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Benign prostatic hyperplasia
- Benign prostatic hyperplasia (BPH) is when the prostate gland grows larger. It is a common condition in older men. Its cause is not known.
- BPH can cause problems with urination (peeing).
- BPH is not a serious condition in itself, although the symptoms can be bothersome. It is, however, important to have a doctor check you and rule out other, more serious, conditions that give rise to similar symptoms.
What is benign prostatic hyperplasia?
Benign prostatic hyperplasia (BPH), also known as prostatic hypertrophy, is an enlargement of the prostate gland. BPH can cause problems with urination (peeing). BPH happens to all men, to some degree, as they get older.
The cause of BPH is not completely understood, although hormones, such as testosterone, may play a role.
The prostate is a small ring-shaped gland that sits just under the bladder and in front of the rectum. It surrounds the urethra, the tube that carries urine from the bladder and through the penis. When it grows larger, the prostate gland can press on the bladder and the urethra, interfering with urination.
The factors that increase the risk of BPH are not very clear at this stage. Family history, increasing age, being overweight or obese, diabetes, high blood pressure (hypertension) and a diet high in saturated fat and red meat have been suggested.
Signs and symptoms
Symptoms of BPH can include:
- Difficulty beginning urination;
- Having to urinate often, especially at night;
- A weak or interrupted stream of urine;
- Straining while urinating;
- A sudden and urgent need to urinate,
- Not being able to completely empty your bladder, and;
- Dribbling at the end of urination.
These symptoms are sometimes known as lower urinary tract symptoms (LUTS).
Symptoms due to BPH often develop gradually and do not usually occur before 50 years of age. The increased size of the prostate does not always correspond to the level of symptoms you may experience.
Ruling out other conditions
Some serious conditions can cause similar symptoms to those of BPH. Checking in with your doctor if you have problems with urinating, or if your pattern of urination changes, can help to identify and treat these early on.
Blood in the urine is a symptom that can indicate serious health conditions that need prompt investigation.
Methods for diagnosis
Your doctor will ask you for details about your symptoms in order to understand how severe they are and how much they affect your lifestyle.
Your doctor may perform a digital rectal exam in order to examine the shape and size of the prostate gland. This test involves a doctor putting a gloved finger into the anus in order to examine the shape and size of your prostate gland.
Your doctor may recommend further tests or refer you to a specialist (urologist).
Protein-specific antigen testing
A blood test is used to to measure the level of prostate-specific antigen (PSA) in the blood. High PSA levels can be caused by a number of different prostate conditions including BPH, prostatitis (inflammation of the prostate) and prostate cancer.
There have been questions raised about PSA testing because PSA levels do not always reflect the risk of prostate cancer. Some men with high PSA levels do not have prostate cancer, while other men with relatively low PSA levels may have prostate cancer.
Your doctor can explain more about PSA testing and discuss the potential benefits and harms of the test.
Other tests that may be recommended include:
- Urine test - to rule out prostate infections;
- Ultrasound scan to assess the size of the prostate, as well as look at the bladder and kidneys, and;
- Urodynamic testing will test how your urinary system (including the bladder, the urethra and the muscles that control urine flow) stores and releases urine.
Types of treatment
Men with mild BPH may not require treatment if the symptoms do not bother them. Symptoms can sometimes improve without treatment.
A variety of treatments and self-care measures are available:
There are things you can do that can help to reduce and/or manage symptoms caused by BPH:
- Caffeine and alcohol increase how frequently you urinate. Limiting of amount of these drinks can help;
- Limit the amount of fluids you drink before bed. This will make you less likely to need to urinate during the night;
- Be physically active for 30-60 minutes a day. Regular exercise, such as walking or cycling, can help to improve symptoms;
- Avoid constipation by eating a healthy diet that is rich in fiber. Constipation can strain your pelvic floor muscles which are important for bladder control, and;
- Lose weight if you are overweight or obese.
Bladder training involves exercises that can help to increase the amount of urine your bladder can hold before needing to urinate. Bladder training is not suitable for everyone; your doctor or urologist can advise whether it can help you.
Several types of medications can help you with the urinary flow problems that BPH causes. Once you start taking medications, you will need to continue to take them on an ongoing basis for them to be effective.
Alpha blockers such as prazosin and tamsulosin can help to relax muscles in the bladder and prostate, and improve urinary flow. Side effects of these drugs can include dizziness, headaches and, particularly with tamsulosin, little or no sperm when you ejaculate. They can also cause problems if you have eye surgery while taking these medications.
5-alpha-reductase inhibitors, such as dutasteride and finasteride, work by blocking the production of dihydrotestosterone (DHR). DHR is a hormone that stimulates growth of the prostate. Blocking DHR can reduce the size of the prostate gland and improve urinary symptoms.
These medications are usually only prescribed for men who have a particularly large prostate. It can take a few months for these medications to have a noticeable effect.
Common side effects of these medications can include a decreased sex drive, erectile dysfunction, and problems with ejaculation. These medications can also cause birth defects in babies if the father is taking them when the baby is conceived, or if broken or crushed tablets are handled by a pregnant woman.
Saw palmetto (also known as Serenoa repens) has been used to treat urinary symptoms associated with BPH. However, trials have not shown evidence that it is effective.
For men with severe BPH symptoms, surgery to remove some or all of the prostate may be recommended.
Transurethral resection of the prostate (TURP)
A small instrument called a resectoscope is inserted into the urethra. The end of the instrument (a wire loop) is used to cut away excess tissue in the region where the prostate is pressing on the urethra.
This operation is done under anesthesia. You may spend one or more nights in hospital recovering.
Transurethral incision of the prostate (TUIP)
The resectoscope is used to make one or two cuts in the bladder neck, the area where the bladder and prostate connect. This can help to open up the area and increase urinary flow.
Techniques such as photoselective vaporization of the prostate (PVP) and Holmium laser enucleation of the prostate (HoLEP) are similar to TURP, but use lasers to remove the prostate tissue. These techniques are less invasive than TURP and may offer some benefits, such as reduced recovery time.
Rarely, the whole prostate may be removed. It is not commonly performed for BPH, but may be recommended if the prostate is severely enlarged.
While BPH is unlikely to cause serious health conditions, it can sometimes lead to:
- Urinary tract infection. If your bladder does not empty of urine completely, bacteria can infect the urinary tract, and;
- Acute urinary retention (AUR). This is a condition in which a person is suddenly unable to pee. While it is not common for BPH to cause acute urinary retention, it requires immediate treatment, because it can lead to kidney damage.
Complications of surgery
All surgeries to treat BPH can have complications. Before surgery, your urologist can discuss the potential benefits and drawbacks of the surgical techniques available, and which of them may be most suitable for you.
Complications can include:
- Bleeding following the surgery. This normally stops within weeks;
- Retrograde ejaculation. In this condition, the semen passes back into the bladder and then is passed when you next urinate. It does not cause health problems and does not prevent an orgasm; however, it can cause infertility;
- Erectile dysfunction. Some men are not able to get or sustain an erection following surgery. This is more common in men who have erectile problems prior to surgery;
- Urinary incontinence. Due to bladder problems or damage to the muscles that control urine flow (called sphincters), some men are unable to control urinary flow after surgery, and;
- Urethral strictures. Scarring in the urinary tract can lead to blockages of flow.
BPH does not usually cause serious health problems for men, although the symptoms can be bothersome and affect your quality of life. Generally, symptoms slowly get worse without treatment. Treatments can help to deal with symptoms, but can have significant side effects.
The lifestyle measures listed in the 'Types of treatment' section above can help to prevent or delay BPH.