UNDERSTANDING BPH AND HOW IFS DIAGNOSED: THE PHYSICAL EXAM
Your doctor will probably begin with the outside first, checking your abdomen for swelling (to see whether the bladder is emptying completely), and to make sure the kidneys feel normal—and that they’re not palpable. (Normally, kidneys cannot be felt in a physical exam through the abdomen.) Also, your doctor will probably examine your testicles, to make certain that both are present and that they’re normal in size.
Because of the prostate’s location—below the bladder, and just in front of the rectum—it can’t be seen or examined from the outside. So the first step in examining it is usually the digital rectal examination, in which a doctor’s gloved, lubricated finger is inserted into the rectum to feel for lumps, enlargement, or areas of hardness that might indicate the presence of cancer. Because BPH affects only the innermost core of the prostate, your doctor may find nothing out of the ordinary here. It’s important to keep in mind that the size of the prostate often has nothing to do with the degree of symptoms. Some men with major prostate enlargement have no urinary tract trouble, while other men with seemingly minor enlargement suffer many symptoms of obstruction. Again, it depends on the site of enlargement in the prostate (see above). Some men, for example, may have middle lobe growth, but hardly any lateral lobe enlargement. Because the middle lobe can’t be felt by a doctor’s finger, a man may have what feels like a very small prostate, yet have big trouble with urinary retention.
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