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 complications.
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 develop BPH.
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 urination.
- 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 urethra.
- 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 the following:
- 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 and finasteride 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 prostate.
- Transurethral 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.
- Transurethral 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 procedure.
Potential Complications of BPH
Men who have a long-standing history of BPH may develop the following complications:
- 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.