Benign enlargement of the prostate is a common condition in which your prostate gland swells beyond normal size. It is also known as benign prostatic hyperplasia, or BPH. If you have this disorder, keep in mind that it’s not a cancer. The condition does, however, still require treatment if it is accompanied by symptoms.
The prostate gland is only found in men and is normally about the size of a walnut. It sits immediately underneath the bladder and just above the penis. A tube called the urethra, which carries urine from your bladder, passes through the center of the prostate gland.
An enlarged prostate can compress the urethra, which causes narrowing or blockage of the tube and prevents your urine from flowing normally.
Fortunately, your prostate gland isn’t essential to sustain life. It’s possible to surgically remove the prostate if the problems interfere too much with your quality of life.
Causes and Risk Factors
Once you reach age 45, you’re more likely to develop an enlarged prostate. Your risk increases as you age. Around one-third of men older than 50 have an enlarged prostate. By age 85, this increases to a whopping 90 percent.
Some research suggests that prostate enlargement could result from hormonal changes occurring in men as they age.
If you have a close relative with benign prostate enlargement, you’re more likely to develop the condition yourself.
If you have an enlarged prostate, you may experience some of the following symptoms, which tend to worsen as time goes on:
- a need to urinate more often than normal
- an increased need to urinate during the night (nocturia)
- finding it difficult to start urinating
- having a flow of urine that is weak, or stops and starts (dribbling)
- feeling as if you have to strain to produce urine
- feeling as if your bladder hasn’t emptied properly after urinating
- urine continuing to drip out after you have finished urinating
You may also experience complications from an enlarged prostate, such as a urinary tract infection. You could also develop bladder or kidney stones.
However, not everyone experiences symptoms. You may even experience symptoms that don’t appear to relate to the prostate gland.
Your doctor will ask questions about your symptoms. They may perform a rectal examination to check the size and shape of your prostate gland.
You also may undergo urine and blood tests. These tests will check for infections and measure the prostate specific antigen (PSA) levels in your blood. The PSA number goes up when the prostate enlarges.
High levels of PSA can sometimes indicate prostate cancer, and your doctor may want to check for this. If there’s any doubt at all, your doctor can analyze a sample of cells from your prostate. You may also need an ultrasound scan.
Another test is a cystoscopy, where your doctor inserts a slender instrument with a camera into the urethra through the end of the penis. Your doctor can use this method to inspect your prostate gland from within the body.
You might also need to urinate into a device that measures your urine flow.
If your symptoms are mild, you may not need medical treatment. You might be able to manage your condition with lifestyle changes, such as restricting fluid intake at night and reducing alcohol and caffeine consumption. Your doctor will monitor your prostate at regular intervals.
Drugs are the most frequently used treatment when your symptoms are moderate. You may receive alpha-blockers to relax the muscles in your prostate. Your doctor might also prescribe drugs known as 5-alpha-reductase inhibitors, which alter your hormone balance, and encourage the prostate to reduce in size. Patients often take both types of medication. If taken, you need to have your blood pressure monitored, as these drugs can affect BP readings.
If your prostate doesn’t respond to drug treatment, or if it’s quite large, surgery may be necessary to remove the enlarged portion of the gland. The most common operation is known as transurethral resection of the prostate (TURP). As with the cystoscopy, a long, thin instrument with a camera enters the urethra to reach your prostate. Then the instrument removes the enlarged tissues using an electrical loop. The loop not only cuts, but also cauterizes the blood vessels to control bleeding.
Another type of surgery is transurethral incision of the prostate (TUIP). This procedure widens the urethra to allow for stronger urine flow. This is an “open” surgery, meaning it requires an external incision to reach the prostate. Doctors use this procedure only under more severe circumstances.
Non-surgical techniques use microwaves, radio waves, or lasers to remove the enlarged prostate tissue. These may cause fewer side effects, but aren’t as proven as conventional methods for long-term effectiveness.
With common treatment — medication, lifestyle changes, or surgery — most men find their condition greatly improves. Some men worry that prostate surgery will affect their sexual function. However, if you were capable of achieving an erection before your prostate surgery, you should be able to resume your normal sex life after fully recovering from the procedure.