxins from the blood. A sick body is a toxic and infected (or soon to be infected) body. Arguably, most every chronic disease and every infection is indicative of an overwhelmed lymphatic system. When the system is overwhelmed, the body is overwhelmed. With any chronic illness, getting well includes improving lymphatic function.
Edema, or Oedema – Swelling that results when tissues cannot drain fluid into the lymphatic system quickly enough – see image above.
Lymphedema – Caused by a blockage in the lymphatic system, part of the immune and circulatory systems. Lymphedema is most commonly caused by lymph node removal or damage due to cancer treatment.
Elephantiasis – Medically known as lymphatic filariasis, a condition characterized by enlargement of an area of the body, typically the limbs. It looks like a severe case of edema, and it is.
Glandular fever – A type of viral infection that mostly affects young adults. Symptoms include tender lymph nodes.
Hodgkin’s disease – A type of cancer of the lymphatic system.
Tonsillitis – Infection of the tonsils in the throat.
Lymphadenopathy – Occurs when the lymph nodes swell due to infections. Viral infections like measles, rubella, glandular fever, and HIV may also cause lymphadenopathy of the lymph nodes.
Lymphadenitis – Inflammation of the lymph nodes usually caused due to infections.
Filariasis – An infection of the lymphatic channels by a worm or parasite.
Splenomegaly – Swelling of the spleen due to a viral infection like infectious mononucleosis.
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Swollen glands are a sign that your body is fighting off an infection or an illness. Most of the time, they return to normal size when their job is done.
These glands are your lymph nodes. You have them throughout your body. But there are clusters of them in places like your neck, under your arm and in the crease between your thigh and your torso (were your leg begins). You can sometimes feel these clusters as little bumps, especially if they’re swollen.
They’re part of your lymphatic system. Along with your spleen, tonsils, and adenoids, they help protect you from harmful germs.
Why Do They Swell?
These round and bean-shaped glands have immune cells called lymphocytes in them. They attack bacteria, viruses, and other things that can make you sick. When you’re fighting off harmful germs, your body makes more of those immune cells -- that causes the swelling.
Your lymph nodes come across all kinds of germs, so they can be swollen for lots of reasons. Usually, it’s something that’s easy to treat, like a cold, an ear infection, or an abscessed (infected) tooth.
Much less often, it can be a more serious illness. They can include tuberculosis (a potentially serious infection of bacteria that usually affects your lungs), a problem with your immune system (like lupus), or certain kinds of cancer, including lymphoma (a cancer that starts in your lymphatic system) and leukemia (a cancer of the cells that make blood).
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