Robert, a 68-year-old man, has trouble urinating and is given a rectal exam. What is Robert’s most probable condition, and what is the purpose of the rectal exam?

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In middle aged men, an enlarged prostrate is a common cause of symptoms such as difficulty urinating, frequent urination, incomplete emptying of the bladder, and incontinence. The prostrate is a gland that produces semen, a fluid that faciliates the movement of sperm during insemination. Because the prostrate encircles the urethra, an enlarged gland can cause discomfort, blockages, and urinary dysfunction. A digital rectal exam, in which a doctor inserts a finger into the rectum, is used to palpate the prostrate and determine if it is larger than normal.

If the prostrate is enlarged, additional tests are required. Doctors will typically order a urinalysis and urine culture to test for a urinary tract infection, which may require antibiotics. A prostrate specific antigen test is also needed to rule out the possibility of prostate cancer.

If all of these tests are negative, the diagnosis is typically benign prostratic hyperplasia, the most common cause of enlarged prostate. Although the condition is not life-threatening, it may require additional testing of bladder function, medication, and surgery to reduce the size of the prostate or remove it altogether.

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