Benign prostatic hyperplasia (BPH) is an irregular enlargement of the prostate, a walnut-size gland located just below the bladder in men that produces about 30 percent of the fluid portion of semen. The prostate surrounds the urethra, the tube through which urine empties from the bladder. An enlarged prostate may eventually squeeze the urethra and interfere with urination.
BPH is so common that all men will have an enlarged prostate if they live long enough. A small amount of prostate enlargement is present in many men over age 40 -- half of them by age 75. Some studies show 90% of men with BPH after age 80.
What are the Causes of BPH?
It is an unknown. Many researchers believe it is linked to aging and it may be linked to the growth of the testicles. Men who have had their testicles removed at a young age – because of cancer, for instance -- do not develop BPH. Similarly, if the testicles are removed after a man develops BPH, the prostate begins to shrink in size. No risk factors have been identified other than having normally functioning testicles.
Symptoms
Interestingly, less than half of all men with BPH have symptoms of the disease. The most common symptoms include:
- Slowed or delayed start of the urinary stream
- Weak urine stream
- Dribbling after urinating
- Straining to urinate
- Sudden urge to urinate
- Incomplete emptying of your bladder
- Needing to urinate two or more times per night
- Urinary retention (complete inability to urinate)
- Incontinence
- Pain with urination or bloody urine, both could indicate infection
Exams and Tests
Some men avoid the DRE (digital rectal exam) because they are uncomfortable with the procedure – but it is an essential screening tool for prostate cancer and can determine the extent of BPH. It is not painful and lasts less than a minute.
During a DRE, the patient either bends forward over the examination table, lies on his side, or kneels on the table. The doctor then inserts a gloved, lubricated finger a few inches into the rectum and gently palpates the prostate gland to feel for a nodule or lump, change in size, hard tissue, or any other abnormality that might indicate a tumor is present.
The American Cancer Society and American Urology Association recommend that all men over age 50 have a DRE, along with a PSA (prostate-specific antigen) test, once a year—and earlier if they are at high risk for prostate cancer.
Other tests may include urine flow rate, urinalysis to check for blood or infection, urine culture to check for infection, and a PSA blood test to screen for prostate cancer.
Treatments -- Self Care and Surgical
Doctors cannot accurately predict how quickly an enlarged prostate will require treatment. Symptoms from obstruction of the urethra can remain stable for years and may even improve over time in as many as one-third of men.
For mild symptoms:
- Urinate when you first get the urge. Also, go to the bathroom when you have the chance, even if you don't feel a need to urinate.
- Avoid excess alcohol, caffeine or fluid intake, especially at night.
- Try NOT to take over-the-counter cold and sinus medications that contain decongestants or antihistamines. These medications can increase BPH symptoms.
- Keep warm and exercise regularly. Cold weather and lack of physical activity may worsen symptoms.
- Ask your doctor about heat treatments, including minimally invasive microwave or radio-frequency energy, which are available on an outpatient basis
Doctors may prescribe medication such as Proscar (finasteride) to shrink the prostate or drugs that relax muscles around the prostate (alpha-blockers).
In more severe cases:
- The most common surgical treatment is the removal of excess tissue from an enlarged prostate via transurethral resection of the prostate (TURP). Surgeons pass a thin, lighted viewing tube through the penis into the urethra. A minuscule cutting tool at the end of the tube is used to excise prostate tissue that is pressing upon the urethra.
- If the prostate is unusually large, surgical removal of obstructing prostate tissue via an abdominal incision may be necessary.
Contributing background information for this article: John Hopkins Medical white papers 2007 and 2008, the New York Times online, and the American Cancer Society website
Other articles by Steve Vogel on prostate cancer risks and treatment options.
