The prostate is a small, muscular gland in the male reproductive
system. Your prostate surrounds your urethra and produces most of the fluid in
your semen. The muscular action of the prostate helps propel the fluid and
semen through your penis during sexual climax.
Benign prostatic hypertrophy, or benign prostatic hyperplasia
(BPH), occurs when the cells of the prostate gland begin to multiply. These
additional cells cause your prostate gland to swell, which squeezes the urethra
and limits the flow of urine.
Obstruction may be so severe that no urine can leave the bladder
at all. This is called bladder outlet obstruction (BOO), and it’s a
complication of BPH. It can be dangerous because urine trapped in the bladder can
cause urinary tract infections (UTIs) and damage your kidneys.
BPH is not the same as prostate cancer. It’s a benign condition
that doesn’t increase the risk of cancer. BPH is a common condition in men over
the age of 50.
What Are the Symptoms of BPH?
The symptoms of BPH are often very mild at first, but they become
more serious if they aren’t treated. Common symptoms include.
- incomplete bladder emptying
- nocturia, which is the need to urinate two or
more times per night
- dribbling at the end of the urinary stream
- incontinence, or leakage of urine
- the need to strain when urinating
- a weak urinary stream
- a sudden urge to urinate
- a slowed or delayed urinary stream
- painful urination
- blood in the urine
- pus in the urine
Tell your doctor if you’re concerned about any symptoms you’re
having. These symptoms are treatable, and prompt treatment will prevent
What Causes BPH?
BPH is considered a normal condition of male aging, and it’s
estimated that over
half of men over the age of 80 have BPH symptoms. Although the exact cause
is unknown, changes in male sex hormones as you age may be a factor. Any family
history of prostate problems or any abnormalities with your testicles may raise
your risks for BPH. Men who’ve had their testicles removed at a young age don’t
How Is BPH Diagnosed?
Evaluation for BPH begins with a physical exam and review of your
medical history. The physical exam includes a rectal examination that allows
the doctor to estimate the size and shape of your prostate. Other tests can
include the following:
- During a urinalysis or urine culture, your urine
is checked for blood and bacteria.
- During a prostatic biopsy, a small amount of
prostate tissue is removed and examined for abnormalities.
- During a urodynamic test, your bladder is filled
with liquid via a catheter to measure the pressure of your bladder during
- A prostate-specific antigen (PSA) test is a
blood test used to check for cancer of the prostate.
- A post-void residual is done to see how much
urine is left in the bladder after urination.
- During a cystoscopy, your doctor examines your
urethra and bladder through a tiny lighted instrument inserted into your
- During a rectal ultrasound and prostatic biopsy,
your doctor can confirm a diagnosis of BPH and rule out malignancy.
- During an intravenous pyelogram or urogram, a dye
is injected into your system. This reveals your entire urinary system on an
X-ray or CT scan.
What Are the Treatments for BPH?
Treatment of BPH can begin with self-care. If symptoms don’t subside
through self-care, medication or surgery may be recommended. Your age and
general health will also influence the prescribed treatment. Self-care includes
- Urinate as soon as you feel the urge.
- Make a habit of going to the bathroom to
urinate, even when you don’t feel the urge.
- Avoid taking over-the-counter decongestants or
antihistamine medications. They can make it harder for the bladder to empty.
- Avoid alcohol and caffeine, especially in the
hours after dinner.
- Reduce your stress level. Nervousness can
increase the frequency of urination.
- Exercise regularly. A lack of exercise can
aggravate your symptoms.
- Learn and practice Kegel exercises to strengthen
your pelvic muscles.
- Keep warm. Being cold can make symptoms worse.
Other treatment options include:
Alpha-1 blockers are medications that relax the muscles of the
bladder and prostate. Alpha-1 blockers relax the neck of the bladder and make
it easier for urine to flow. Examples of alpha-1 blockers include:
Medications that reduce the levels of hormones produced by the
prostate gland such as dutasteride
are commonly prescribed. These are two medications that lower the levels of
testosterone. Sometimes, lowering the hormone levels will make the prostate get
smaller and improve urine flow. However, these medications may also lead to
undesired side effects such as impotence and a decreased sex drive.
Antibiotics can be used if your prostate becomes chronically
inflamed, a condition known as prostatitis. They can be prescribed when this
inflammation of the prostate accompanies BPH. Treating prostatitis with
antibiotics can also improve your symptoms of BPH. Antibiotics are also helpful
for treating UTIs. These infections can occur whenever urine flow from the
bladder is decreased.
Minimally Invasive Procedures
There are minimally invasive procedures available that may be
used in an outpatient setting.
These involve inserting an instrument into your urethra and into
the prostate gland. Non-surgical alternatives include the following:
- In transurethral needle ablation (TUNA), radio
waves are used to scar and shrink prostate tissue.
- In transurethral microwave therapy (TUMT), microwave
energy is used to eliminate prostate tissue.
- In water-induced thermotherapy (WIT), heated
water is used to destroy excess prostate tissue.
- In high-intensity focused ultrasound (HIFU), sonic
energy is used to eliminate excess prostate tissue.
Surgery for BPH
Surgery in a hospital setting might be recommended if you have
any of the following symptoms:
- kidney failure
- bladder stones
- recurrent UTIs
- a complete inability to empty the bladder
- recurrent episodes of blood in the urine
Surgery can relieve symptoms of BPH, but BPH can return even
after surgical intervention. Here’s a list of surgeries for an enlarged
resection of the prostate (TURP) is the most commonly used surgical
treatment for BPH. Your doctor inserts a small instrument through your urethra
into the prostate. The prostate is then removed piece by piece. This procedure
usually requires a hospital stay.
- In a simple
prostatectomy, your doctor makes an incision in your abdomen or perineum,
which is the area behind the scrotum. The inner part of your prostate is
removed, leaving the outer part behind. This procedure is done using general or
spinal anesthesia. Hospitalization may last for five to 10 days.
incision of the prostate (TUIP) starts off similar to TURP, but the
prostate isn’t removed. Instead, a small incision is made in your prostate that
will enlarge your bladder outlet and urethra. The incision allows urine to flow
more freely. People aren’t always required to stay in a hospital with this
Potential Complications of BPH
Men who have a long-standing history of BPH may develop the
- urinary stones
- kidney damage
- bleeding in the urinary tract
- a sudden inability to urinate
When to See Your Doctor
Many men ignore their symptoms of BPH. However, early treatment
can help you avoid potentially dangerous complications. Call your doctor if you’re
urinating less than usual and your bladder isn’t emptying completely. Let your
doctor know if you have:
- a fever
- pain in you back, side, or abdomen
- blood or pus in your urine
Also, talk with your doctor about any medications you’re taking that
might be affecting your urinary system, such as:
Your doctor can make any necessary medication adjustments. Don’t
attempt to adjust your medications or doses yourself. Let your doctor know if you’ve
taken self-care measures for your symptoms for at least two months without
noticing any improvement.
BPH doesn’t always require medical treatment. Sometimes, your
doctor will want you to have regular checkups to monitor your symptoms and the
size of your prostate.
Lifestyle changes, medication, and surgery are all treatment
options for symptoms that are affecting your quality of life. Your doctor will
work with you to develop a treatment plan that helps you manage your symptoms
and live a regular life.