The Digital Rectal Exam Biology Essay


The digital rectal exam is used to detect an enlarged prostate and helps rule out prostate cancer or problems with the muscles in the rectum that might be causing symptoms, but it can underestimate the prostate's size. It is never the sole diagnostic tool for either prostate cancer or BPH.

The doctor will press and palpate the abdomen and sides to detect any signs of bladder or kidney abnormalities. The doctor might also test sensations, reflexes, and motor response in the lower body to rule out possible nerve-related (neurologic) causes of bladder dysfunction.

A PSA test is a widely used but controversial screening test for prostate cancer. High PSA levels may indicate prostate cancer, but BPH itself usually raises PSA levels. And, some drugs used to treat BPH can decrease PSA levels.

A urinalysis can detect signs of bleeding or infection. It also helps rule out bladder cancer.

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Uroflowmetry can determine whether the bladder is obstructed, and measures the speed of urine flow. A reduced flow may indicate BPH. However, bladder obstruction can also be caused by other conditions including weak bladder muscles and problems in the urethra.

Cystoscopy or urethrocystoscopy can be performed to check for problems in the lower urinary tract, including the urethra and bladder. The presence of structural problems including enlargement of the prostate, obstruction of the urethra or neck of the bladder, anatomical abnormalities, or bladder stones can be determined by the doctor. The test may also identify bladder cancer, and causes of blood in the urine and infection.

Ultrasound can give an accurate picture of the size and shape of the prostate gland. Ultrasound may also be used for detecting kidney damage, tumors, and bladder stones. Ultrasound tests of the prostate generally use one of two methods, either by transrectal ultrasonography (TRUS) or transabdominal ultrasonography.

The postvoid residual urine volume (PVR) test measures the amount of urine left after urination. Normally, about 50 mL or less of urine is left; more than 200 mL is a sign of abnormalities. Measurements in between will required further tests.

In addition to prostate cancer, other factors and conditions such as structural abnormalities, prostatitis and medications can cause lower urinary tract symptoms similar to those associated with BPH. Bladder cancer or urinary tract infection (UTI) may also produce symptoms similar to those of BPH. For any patient who has LUTS, a urinalysis to screen for infection or hematuria is performed. If a UTI is found, the patient will be treated and re-evaluated. If microscopic hematuria is detected, a further work-up is done to rule out bladder cancer. Thus, if blood tests indicate an elevated PSA and the digital rectal examination indicates irregularities of the prostate, a biopsy of the prostate gland may be advised in order to rule out for prostate cancer.

Some of the physicians believe that a number of men may be incorrectly diagnosed with BPH when they have interstitial cystitis (IC). The potassium sensitivity test is sometimes used to rule out IC. However, some experts believe this test missed many IC patients, although a 2001 study concluded that a combination of potassium sensitivity and urodynamic tests is useful in distinguishing between BPH and interstitial cystitis (, 2013).


5.2 Treatment

Treatment will depend on the patient overall health, age and the severity of the symptoms. There are many ways to correct the condition and successfully treat BPH.

5.2.1 Lifestyle

Many men with BPH may only have minor symptoms. Some simple lifestyle changes may be all they need to feel better:

• Urinate when you first get the urge.

• Avoid alcohol and caffeine, especially after dinner. Try not to drink within 2 hours before going to bed.

• Spread out your fluid intake throughout the day, avoid drinking large amounts of fluid at one time.

• Avoid cold and sinus medications. Decongestants and antihistamines can worsen BPH symptoms.

• Exercise regularly.

• Reduce stress.

5.2.2 Medications

Alpha blockers or alpha-adrenergic antagonists, can cause the muscles around the bladder to relax, making it easier to urinate. It seems to work best in men with moderately enlarged prostates. Common side effects include decreased ejaculation and low blood pressure. These drugs should not be taken with medications for erectile dysfunction, such as Viagra or Cialis. Alpha blockers include:

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• Terzosin (Hytrin)

• Doxazosin (Cardura)

• Tamsulosin (Flomax)

• Alfuzosin (Uroxatral)

Enzyme inhibitors or 5-alpha-reductase inhibitors shrink the prostate gland by decreasing the amount of testosterone the body converts into dihydrotestosterone, a hormone the prostate needs to grow. These drugs take longer to work than alpha blockers. Enzyme inhibitors include:

• Finasteride (Proscar)

• Dutasteride (Avodart)

• Botulinum toxin (Botox)

5.2.3 Surgery

Transurethral resection of the prostate (TURP) is the most common surgical treatment for BPH. Transurethral incision of the prostate (TUIP) is similar to TURP, but is usually performed in men who have a relatively small prostate. Two types of laser surgery are used to destroy excess prostate tissue. Holmium laser enucleation of the prostate (HoLEP) is usually used for men with severely enlarged prostates while Photosensitive vaporization of the prostate (PVP) is used for men with mild to moderate prostate enlargement. Open prostatectomy is an open prostatectomy and is usually performed using general or spinal anesthesia.

5.2.4 Nutrition and Dietary Supplements

Beta-sitosterol is a cholesterol-like compound found in plants. It has been studied for BPH and found to significantly improve urinary flow and decrease the amount of urine left in the bladder. Consume 60 - 130 mg per day.

5.2.5 Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications (University of Maryland, 2011).

5.3 Prognosis

Majority of men get better with treatment of BPH, however, men who have had a long standing BPH may develop:

• Sudden inability to urinate

• Urinary tract infections

• Urinary stones

• Damage to the kidneys

• Blood in the urine

5.4 Conclusion

Despite the deceptively simple description of benign prostatic hyperplasia (BPH), the actual relationship between BPH, bladder outlet obstruction, lower urinary tract symptoms (LUTS), and benign prostatic enlargement obstruction is complex and requires a solid understanding of the definitional issues involved. The actual causes or etiology of BPH and LUTS is still poorly understood, but the hormonal theories have been proposed. Nowadays, here are many minimally invasive treatment and medical options available for affected patients.