What is Benign Prostatic Hyperplasia (BPH)?

Symptoms

What Are The Symptoms of BPH?

With BPH, the prostate gets larger. When it is enlarged, it can irritate or block the bladder. A common symptom of BPH is the need to urinate often. This can be every one to two hours, especially at night.

Other symptoms include:

  • Feeling that the bladder is full, even right after urinating
  • Feeling that urinating "can't wait"
  • Weak urine flow
  • Dribbling of urine
  • The need to stop and start urinating several times
  • Trouble starting to urinate
  • The need to push or strain to urinate

In severe cases, you might not be able to urinate at all. This is an emergency. It must be treated right away.

How Can BPH Affect Your Life?

In most men, BPH gets worse as you age. It can lead to bladder damage and infection. It can cause blood in the urine. It can even cause kidney damage. Men with BPH should get treated.

Causes

What Causes BPH?

The cause of benign prostatic hyperplasia is not well understood; however, it occurs mainly in older men. Benign prostatic hyperplasia does not develop in men whose testicles were removed before puberty. For this reason, some researchers believe factors related to aging and the testicles may cause benign prostatic hyperplasia.

Throughout their lives, men produce testosterone, a male hormone, and small amounts of estrogen, a female hormone. As men age, the amount of active testosterone in their blood decreases, which leaves a higher proportion of estrogen. Scientific studies have suggested that benign prostatic hyperplasia may occur because the higher proportion of estrogen within the prostate increases the activity of substances that promote prostate cell growth.

Another theory focuses on dihydrotestosterone (DHT), a male hormone that plays a role in prostate development and growth. Some research has indicated that even with a drop in blood testosterone levels, older men continue to produce and accumulate high levels of DHT in the prostate. This accumulation of DHT may encourage prostate cells to continue to grow. Scientists have noted that men who do not produce DHT do not develop benign prostatic hyperplasia.

What Are The Risk Factors For BPH?

Risk factors include aging and a family history of BPH. Other risk factors are obesity, lack of physical activity, and erectile dysfunction (ED).

Can BPH be Prevented?

There is no sure way to prevent BPH. Because excess body fat may affect hormone levels and cell growth, diet may play a role. Losing weight and eating a healthy diet, with fruits and vegetables, may help prevent BPH. Staying active also helps weight and hormone levels.

Diagnosis

How is BPH Diagnosed?

The American Urological Association (AUA) developed a BPH Symptom Score Index. It asks how often urinary symptoms happen. The score rates BPH as mild to severe. Take the test and talk with your healthcare provider about your results.

Your health care provider will review your Symptom Score and take a medical history. There will be a physical exam with a digital rectal exam (DRE). You may also have:

  • Urinalysis (urine test)
  • PSA blood test to screen for prostate cancer
  • Urinary blood test to screen for bladder cancer
  • Post-void residual volume (PVR) to measure urine left in the bladder after urinating
  • Uroflowmetry to measure how fast urine flows
  • Cystoscopy to look at the urethra or bladder with a scope
  • Urodynamic pressure to test pressure in the bladder during urinating
  • Ultrasound of the prostate

You should see your health care provider if you have symptoms. See your health care provider right away if you have blood in your urine , pain or burning when you urinate, or you cannot urinate.

PSA Test

The prostate-specific antigen (PSA) blood test, tests the level of prostate-specific antigen (PSA) in the blood. PSA is a protein made only by the prostate gland. The PSA test can be done in a lab, hospital or health care provider's office. There is no special preparation. The PSA test should come before the health care provider does a DRE. Ejaculation can raise the PSA level for 24 to 48 hours. So the patient should not ejaculate for two days before a PSA test.

Very little PSA is found in the blood of a man with a healthy prostate. A low PSA is better for prostate health. A rapid rise in PSA may be a sign that something is wrong. One possible cause of a high PSA level is benign (non-cancer) enlargement of the prostate . Inflammation of the prostate, called prostatitis is one more common cause of high PSA levels.

DRE

The digital rectal examination (DRE) is done with the man bending over or lying curled on his side. The health care provider puts a lubricated gloved finger into the rectum. The health care provider will feel the prostate. They will be looking for abnormal shape or thickness in the prostate. The DRE can help your health care provider find prostate problems.

Treatment

How is BPH Treated?

There are many treatments for BPH. You and your health care provider will decide together which treatment is right for you. Mild cases of BPH may need no treatment at all. In some cases, minimally invasive procedures that do not require anesthesia are good choices. And sometimes a combination of medical treatments works best.

The main treatments for BPH are:

After Treatment

What Happens After Treatment?

For most men, symptoms improve after treatment. Infection, bleeding, incontinence , and erectile dysfunction may occur after some treatments. In some cases, scar tissue may form. There may be complications after surgery. Some men need further or new treatment.

What are the long term side effects of treatment?

Side effects vary with the type of treatment you choose. Most side effects are temporary. It may take a while for sexual function to return fully. Most experts agree that if you were able to have an erection shortly before surgery, you will probably be able to after surgery. Most men find little or no difference in orgasm. They may have retrograde ejaculation. This is when semen enters the bladder rather than being sent out. For most men, side effects lessen with time. But there may be long term side effects for some men for some treatments.

How can you prevent a recurrence of BPH?

Once you have been treated, taking medication continually can prevent BPH symptoms from returning or getting worse. In some men, a different treatment may be necessary. Some men they will need repeated treatments to get rid of bothersome symptoms. In older men, it may be possible to control the symptoms of BPH to the end of life.