Benign Prostatic Hyperplasia (BPH)

Alternative names

prostate gland enlargement, prostatic hypertrophy

Description

Many men find that as they get older, they have problems urinating. These problems may include difficulty urinating, having to urinate more frequently or stopping and starting while urinating. These problems may create hassles during their daily lives or lead to trouble sleeping.

These difficulties are often caused by an enlargement of the prostate gland. This gland sits between the bladder and the penis and is normally approximately the size of a walnut. The primary purpose of the prostate gland is to secrete the fluid that mixes with the sperm to create semen. This fluid protects and nourishes the sperm.

Urine is expelled through the urethra, which runs through the prostate gland, and as the prostate enlarges, it squeezes or blocks the urethra, preventing proper urine flow.

Prostate gland enlargement is common. Treatment for an enlarged prostate may include medication, lifestyle changes and, in some cases, surgery.

Causes

Doctors and researchers aren’t exactly sure what contributes to prostate enlargement although it is a common problem as men age; however, changing levels of hormones as men age do appear to play a role.

Risk Factors

Men with benign prostatic hyperplasia tend to fall into one or more of three categories.

BPH is very rare in men under the age of 40. By age 55, about one in four men experience symptoms related to BPH, and by age 75, symptoms are reported by about half of all men. Over age 80, the likelihood of having an enlarged prostate may increase to about 90 percent.

Men with a family history of BPH are more likely to develop the condition. A man’s location appears to play a role as well. Men in America and Australia appear to be more prone to BPH while men in China, Japan and India are less likely to develop the condition.

Symptoms

The main symptoms of BPH relate to difficulties urinating. The most common signs and symptoms in men with the condition include:

• A weak urine stream
• Dribbling toward the end of urination
• Stopping and starting during urination
• Difficulty initiating a urine stream
• Increased frequency or urgency especially at night
• Straining during urination
• Difficulty emptying the bladder completely
• Frequent urinary tract infections
• Kidney stones
• Problems with kidney function

The severity of the symptoms doesn’t appear to be linked to the severity of the enlargement. A man can have only minor enlargement and experience severe symptoms or vice versa. In fact, about half of men who are found to have BPH don’t experience any symptoms at all.

Tests and Exams

Checking for an enlarged prostate may include all or some of the following tests:

• A symptom questionnaire designed by the American Urological Association
• A digital rectal exam so that the doctor can manually feel the size of the prostate
• Testing to rule out other causes of the symptoms including a neurological evaluation and urinalysis
• A urinary flow test, which may be performed multiple times to determine whether the condition is worsening
• A postvoid residual volume test to determine whether you are emptying your bladder completely

Since prostate cancer can cause many of the same symptoms as BPH, your doctor may perform a number of the following tests to rule out the possibility of prostate cancer:

• A prostate-specific antigen (PSA) blood test, which determines the levels of PSA, a protein which helps to liquefy semen (high levels of PSA may indicate prostate cancer)
• An ultrasound to view your prostate
• A prostate biopsy
• A cystoscopy, which allows the doctor to see into the urethra and bladder using a tiny camera on a tube that is inserted into your urethra
• A CT urogram, which uses CT technology to detect blockages such as tumors or kidney stones

Diagnosis

If your prostate is larger than normal and other medical reasons for your symptoms are ruled out, your diagnosis will be benign prostatic hyperplasia.

Treatment

Depending on the level of enlargement and the severity of the symptoms, your treatment may include lifestyle changes, medications or surgery.

Some of the recommended lifestyle changes that can help reduce the symptoms of BPH include:

• Limiting evening beverages
• Reducing intake of caffeine and alcohol
• Discussing diuretic use with your doctor
• Scheduling bathroom time to help “retrain” your bladder

A variety of medications are used to treat BPH. Some are intended to reduce the symptoms while others attempt to shrink the prostate. These medications may be taken in combination for more effective treatment.

Medications that reduce the symptoms of BPH are known as alpha-blockers. They relax the fibers in the bladder and the prostate to reduce blockage and make urinating easier. These medications include tamsulosin (Flomax), doxazosin (Cardura) and alfuzosin (Xatral).

Medications that are intended to shrink the prostate work by preventing the hormonal changes that are believed to contribute to prostate growth. They are called 5 alpha reductase inhibitors and include finasteride and dutasteride. These medications may take weeks to months to work and are typically used in cases where the prostate is severely enlarged. They may also produce undesirable sexual side effects.

If lifestyle changes and medication therapy are not effective or if the blockage is severe and causing bladder infections or loss of kidney function, surgery may be necessary. The goal of surgery in BPH is typically to reduce the size of the prostate and help open the urethra.

Prognosis

With appropriate treatment, most patients can expect an improvement in their symptoms and increased quality of life. Without treatment, the prostate may continue to enlarge, eventually leading to problems like urinary tract infections caused by urinary retention or decreased kidney function, which may require surgery to correct.

Complications

If your ability to urinate is compromised by BPH, you could experience some dangerous complications including:

• Painful acute urinary retention or the inability to urinate
• Urinary tract infections
• Kidney or bladder stones
• Damage to the bladder or kidneys

Benign prostatic hyperplasia has not been shown to have any effect on a person’s risk of developing prostate cancer.

When to Contact a Health Professional

If you are experiencing difficulty urinating or any of the other urinary symptoms related to BPH, schedule an appointment with your general practitioner or a urologist. If you are completely unable to urinate or urinating causes you acute pain, this is a medical emergency, and you should seek emergency care immediately.

Prevention

Most of the risk factors for developing BPH are not preventable; however, research has shown that maintaining a healthy weight and eating a diet rich in fruits and vegetables as well as limiting saturated fat may reduce a person’s chances of developing BPH or at least slow the prostate’s growth.

To reduce symptoms, avoid consuming beverages shortly before bedtime and limit caffeine and alcohol. Take your medications as prescribed and follow your doctor’s instructions.