The Prostate Examination
At some point most men will either be offered a prostate examination as part of general health screening, or, it will be advised because of their age (usually 50+) or some problem relating to difficulty in passing urine.
Procedure
· The man is advised that a finger needs to be inserted into their rectum in order to examine the prostate gland.
· Usually the man is asked to stand, feet apart, face the examination couch and bend forward so that arms or elbows are on the couch.
· The doctor will put on a surgical glove and will cover a finger in lubricant
· The doctor will most likely say that you will feel a little pressure but no discomfort
· The finger will be inserted in a downwards angle as if pointing to the umbilicus (belly button)
· A few seconds may elapse as the doctor waits for the external sphincter muscle to relax
· You may be aware of some movement of the finger before it is removed. The doctor will probably tell you they are going to remove their finger and then offer you some tissue to wipe the lubricant from the anus and buttocks.
What The Doctor is Examining
The doctor moves their finger in a circular motion in order to identify the lobes and groove of the prostate gland. In a normal sized prostate gland they would expect to find the prostate around 2-4 cm long and triangular in shape. They would also expect the prostate to feel firm and rubbery.
Wednesday, July 1, 2009
Monday, June 29, 2009
Prostate Prevention
Prevent Prostate-related Diseases by Knowing the Cause of Prostate Problems
It is wise for all the men to know the cause of prostate problems as these problems can be prevented.
The major reason for prostate problem is Aging. As men get older, their prostate keeps growing. In old age, the body looses its flexibility and moreover it becomes heavier. It gradually clamps down on the urethra, disrupting the flow of urine.
Since urine travels from the bladder through the urethra, the pressure from the enlarged prostate may affect bladder control. Hence, aging is the major contributor to this problem and as human, it is impossible for us to prevent aging! In fact, some people believe that all men would have an enlarged prostate if they lived long enough!
However, a regular medical check up is always necessary for men from time to time to prevent themselves from prostate problems. Men shouldn’t feel ashamed to consult doctors. Men who notice any signs of prostate problems, even those who are under 50 years of age, should make it a point to visit a health care provider. Those who are after the age of 50, regular prostate check-ups are highly recommended for them. An annual medical examination can assist to avoid major complications with prostate cancer in life.
Besides aging, there are other risk factors that contribute to these prostate problems. Those men whose occupations involve sitting for long time at the workplace, for instance, in the office, workshops, sites or in the car are at the higher risk of getting prostate problem because sitting for a long time increases the pressure on pelvis which in turn develops congestion for the prostate gland.
Moreover, some men who like to work with their notebooks / laptops on their lap for a long period are having higher risk to suffer from prostate-related diseases. Another factor that may cause prostate problem is constipation. In some case, the extra excitement for sex is also found to contribute this problem.
A man’s risk of facing prostate related problems can be reduced by doing physical exercise frequently and maintaining a low-fat diet that includes plenty of fruits, vegetables and whole grains.
Those suggested nutritious food and drinks are tomatoes, garlic, watermelons, red grapefruit, papaya, red berries, onions, broccoli, green tea and red wine. Eating healthy food can help to prevent prostate problems as such food promotes a strong immune system and helps in supporting prostate health in men.
Here are some eating tips to ensure prostate health:
1.You should always eat fresh food. The nutrients in fresh food provide more health benefits.
2.Stay away from food that is high in fat which is not good for prostate health
It is wise for all the men to know the cause of prostate problems as these problems can be prevented.
The major reason for prostate problem is Aging. As men get older, their prostate keeps growing. In old age, the body looses its flexibility and moreover it becomes heavier. It gradually clamps down on the urethra, disrupting the flow of urine.
Since urine travels from the bladder through the urethra, the pressure from the enlarged prostate may affect bladder control. Hence, aging is the major contributor to this problem and as human, it is impossible for us to prevent aging! In fact, some people believe that all men would have an enlarged prostate if they lived long enough!
However, a regular medical check up is always necessary for men from time to time to prevent themselves from prostate problems. Men shouldn’t feel ashamed to consult doctors. Men who notice any signs of prostate problems, even those who are under 50 years of age, should make it a point to visit a health care provider. Those who are after the age of 50, regular prostate check-ups are highly recommended for them. An annual medical examination can assist to avoid major complications with prostate cancer in life.
Besides aging, there are other risk factors that contribute to these prostate problems. Those men whose occupations involve sitting for long time at the workplace, for instance, in the office, workshops, sites or in the car are at the higher risk of getting prostate problem because sitting for a long time increases the pressure on pelvis which in turn develops congestion for the prostate gland.
Moreover, some men who like to work with their notebooks / laptops on their lap for a long period are having higher risk to suffer from prostate-related diseases. Another factor that may cause prostate problem is constipation. In some case, the extra excitement for sex is also found to contribute this problem.
A man’s risk of facing prostate related problems can be reduced by doing physical exercise frequently and maintaining a low-fat diet that includes plenty of fruits, vegetables and whole grains.
Those suggested nutritious food and drinks are tomatoes, garlic, watermelons, red grapefruit, papaya, red berries, onions, broccoli, green tea and red wine. Eating healthy food can help to prevent prostate problems as such food promotes a strong immune system and helps in supporting prostate health in men.
Here are some eating tips to ensure prostate health:
1.You should always eat fresh food. The nutrients in fresh food provide more health benefits.
2.Stay away from food that is high in fat which is not good for prostate health
Friday, June 26, 2009
How to do Prostate Examination
Rectal examination
A rectal examination or rectal exam is an internal examination of the rectum such as by a physician or other healthcare professional.
Digital rectal exam; drawing shows a side view of the male reproductive and urinary anatomy, including the prostate, rectum, and bladder; also shows a gloved and lubricated finger inserted into the rectum to feel the prostate.
The digital rectal examination (DRE, Latin palpatio per anum or PPA) is a relatively simple procedure. The patient is placed in a position where the anus is accessible and relaxed (lying on the side, squatting on the examination table, bent over the examination table, or lying down with feet in stirrups). The physician inserts a gloved and lubricated finger into the rectum through the anus and palpates the insides for approximately 60 seconds.
The DRE is inadequate as a screening tool for colorectal cancer because it examines less than 10% of the colorectal mucosa; colonoscopy is preferred. However, it's an important part of a general examination, as many tumors or other diseases are made manifest in the distal part of the rectum.
A rectal examination or rectal exam is an internal examination of the rectum such as by a physician or other healthcare professional.
Digital rectal exam; drawing shows a side view of the male reproductive and urinary anatomy, including the prostate, rectum, and bladder; also shows a gloved and lubricated finger inserted into the rectum to feel the prostate.
The digital rectal examination (DRE, Latin palpatio per anum or PPA) is a relatively simple procedure. The patient is placed in a position where the anus is accessible and relaxed (lying on the side, squatting on the examination table, bent over the examination table, or lying down with feet in stirrups). The physician inserts a gloved and lubricated finger into the rectum through the anus and palpates the insides for approximately 60 seconds.
The DRE is inadequate as a screening tool for colorectal cancer because it examines less than 10% of the colorectal mucosa; colonoscopy is preferred. However, it's an important part of a general examination, as many tumors or other diseases are made manifest in the distal part of the rectum.
- This examination may be used:
for the diagnosis of rectal tumors and other forms of cancers
in males, for the diagnosis of prostatic disorders, notably tumors and benign prostatic hyperplasia
for the diagnosis of appendicitis or other examples of an acute abdomen (i.e. acute abdominal symptoms indicating a serious underlying disease);
for the estimation of the tonicity of the anal sphincter, which may be useful in case of fecal incontinence or neurologic diseases, including traumatic spinal cord injuries;
in females, for gynecological palpations of internal organs
for examination of the hardness and color of the feces (ie. in cases of constipation, and fecal impaction);
prior to a colonoscopy or proctoscopy
to evaluate haemorrhoids
The DRE is frequently combined with an FOBT (fecal occult blood test), which may be useful for diagnosing the etiology of an anemia and/or confirming a gastrointestinal bleed.Sometimes proctoscopy may also be part of a rectal examination.
Thursday, June 25, 2009
What I need to know about Prostate Problems
What is the prostate?
The prostate is part of a man’s sex organs. It’s about the size of a walnut and surrounds the tube called the urethra, located just below the bladder.
The urethra has two jobs: to carry urine from the bladder when you urinate and to carry semen during a sexual climax, or ejaculation. Semen is a combination of sperm plus fluid that the prostate adds.
The male urinary tract. The prostate surrounds the urethra, where urine leaves the bladder.
What are prostate problems?
For men under 50, the most common prostate problem is prostatitis.
For men over 50, the most common prostate problem is prostate enlargement. This condition is also called benign prostatic hyperplasia (BPH). Older men are at risk for prostate cancer as well, but this disease is much less common than BPH.
For younger men, the most common prostate problem is prostatitis. For older men, it’s an enlarged prostate.
What is prostatitis?
Prostatitis means the prostate might be inflamed or irritated. If you have prostatitis, you may have a burning feeling when you urinate, or you may have to urinate more often. Or you may have a fever or just feel tired.
If you have bacterial prostatitis, your doctor can look through a microscope and find bacteria in a sample of your urine.
You may have to work with your doctor to find a treatment that’s right for you. Changing your diet or taking warm baths may help. Your doctor may give you a medicine called an alpha-blocker to relax the muscle tissue in the prostate.
What is prostate enlargement, or BPH?
If you’re a man over 50 and have started having problems urinating, the reason could be an enlarged prostate, or BPH. As men get older, their prostate keeps growing. As it grows, it squeezes the urethra. Since urine travels from the bladder through the urethra, the pressure from the enlarged prostate may affect bladder control.
If you have BPH, you may have one or more of these problems:
A frequent and urgent need to urinate. You may get up several times a night to go to the bathroom.
Trouble starting a urine stream. Even though you feel you have to rush to get to the bathroom, you find it hard to start urinating.
A weak stream of urine
A small amount of urine each time you go
The feeling that you still have to go, even when you have just finished urinating
Leaking or dribbling urine
Small amounts of blood in your urine
Is BPH a sign of cancer?
No. It’s true that some men with prostate cancer also have BPH, but that doesn’t mean that the two conditions are always linked. Most men with BPH don’t develop prostate cancer. However, because the early symptoms are the same for both conditions.
Is BPH a serious disease?
By itself, BPH is not a serious condition, unless the symptoms are so bothersome that you can’t enjoy life. But BPH can lead to serious problems. One problem is urinary tract infections.
If you can’t urinate at all, you should get medical help right away. Sometimes this happens suddenly to men after they take an over-the-counter cold or allergy medicine
What tests will ordered by doctor
Digital rectal exam. This exam is usually the first test done. The doctor inserts a gloved finger into the rectum and feels the prostate, which sits directly in front of the rectum. This exam gives the doctor a general idea of the size and condition of the prostate.
Blood test. The doctor may want to test a sample of your blood to look for prostate-specific antigen (PSA). If your PSA is high, it may be a sign that you have prostate cancer. But this test isn’t perfect.
Imaging. The doctor may want to get a picture of your prostate using either x rays or a sonogram. An intravenous pyelogram (IVP) is an x ray of the urinary tract. For an IVP, dye will be injected into a vein.
Urine flow study. You may be asked to urinate into a special device that measures how quickly the urine is flowing.
Cystoscopy. Another way to see a problem from the inside is with a cystoscope, which is a thin tube with lenses like a microscope. The tube is inserted into the bladder through the urethra while the doctor looks through the cystoscope.
How is BPH treated?
Watchful waiting. If your symptoms don’t bother you too much, you may choose to live with them rather than take pills every day or have surgery. But you should have regular checkups to make sure your condition isn’t getting worse.
Medicines. In recent years, scientists have developed several medicines to shrink or relax the prostate to keep it from blocking the bladder opening.
Nonsurgical procedures. A number of devices have been developed that allow doctors to remove parts of the prostate during nonsurgical procedures. These procedures can usually be done in a clinic or hospital without an overnight stay.
Several transurethral procedures are treatments for BPH:
PVP (photoselective vaporization of the prostate): destroys excess prostate tissue interfering with the exit of urine from the body by using a controlled laser beam inside the prostate.
TUIP (transurethral incision of the prostate): widens the urethra by making a few small cuts in the bladder neck, where the urethra joins the bladder, and in the prostate gland itself.
TUMT (transurethral microwave thermotherapy): destroys prostate tissue by using a probe in the urethra to deliver microwaves.
TUNA (transurethral needle ablation): destroys excess prostate tissue with electromagnetically generated heat by using a needle-like device in the urethra.
Surgical treatment. Surgery to remove a piece of the prostate can be done through the urethra or in open surgery, which requires cutting through the skin above the base of the penis. The most common surgery is called transurethral resection of the prostate (TURP). In TURP, the surgeon inserts a thin tube up the urethra and cuts away pieces of the prostate with a wire loop while looking through a cystoscope. TURP and open surgery both require general anesthesia and a stay in the hospital.
Is TURP the same as removing the prostate?
No. TURP and other procedures for BPH remove only enough tissue to relieve urine blockage. In a few cases, the prostate may continue to grow, and urinary problems return.
A prostate removal, or radical prostatectomy, is usually done only to stop prostate cancer from spreading.
The prostate is part of a man’s sex organs. It’s about the size of a walnut and surrounds the tube called the urethra, located just below the bladder.
The urethra has two jobs: to carry urine from the bladder when you urinate and to carry semen during a sexual climax, or ejaculation. Semen is a combination of sperm plus fluid that the prostate adds.
The male urinary tract. The prostate surrounds the urethra, where urine leaves the bladder.
What are prostate problems?
For men under 50, the most common prostate problem is prostatitis.
For men over 50, the most common prostate problem is prostate enlargement. This condition is also called benign prostatic hyperplasia (BPH). Older men are at risk for prostate cancer as well, but this disease is much less common than BPH.
For younger men, the most common prostate problem is prostatitis. For older men, it’s an enlarged prostate.
What is prostatitis?
Prostatitis means the prostate might be inflamed or irritated. If you have prostatitis, you may have a burning feeling when you urinate, or you may have to urinate more often. Or you may have a fever or just feel tired.
If you have bacterial prostatitis, your doctor can look through a microscope and find bacteria in a sample of your urine.
You may have to work with your doctor to find a treatment that’s right for you. Changing your diet or taking warm baths may help. Your doctor may give you a medicine called an alpha-blocker to relax the muscle tissue in the prostate.
What is prostate enlargement, or BPH?
If you’re a man over 50 and have started having problems urinating, the reason could be an enlarged prostate, or BPH. As men get older, their prostate keeps growing. As it grows, it squeezes the urethra. Since urine travels from the bladder through the urethra, the pressure from the enlarged prostate may affect bladder control.
If you have BPH, you may have one or more of these problems:
A frequent and urgent need to urinate. You may get up several times a night to go to the bathroom.
Trouble starting a urine stream. Even though you feel you have to rush to get to the bathroom, you find it hard to start urinating.
A weak stream of urine
A small amount of urine each time you go
The feeling that you still have to go, even when you have just finished urinating
Leaking or dribbling urine
Small amounts of blood in your urine
Is BPH a sign of cancer?
No. It’s true that some men with prostate cancer also have BPH, but that doesn’t mean that the two conditions are always linked. Most men with BPH don’t develop prostate cancer. However, because the early symptoms are the same for both conditions.
Is BPH a serious disease?
By itself, BPH is not a serious condition, unless the symptoms are so bothersome that you can’t enjoy life. But BPH can lead to serious problems. One problem is urinary tract infections.
If you can’t urinate at all, you should get medical help right away. Sometimes this happens suddenly to men after they take an over-the-counter cold or allergy medicine
What tests will ordered by doctor
Digital rectal exam. This exam is usually the first test done. The doctor inserts a gloved finger into the rectum and feels the prostate, which sits directly in front of the rectum. This exam gives the doctor a general idea of the size and condition of the prostate.
Blood test. The doctor may want to test a sample of your blood to look for prostate-specific antigen (PSA). If your PSA is high, it may be a sign that you have prostate cancer. But this test isn’t perfect.
Imaging. The doctor may want to get a picture of your prostate using either x rays or a sonogram. An intravenous pyelogram (IVP) is an x ray of the urinary tract. For an IVP, dye will be injected into a vein.
Urine flow study. You may be asked to urinate into a special device that measures how quickly the urine is flowing.
Cystoscopy. Another way to see a problem from the inside is with a cystoscope, which is a thin tube with lenses like a microscope. The tube is inserted into the bladder through the urethra while the doctor looks through the cystoscope.
How is BPH treated?
Watchful waiting. If your symptoms don’t bother you too much, you may choose to live with them rather than take pills every day or have surgery. But you should have regular checkups to make sure your condition isn’t getting worse.
Medicines. In recent years, scientists have developed several medicines to shrink or relax the prostate to keep it from blocking the bladder opening.
Nonsurgical procedures. A number of devices have been developed that allow doctors to remove parts of the prostate during nonsurgical procedures. These procedures can usually be done in a clinic or hospital without an overnight stay.
Several transurethral procedures are treatments for BPH:
PVP (photoselective vaporization of the prostate): destroys excess prostate tissue interfering with the exit of urine from the body by using a controlled laser beam inside the prostate.
TUIP (transurethral incision of the prostate): widens the urethra by making a few small cuts in the bladder neck, where the urethra joins the bladder, and in the prostate gland itself.
TUMT (transurethral microwave thermotherapy): destroys prostate tissue by using a probe in the urethra to deliver microwaves.
TUNA (transurethral needle ablation): destroys excess prostate tissue with electromagnetically generated heat by using a needle-like device in the urethra.
Surgical treatment. Surgery to remove a piece of the prostate can be done through the urethra or in open surgery, which requires cutting through the skin above the base of the penis. The most common surgery is called transurethral resection of the prostate (TURP). In TURP, the surgeon inserts a thin tube up the urethra and cuts away pieces of the prostate with a wire loop while looking through a cystoscope. TURP and open surgery both require general anesthesia and a stay in the hospital.
Is TURP the same as removing the prostate?
No. TURP and other procedures for BPH remove only enough tissue to relieve urine blockage. In a few cases, the prostate may continue to grow, and urinary problems return.
A prostate removal, or radical prostatectomy, is usually done only to stop prostate cancer from spreading.
Wednesday, June 24, 2009
Enlarged Prostate Signs and Symptoms
What is enlarged prostate or BPH?
BPH stands for benign prostatic hyperplasia.Benign means "not cancer," and hyperplasia means too much growth. The result is that the prostate becomes enlarged. BPH is not linked to cancer and does not raise your chances of getting prostate cancer--yet the symptoms for BPH and prostate cancer can be similar.
BPH Symptoms
BPH symptoms usually start after the age of 50. They can include:
Trouble starting a urine stream or making more than a dribble
Passing urine often, especially at night
Feeling that the bladder has not fully emptied
A strong or sudden urge to pass urine
Weak or slow urine stream
Stopping and starting again several times while passing urine
Pushing or straining to begin passing urine
At its worst, BPH can lead to:
A weak bladder
Backflow of urine causing bladder or kidney infections
Complete block in the flow of urine
Kidney failure
BPH affects most men as they get older. It can lead to urinary problems like those with prostatitis. By age 60, many men have signs of BPH. By age 70, almost all men have some prostate enlargement.
The prostate starts out about the size of a walnut. By the time a man is 40, it may have grown slightly larger, to the size of an apricot. By age 60, it may be the size of a lemon.
References
Kirby R, Lepor H. Evaluation and Nonsurgical Management of Benign Prostatic Hyperplasia. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 87.
Roehrborn CG, Siami P, Barkin J, Damiao R, Major-Walker K, Morrill B, et al. The effects of dutasteride, tamsulosin, and combination therapy on lower urinary tract symptoms in men with benign prostatic hyperplasia and prostatic enlargement. 2-year results from the CombAT study. J Urol. 2008;179:616-621.
Tuesday, June 23, 2009
Prostate Enlargement : Benign Prostatic Hyperplasia
General Information
The prostate is a walnut-sized gland that forms part of the male reproductive system. The gland is made of two lobes, or regions, enclosed by an outer layer of tissue. As the diagrams show, the prostate is located in front of the rectum and just below the bladder, where urine is stored. The prostate also surrounds the urethra, the canal through which urine passes out of the body.
It is common for the prostate gland to become enlarged as a man ages. Doctors call this condition benign prostatic hyperplasia (BPH), or benign prostatic hypertrophy.
Enlarged-Prostate.jpg
As a man matures, the prostate goes through two main periods of growth. The first occurs early in puberty, when the prostate doubles in size. At around age 25, the gland begins to grow again. This second growth phase often results, years later, in BPH.
Though the prostate continues to grow during most of a man's life, the enlargement doesn't usually cause problems until late in life. BPH rarely causes symptoms before age 40, but more than half of men in their sixties and as many as 90 percent in their seventies and eighties have some symptoms of BPH.
As the prostate enlarges, the layer of tissue surrounding it stops it from expanding, causing the gland to press against the urethra like a clamp on a garden hose. The bladder wall becomes thicker and irritable. The bladder begins to contract even when it contains small amounts of urine, causing more frequent urination. Eventually, the bladder weakens and loses the ability to empty itself, so some of the urine remains in the bladder. The narrowing of the urethra and partial emptying of the bladder cause many of the problems associated with BPH.
The cause of BPH is not well understood. No definite information on risk factors exists. For centuries, it has been known that BPH occurs mainly in older men and that it doesn't develop in men whose testes were removed before puberty. For this reason, some researchers believe that factors related to aging and the testes may spur the development of BPH.
Throughout their lives, men produce both testosterone, an important male hormone, and small amounts of estrogen, a female hormone. As men age, the amount of active testosterone in the blood decreases, leaving a higher proportion of estrogen. Studies done on animals have suggested that BPH may occur because the higher amount of estrogen within the gland increases the activity of substances that promote cell growth.
Another theory focuses on dihydrotestosterone (DHT), a substance derived from testosterone in the prostate, which may help control its growth. Most animals lose their ability to produce DHT as they age. However, some research has indicated that even with a drop in the blood's testosterone level, older men continue to produce and accumulate high levels of DHT in the prostate. This accumulation of DHT may encourage the growth of cells. Scientists have also noted that men who do not produce DHT do not develop BPH.
Many symptoms of BPH stem from obstruction of the urethra and gradual loss of bladder function, which results in incomplete emptying of the bladder. The symptoms of BPH vary, but the most common ones involve changes or problems with urination, such as
a hesitant, interrupted, weak stream
urgency and leaking or dribbling
more frequent urination, especially at night
Sometimes a man may not know he has any obstruction until he suddenly finds himself unable to urinate at all. This condition, called acute urinary retention, may be triggered by taking over-the-counter cold or allergy medicines. Such medicines contain a decongestant drug, known as a sympathomimetic. A potential side effect of this drug may prevent the bladder opening from relaxing and allowing urine to empty. When partial obstruction is present, urinary retention also can be brought on by alcohol, cold temperatures, or a long period of immobility.
Severe BPH can cause serious problems over time. Urine retention and strain on the bladder can lead to urinary tract infections, bladder or kidney damage, bladder stones, and incontinence—the inability to control urination.
References
Bent S, Kane C, Shinohara K, et. al. Saw palmetto for benign prostatic hyperplasia. NEJM. 2006; 354:557-566
Roehrborn CG, McConnell JD. Benign Prostatic Hyperplasia: Etiology, Pathophysiology, Epidemiology, and Natural History. Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 86.
Rich KT, Safranek S. PPIN's clinical inquiries. Medical treatment of benign prostatic hyperplasia. Am Fam Physician. 2008;77:665-666.
Tuesday, May 19, 2009
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