Benign Prostatic Hyperplasia
otherwise known as BPH, is the enlargement of the prostate. BPG is very common and the chance increases with age.
Benign Prostatic Hyperplasia Overview
Benign prostatic hyperplasia (BPH) otherwise known as benign prostatic hypertrophy is the enlargement of the prostate.
BPH is very common that it has been said all men will have an enlarged prostate if they live long enough.
Patients with BPH can experience a variety of signs or symptoms such as
- difficulty urinating (hesitation, dribbling, weak stream, and incomplete bladder emptying)
- painful urination
- urinary frequency
- urinary urgency
The cause of prostate enlargement is unknown. However certain factors such as age and changes in the cells of the testicles may play a role.
The treatment options include watchful waiting and self-care (lifestyle changes), medications, and surgery in some cases.
Patients should visit their doctor each year to monitor symptoms and determine if a change in treatment is warranted.
Benign Prostatic Hyperplasia Symptoms
Patients with BPH can experience a variety of signs or symptoms which may include:
- Urine dribbling out of the penis
- Inability to urinate (urinary retention)
- Bladder feels full even after voiding
- Incontinence (inability to control urination)
- Needing to urinate two or more times per night
- Pain with urination or bloody urine (these may indicate infection)
- Slowed or delayed start of the urinary stream
- Straining to urinate
- Strong and sudden urge to urinate
- Weak urine stream
Benign Prostatic Hyperplasia Causes
The cause of prostate enlargement is unknown. However certain factors such as age and changes in the cells of the testicles may play a role.
Men who have had their testicles removed at a young age, usually before puberty, do not develop BPH.
Some factors associated with BPH:
- The likelihood of developing BPH, increases with age
- A small amount of prostate enlargement is present in many men over age 40. More than 90% of men over age 80 have the BPH.
Benign Prostatic Hyperplasia Diagnosis
Your doctor will take your medical history, perform a physical exam, and ask you about your symptoms.
Your doctor will perform a digital rectal exam in order to feel your prostate gland. In those men with BPH, the prostate is usually, but not always enlarged (more than 20 g).
Your doctor will order other tests that may include:
- Urine flow rate
- Post-void residual urine test to see how much urine is left in your bladder after urination
- Pressure flow studies to measure the pressure in the bladder as you urinate
- Urinalysis
- Prostate-specific antigen (PSA) blood test to screen for prostate cancer
Your doctor will also ask you about all the medications including prescription, nonprescription, and supplements, you take since some medications can cause or worsen BPH symptoms.
Living With Benign Prostatic Hyperplasia
Support groups may help some men in managing BPH.
Patients should visit their doctor each year to monitor symptoms and determine if a change in treatment is warranted.
Try these lifestyle changes:
- 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 alcohol and caffeine, especially after dinner.
- Do not drink a lot of fluid all at once. Spread out fluids during the day. Avoid drinking fluids within 2 hours of bedtime.
- Try NOT to take over-the-counter cold and sinus medicines that contain decongestants or antihistamines. These drugs can worsen BPH symptoms.
- Keep warm and exercise regularly. Cold weather and lack of physical activity may worsen symptoms.
- Learn and perform Kegel exercises (pelvic strengthening exercises).
- Reduce stress. Nervousness and tension can lead to more frequent urination.
Benign Prostatic Hyperplasia Treatments
The treatment your doctor decides on will be based on how severe your symptoms are and how bothersome they are.
The treatment options include:
- Watchful waiting and Self-care (lifestyle changes)
- Medications
- Surgery
Watchful waiting and self-care:
If you are over 60, you are more likely to have symptoms. However many men with an enlarged prostate have only minor symptoms and self-care steps are often enough to make a difference.
For those men with mild disease or for those with moderate disease with mild bothersome 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 alcohol and caffeine, especially after dinner.
- Do not drink a lot of fluid all at once. Spread out fluids during the day. Avoid drinking fluids within 2 hours of bedtime.
- Try NOT to take over-the-counter cold and sinus medicines that contain decongestants or antihistamines. These drugs can worsen BPH symptoms.
- Keep warm and exercise regularly. Cold weather and lack of physical activity may worsen symptoms.
- Learn and perform Kegel exercises (pelvic strengthening exercises).
- Reduce stress. Nervousness and tension can lead to more frequent urination.
Medications:
Alpha blockers include:
Alpha 1-blockers are a class of drugs that are also used to treat high blood pressure. These medicines relax the muscles of the bladder neck and prostate which allows easier urination. Most people who take alpha 1-blockers will notice improvement in their symptoms.
These medications may help control your condition, but will not cure it. Continue to take your medication even if you feel well. Do not stop taking your medication without talking to your doctor.
5-Alpha reductase inhibitors include:
5-Alpha reductase inhibitors lower levels of hormones produced by the prostate. These medicines may need to be taken for 3 to 6 months before you notice symptoms getting better. Possible side effects include decreased sex drive and impotence.
5-Alpha reductase inhibitors fall into category X as these medications may harm your unborn baby. Pregnant women or those women who may potentially be pregnant, should not handle these medications as touching the contents of the medication may harm the unborn baby. The contact area should be washed immediately with soap and water.
Chronic prostatitis (inflammation of the prostate) may occur with BPH. In this cases, antibiotics may be prescribed.
Surgery may be recommended in certain cases such as in those men who have:
- Recurrent blood in the urine
- Inability to fully empty the bladder (urinary retention)
- Recurrent urinary tract infections
- Decreasing kidney function
- Bladder stones
The type of surgical procedure used will be based on how severe the symptoms are and based on the size/shape of the prostate gland.
Types of surgery include:
- Transurethral resection of the prostate (TURP)
- Prostatectomy
There are several other procedures that are options and are less invasive then conventional surgery. Your doctor will determine the best procedure for you.
The amount of time you will stay in the hospital after surgery will depend on the type of surgery you had and how quickly you recover.
Benign Prostatic Hyperplasia Related Medications
Saw palmetto
Many herbs have been tried for treating an enlarged prostate. Many men use saw palmetto to ease symptoms. Some studies have shown saw palmetto may help with symptoms, but the results are mixed and more research is needed. If you use saw palmetto or are thinking about using saw palmetto, ask your doctor to determine if this alternative treatment is right for you.
Benign Prostatic Hyperplasia Prognosis
Severe BPH can cause serious problems over time. The inability to urinate (urine retention) and strain on the bladder can lead to urinary tract infections, bladder or kidney damage, bladder stones, and incontinence which is the inability to control urination. If damage occurs to the the bladder, treatment for BPH may not be effective. Diagnosing BPH early on reduces the risk of developing complications over time.
BPH may come back over time even after having surgery.