Living with
Benign Prostatic Hyperplasia

What is benign prostatic hyperplasia?

If you are a man with benign prostatic hyperplasia (BPH) it means that your prostate gland is enlarged. BPH is a common condition as men get older.
An enlarged prostate gland can block the flow of urine out of the bladder, causing difficulty or discomfort when urinating.
BPH is also called benign prostatic hypertrophy, benign prostatic obstruction or benign prostatic enlargement (BPE).

 

BPH is benign, or non-cancerous. While BPH does not cause or lead to cancer, it can occur at the same time as prostate cancer, with which it has similar symptoms, meaning that your doctor will have to test for both conditions if you have symptoms of an enlarged prostate.
BPH is diagnosed through rectal examination and a combination of blood and urine tests.

 

There are several effective treatments for BPH and the an enlarged prostate in general, including medications that relax the muscles of the prostate and bladder and those that shrink the prostate. Sometimes surgery is necessary, however, to relieve severe symptoms of an enlarged prostate.
If left untreated, BPH can cause chronic urinary obstruction which can lead to severe bladder and/or kidney complications.

 

 

What is the prostate?

The prostate gland is a part of the male reproductive system located below the bladder and in front of the rectum. It is roughly the shape and size of a walnut.
It goes all around the tube that transports urine from the bladder out of your penis (the urethra), which passes through the centre of the gland. Therefore, when the prostate enlarges, it can affect urine flow.

 

The prostate gland makes seminal fluid. During sexual intercourse, sperm from the testicles and fluid from the prostate and seminal vesicles move to the urethra, combining to make semen. The muscular action of the prostate then impels the fluid through the penis during ejaculation.

 

As a man ages, the prostate undergoes two main periods of growth.
The first occurs early in puberty, when the prostate doubles in size, while the second usually begins at roughly age 25 years and continues throughout the rest of a man’s life.
Benign prostatic hyperplasia often occurs as a result of the continuing second growth phase, when cell numbers in the prostate increase (an increase in the number of cells in an organ or tissue is called hyperplasia).

How do you know you have BPH?

The symptoms of BPH are often very mild at first, but they become more severe if left untreated. However, the degree to which your prostate is enlarged does not necessarily determine the severity of your symptoms. In other words, you can have mild enlargement and severe symptoms.
You might also find that your symptoms eventually improve over time, but they will not completely go away.

 

Common symptoms of an enlarged prostate include:

  • Frequent, urgent or sudden need to urinate
  • Increased need to urinate at night (nocturia)
  • Difficulty starting urination
  • Straining (needing to push) to urinate
  • Weak or slow urine stream
  • Needing to stop and start urinating several times
  • Dribbling at the end of urination
  • Incomplete bladder emptying (feeling the bladder is full even after urinating)
  • Some degree of incontinence or leaking of urine
  • Pain on urination or after ejaculation
  • Rarely, blood in the urine (medically known as haematuria)
  • Sometimes erectile dysfunction.

When to see your doctor:

Discuss any problems you might experience urinating with your doctor, as, besides from BPH, urinary problems may also indicate possible urinary tract infections and prostatitis (inflammation of the prostate) that require antibiotic treatment, as well as bladder or kidney stones, or prostate cancer.

Contact your doctor immediately if you are unable to pass urine at all, have blood in your urine or experience pain on urination.

 

 

What causes BPH?

BPH is a common condition in men that increases in prevalence with age. The Urology Care Foundation estimates that half of men between 51-60 years of age have BPH, while some 90 % of men over 80 years will have the condition.

 

While it is not entirely clear what causes the prostate to enlarge in the second growth stage, it is thought due to changes in the balance of sex hormones as men grow older. As men age, they produce less testosterone but the same amount of oestrogen.
It is thought that this imbalance, along with the continual production of the male hormone involved in prostate growth, dihydrotestosterone (DHT), as testosterone levels drop, results in increased production of prostatic cells (hyperplasia).

 

Risk factors for prostate gland enlargement include:

  • Age: Symptoms of BPH are rare in men younger than 40 years, while about one-third of men will experience moderate to severe symptoms by age 60 years, and half of men by age 80 years.
  • Genetics/having a family history: Studies have identified a variety of genes that may play a role in BPH. Therefore, if you have a family member, particularly a father or a brother, with prostate enlargement, it might mean that you are also more likely to develop BPH.
  • Diabetes and heart disease: Studies show that if you have diabetes or heart disease, including hypertension, and use beta-blockers, you might have an increased risk of developing BPH.
  • Unhealthy lifestyle: Obesity and leading a sedentary lifestyle (being physically inactive) seems to increase the risk of developing BPH.

How is BPH diagnosed?

Your doctor will diagnose BPH if you have symptoms and signs of an enlarged prostate.
Tests for the diagnosis of an enlarged prostate include:

  • Digital rectal exam: Your doctor will insert a finger into your rectum to palpate/feel your prostate and check its size.
  • Urine and blood test: Your doctor will test samples of your urine and blood for signs of infection or other conditions that can cause similar urinary problems to BPH.
  • Prostate-specific antigen (PSA) blood test: PSA is a substance produced by your prostate. PSA levels increase when you have an enlarged prostate. However, elevated PSA levels can indicate recent urinary tract infection, surgery or prostate cancer.

After these tests, your doctor might recommend additional testing to help confirm an enlarged prostate and to rule out other conditions. You may be referred to a urologist for these tests, which can include:

  • Urinary flow test: You will be asked to urinate into a receptacle attached to a machine that measures the strength and amount of urine you pass.
  • Post-void residual volume test: This test measures whether you can empty your bladder completely, and can be done using ultrasound or by inserting a catheter to measure how much urine is left in your bladder.
  • Urodynamic and pressure flow studies: A catheter is inserted into your bladder through your urethra for this test. Water is then slowly injected into your bladder. Your doctor then measures the bladder pressure and determines how well your bladder muscles are working.
  • Cystoscopy: You will be given a light anaesthetic before a flexible scope with a light at the end is inserted into your urethra to your prostate.

Living and managing

The following lifestyle changes and bathroom tips can help relieve your symptoms of BPH:

  • Stay generally healthy: Follow a healthy, well-balanced diet, as obesity is associated with the risk of developing an enlarged prostate.
    See Cooking from the Heart for healthy and affordable, easy-to-make meals.
    It is also important that you exercise regularly as inactivity contributes to urine retention. Even a small amount of exercise can help reduce urinary problems. You can read more about doing regular exercise here. Kegel exercises can also help strengthen your pelvic muscles and improve urinary symptoms.
  • Do not hold your bladder – go when you first feel the urge: Waiting too long can overstretch the bladder, causing it damage and the muscular bladder wall to weaken.
  • Schedule regular bathroom visits: Try to urinate at regular times (such as every four hours). This is especially useful if you experience increased frequency and urgency of urination.
    Also try to relax before you urinate, as anxiety may cause the smooth muscle in the prostate to stay tense, making urination difficult.
  • Practice double voiding: This is the practice of urinating as much as possible, relaxing for a few moments, and then urinating again. Also take plenty of time to urinate and make sure your bladder is empty.
  • Limit beverages in the evening: Try not to drink anything for at least an hour before going to bed.
  • Limit caffeine and alcohol consumption: Alcohol and caffeine can increase urine production and can irritate the bladder, worsening symptoms.
  • Limit decongestants or antihistamine use: These drugs (common over-the-counter medications for allergy symptoms) tighten the band of muscles around the urethra, making it harder for the bladder to empty.

What treatment is available for BPH?

A wide variety of treatments are available for BPH and enlarged prostate in the forms of medication, minimally invasive therapies or surgery.
Your doctor will recommend which treatment choice is best for you based on the size of your prostate, your age, your overall health and the severity of the symptoms you are experiencing.

 

You might choose to manage your symptoms without treatment. Medication, however, is the most common treatment for mild to moderate symptoms of prostate enlargement, and includes:

  • Alpha-blockers: These medications relax the muscles in the neck of your bladder and prostate, making urination easier. Alpha-blockers (including alfuzosin, doxazosin, tamsulosin and silodosin) usually work quickly to relieve symptoms in men with mild to moderate prostate enlargement.
    Side-effects might include dizziness and retrograde ejaculation (a harmless condition where semen is allowed to flow back into the bladder instead of out the urethral opening at the tip of the penis).
  • 5-alpha reductase inhibitors: These medications help shrink your prostate by preventing DHT production. 5-alpha reductase inhibitors (including finasteride and dutasteride) usually take longer to work, sometimes up to six months.
    Side-effects also include retrograde ejaculation. Your doctor may suggest this type of medication in combination with an alpha-blocker.
  • Tadalafil: This medication is used to treat erectile dysfunction and may also be able to treat prostate enlargement.

However, if medication is not effective at relieving your symptoms and if you have severe symptoms (including pain on urination or blood in your urine) or a history of prostate cancer and previous prostate surgery or radiation, then your doctor may suggest minimally invasive therapies or surgery. These procedures include:

  • Transurethral resection of the prostate (TURP) or transurethral incision of the prostate (TUIP): These procedures involve a urologist or surgeon passing a scope with a light at the end through your urethra into your prostate, and then removing the outer part of the gland or making small cuts in to it, respectively, to make urinating easier.
    These procedures generally relieve symptoms quickly and may be suitable if you have moderate prostate enlargement and no underlying health conditions which can make general surgery too risky.
  • Transurethral microwave thermotherapy (TUMT): This procedure involves an electrode inserted into your prostate through the urethra. The electrode emits microwaves that can ablate/destroy the inner part of an enlarged prostate.
    It may take a while after this procedure before relief is noticeable, and relief of symptoms may only be partial; therefore, re-treatment is often needed, and TUMT is therefore only used in special cases of mild prostate enlargement.
  • Transurethral needle ablation (TUNA): In this procedure, a scope is passed into your urethra, allowing the surgeon to place needles into your prostate gland. The needles pass radio waves into the prostate tissue, heating and destroying excess cells blocking urine flow. This process is seldomly used anymore.
  • Laser therapies: These therapies involve using high-energy laser beams to destroy or remove overgrown prostate cells. Laser therapies can relieve symptoms quickly and generally cause less side-effects than other minimally invasive treatments.
  • Prostatic urethral lift (PUL): For this treatment, special tags are implanted surgically to compress the sides of your prostate, increasing urine flow. The effect on ejaculation and sexual function is much lower with PUL than it is for TURP.
  • Embolisation: This is a yet unproven, experimental procedure where the blood supply to or from the prostate is selectively blocked, causing the prostate to shrink.
  • Prostatectomy: For prostatectomy, a surgeon makes an incision into your lower abdomen and removes your prostate. The surgery usually requires a short hospital stay and your doctor may recommend you restrict physical activity for a period of time afterwards, especially heavy lifting and excessive exercise.

What are the complications associated with an enlarged prostate?

If BPH is left untreated, you may experience one or more of the following complications as a result of chronic urinary obstruction:

  • A sudden inability to urinate (urinary retention): This might require a catheter inserted into your bladder to drain the urine. Some men with an enlarged prostate need surgery to relieve urinary retention.
  • Increased risk of urinary tract infections (UTIs): An inability to fully empty the bladder can increase the risk of infection in your urinary tract. This can even lead to infection of the bladder (cystitis) or kidney (pyelonephritis).
    If you experience UTIs frequently, you need to talk to your doctor about possible treatment options for an enlarged prostate.
  • Bladder stones: Being unable to completely empty the bladder can sometimes cause bladder stones. Bladder stones can also cause infection and bladder irritation and damage.
  • Damage to the bladder: A bladder that cannot empty properly can become overstretched, causing the muscle to weaken over time.
  • Kidney damage: Pressure in the bladder from urinary retention can directly damage the kidneys or allow bladder infections to travel up the ureters to reach the kidneys.

While most men with an enlarged prostate will not develop these complications, acute urinary retention and kidney damage are serious health threats and require medical attention.

Sources

Statistics: Urology Care Foundation website. (2019) What is Benign Prostatic Hyperplasia (BPH)? Urology Care Foundation. Available from: https://www.urologyhealth.org/urologic-conditions/benign-prostatic-hyperplasia-(bph)#Treatment

 

National Institutes of Health. (2014) Prostate Enlargement (Benign Prostatic Hyperplasia). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), US Dept. of Health and Human Services. Available from: https://www.niddk.nih.gov/health-information/urologic-diseases/prostate-problems/prostate-enlargement-benign-prostatic-hyperplasia#seekCare

 

Cleveland Clinic Staff. (2020) Benign Prostatic Enlargement/Hyperplasia (BPE/BPH). The Cleveland Clinic. Available from: https://my.clevelandclinic.org/health/diseases/9100-benign-prostatic-enlargement-bph

 

NHS UK website. (2020) Overview: Benign prostate enlargement. NHS UK. Available from: https://www.nhs.uk/conditions/prostate-enlargement/

 

Andriole G. (2019) Benign Prostatic Hyperplasia (BPH). MSD Manual, Merck & Co. Available from: https://www.msdmanuals.com/home/men-s-health-issues/benign-prostate-disorders/benign-prostatic-hyperplasia-bph

 

John Wayne Cancer Institute. (n.d.) Benign Prostatic Hyperplasia (BPH). Urology, St John’s Health Center. Available from: https://www.saintjohnscancer.org/urology/conditions/bph/

 

Healthwise Staff. (2019) Enlarged Prostate: Bathroom Tips. Michigan Medicine Gateway, the University of Michigan. Available from: https://www.uofmhealth.org/health-library/hw55013#:~:text=The%20following%20tips%20may%20make,symptoms%20can%20make%20them%20worse.

 

Beth Israel Lahey Health, Health Library. (n.d.) Risk Factors for Benign Prostatic Hyperplasia (BPH). Winchester Hospital. Available from: https://www.winchesterhospital.org/health-library/article?id=19149

 

Murrell D. (2018) What Do You Want to Know About Enlarged Prostate. Healthline. Available from: https://www.healthline.com/health/enlarged-prostate

 

Marcin J. (2018) What Are the Risk Factors for BPH? Healthline. Available from: https://www.healthline.com/health/enlarged-prostate/bph-risk-factors

 

Mayo Clinic staff. (n.d.) Diseases & Condition: Benign prostatic hyperplasia (BPH). Mayo Clinic. Available from: https://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/symptoms-causes/syc-20370087

 

Mayo Clinic staff. (n.d.) Diagnosis and Treatment: Benign prostatic hyperplasia (BPH). Mayo Clinic. Available from: https://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/diagnosis-treatment/drc-20370093

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Sources

Statistics: Urology Care Foundation website. (2019) What is Benign Prostatic Hyperplasia (BPH)? Urology Care Foundation. Available from: https://www.urologyhealth.org/urologic-conditions/benign-prostatic-hyperplasia-(bph)#Treatment

 

National Institutes of Health. (2014) Prostate Enlargement (Benign Prostatic Hyperplasia). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), US Dept. of Health and Human Services. Available from: https://www.niddk.nih.gov/health-information/urologic-diseases/prostate-problems/prostate-enlargement-benign-prostatic-hyperplasia#seekCare

 

Cleveland Clinic Staff. (2020) Benign Prostatic Enlargement/Hyperplasia (BPE/BPH). The Cleveland Clinic. Available from: https://my.clevelandclinic.org/health/diseases/9100-benign-prostatic-enlargement-bph

 

NHS UK website. (2020) Overview: Benign prostate enlargement. NHS UK. Available from: https://www.nhs.uk/conditions/prostate-enlargement/

 

Andriole G. (2019) Benign Prostatic Hyperplasia (BPH). MSD Manual, Merck & Co. Available from: https://www.msdmanuals.com/home/men-s-health-issues/benign-prostate-disorders/benign-prostatic-hyperplasia-bph

 

John Wayne Cancer Institute. (n.d.) Benign Prostatic Hyperplasia (BPH). Urology, St John’s Health Center. Available from: https://www.saintjohnscancer.org/urology/conditions/bph/

 

Healthwise Staff. (2019) Enlarged Prostate: Bathroom Tips. Michigan Medicine Gateway, the University of Michigan. Available from: https://www.uofmhealth.org/health-library/hw55013#:~:text=The%20following%20tips%20may%20make,symptoms%20can%20make%20them%20worse.

 

Beth Israel Lahey Health, Health Library. (n.d.) Risk Factors for Benign Prostatic Hyperplasia (BPH). Winchester Hospital. Available from: https://www.winchesterhospital.org/health-library/article?id=19149

 

Murrell D. (2018) What Do You Want to Know About Enlarged Prostate. Healthline. Available from: https://www.healthline.com/health/enlarged-prostate

 

Marcin J. (2018) What Are the Risk Factors for BPH? Healthline. Available from: https://www.healthline.com/health/enlarged-prostate/bph-risk-factors

 

Mayo Clinic staff. (n.d.) Diseases & Condition: Benign prostatic hyperplasia (BPH). Mayo Clinic. Available from: https://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/symptoms-causes/syc-20370087

 

Mayo Clinic staff. (n.d.) Diagnosis and Treatment: Benign prostatic hyperplasia (BPH). Mayo Clinic. Available from: https://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/diagnosis-treatment/drc-20370093