Spinal cord injury and prostate disease

Posted by Nurse Linda in Life After Paralysis on April 01, 2019 # Health

Men often wonder about sexual function, which can be affected by spinal cord injury. A part of sexual function includes the activity of the prostate gland, which is the organ that secretes fluid for transmission of sperm that is created in the seminal vesicles. It is made of smooth muscle. The location is just below the bladder, surrounding the urethra. The prostate is affected by testosterone.

With these characteristics, it is no wonder that the prostate gland can be affected by spinal cord injury. Because the track of the urethra is right through the center of the prostate gland, an enlargement can affect the ability to void or to pass a catheter to the bladder and infection can occur. Smooth muscle function can be affected by the autonomic nervous system. Low levels of testosterone and testosterone supplements can also affect the prostate.

The prostate gland is relatively small, the size of a walnut. An enlarged prostate grows in all directions, outwardly from the gland but also inwardly along the urethral passageway. The size can be affected by various factors. Since the urethra passes right through the center of the prostate, and enlargement can impede or even stop the flow of urine from leaving the bladder.

Age is a primary culprit for an enlarged prostate. As men age, sometimes the prostate can become bigger over time due to natural or medical causes of lower production of testosterone. Weight can also affect prostate size. Lower levels of obesity are related to a larger prostate however extremely overweight men tend to have smaller prostates due to lack of testosterone production.

Benign Prostatic Hyperplasia (BPH) is another cause of enlarged prostate. In this case, the prostate gland becomes bigger for no apparent reason or for a combination of factors. It is typically noted first by the individual with symptoms: the frequent need to empty the bladder, difficulty in emptying the bladder, failure to empty the bladder, weak stream, or dribbling. One, some, or all these symptoms might be noticed. If you have issues with sensation or use a catheter for emptying your bladder, you might not be aware of the symptoms. The PSA (prostate-specific antigen) blood test provides an indication if there is a problem with your bladder which is an especially important test if you are unable to recognize the symptoms.

Difficulty in passing a catheter might be your first symptom of an enlarged prostate. You or your caretaker might even notice some tension during insertion just prior to the catheter entering the bladder. A little extra push might be required to pass the catheter at that point. This could be your signal that your prostate is enlarged. Another possible cue to an enlarged prostate is the development of autonomic dysreflexia (AD) or an increase in AD symptoms that are present at catheterization time.

Individuals with spinal cord injury have an increased risk of infection. Infection can occur in any part of the body including the prostate. As the prostate gland is close to the bladder, an infection can spread from one area to another. Improper hygiene or a small fistula in the bowel can expose the entire body to infection. In very rare cases, the bowel can attach itself to the bladder which allows fecal material to pass from one organ to another. If you see small flecks of stool in your urine, be sure to notify your healthcare professional immediately. Infection from the prostate or bladder can quickly travel up to the kidneys.

An infection in the prostate can lead to swelling which will make the diameter of the urethra smaller or even close it. There can be pain in the abdomen, when passing urine or in the lower back. With SCI, the pain might be referred to another part of your body, especially the left shoulder or jaw while AD symptoms can appear or worsen.

Other infection symptoms might be blood or pus in the urine which can be easily mistaken for a urinary tract infection (UTI). If you are diagnosed or treated for a UTI but the symptoms do not improve, a prostate infection might be the cause. A bladder infection can lead to a prostate infection, but a prostate infection can also lead to a bladder infection. A discharge expelled from the prostate might show up at the tip of the penis. The discharge can cause skin breakdown at the opening of the penis. An indwelling catheter irritating that site can lead to further erosion.

Some symptoms of prostate infection are very vague. You might feel like you have the flu which can also be the symptom of just about anything else. Decreased sexual desire can be another symptom. Either of these symptoms can delay treatment until you isolate the problem.

Cancer of the prostate has been noted to occur less often in men with spinal cord injury at any level but especially in injuries above T10. This is due to hormonal changes and denervation of the autonomic nervous system. It appears that since the prostate does not ejaculate with some injuries, especially in higher level injury, the appearance of cancer is less. Most studies are small in the number of subjects, so these facts are somewhat tenuous, however, the rate of prostate cancer is less in men with SCI (that does not mean absent, just less).

Discovery of cancer in the prostate is typically found late in men with or without spinal cord injury. This is because the symptoms can be vague and mimic symptoms of other health issues. Once other causes of symptoms are eliminated, testing for prostate cancer is done. The PSA blood test is a quick eliminator of prostate issues. It can be combined with other blood tests as well. Physical examination is another way to detect an issue in the prostate. Both tests should be performed as your healthcare provider indicates. Neither should be refused or omitted due to positioning challenges or other difficulties. This is your life. Demand the tests.

There are treatments you can use to improve your prostate health. Increasing vegetables and fruits in the diet is a start. Adding activity to your life can provide movement in the abdomen which not only helps your prostate but also moves urine in your bladder and assists with stool moving through the bowel. Activity can include range of motion provided by you moving your body or a caretaker moving it. Some people take over the counter medications for prostate health. No medication, prescription or over the counter is without side effects and interactions with other drugs. Be sure you check with your healthcare provider prior to starting any new medication or supplement.

The difficulty with ejaculation is typically due to messages not traveling from the brain through the autonomic nervous system after spinal cord injury. Some individuals use the prostate message to trigger ejaculation. It should only be done with the consent of your healthcare provider for safety for your individual health status. Essentially, using a well lubricated, gloved finger to protect delicate tissues, you or your partner inserts a finger into the rectum to massage the prostate, which might lead to ejaculation. This procedure is one way of collecting sperm for in-vitro fertilization. It is also a treatment that might be used for reducing an enlarged prostate.

There are some special treatments particular to spinal cord injury that can affect your prostate. Testosterone replacement therapy is often used to increase sex drive and ability after spinal cord injury. It also helps build muscle and reduces fatigue and hair loss. Since the prostate is controlled by the hormone testosterone, high doses in a supplement can increase the risk of prostate cancer. Be sure to have youe PSA levels checked. Human chorionic gonadotropin (HCG) is sometimes used to build muscle. It has been related to an enlarged prostate but not to prostate cancer at this point in time. Viagra is mainly used for sexual function issues, but it sometimes is prescribed for its effect on decreasing the size of the prostate.

To prevent complications from a prostate issue, use good hygiene during catheterization and with your bowel program. If there is any sort of discharge at the penis opening, clean the area and report the issue to your healthcare provider. Review your catheterization technique to be sure it is clean. Be sure you use enough water-soluble lubricant to be able to insert and remove the catheter without irritation or damage to the delicate tissue of the urethra and thereby protecting the prostate as the catheter passes through it.

The Center for disease control recommends prostate screening:

- at 50 years if at average risk,

- at 45 years for African American men and men with a close relative who was diagnosed with prostate cancer before age 65,

- at 40 years for men with more than one early diagnosed relative.

Pediatric Consideration: Prostate issues are not often thought about in young children or adolescents, but complications can happen. If there are any of the above treatments that are needed for your child, discuss the probability of complications with your healthcare provider. Evaluation with prostate examination should be assessed on an individual basis.

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The National Paralysis Resource Center website is supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $8,700,000 with 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government.