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Prostate Health

What is BPH (benign prostatic hyperplasia)?

This article is not intended to replace professional medical care or advice. If you have any questions or need additional information, please talk with your doctor.

There are some cases in which non-cancerous conditions such as benign prostatic hyperplasia, also known as BPH, can cause symptoms in men that are very similar to those of prostate cancer. However, a man with BPH – an enlargement of the prostate – is not any more or less likely to develop prostate cancer, reported the Prostate Cancer Foundation (PCF).

Occurrence of BPH

This non-cancerous condition occurs during the second of two main growth periods of the prostate, according to the source. The first phase of growth happens to adolescents during early puberty when the prostate doubles in size, and the second begins around the age of 25. This second period will continue for most of a man’s life with problematic symptoms generally occurring during a man’s 50s.

BPH is the most common prostate condition for men over the age of 50, according to the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK). It is rare for this condition to occur before the age of 40, and symptoms and occurrence increase as men age. Close to half of all men between the ages of  51 and 60 will be affected by BPH. That rate increases to 90 percent for individuals over the age of 80.

Symptoms

Though the exact cause is still not very well understood, there are several symptoms of the lower urinary tract that may indicate benign prostatic hyperplasia. BPH begins in the ring of tissue that forms a natural circle around the urethra, called the transition zone, according to the PCF. Because the growth is inward, it causes tightening around the urethra – the organ that carries urine from the bladder through the prostate to the penis. Thus, urination becomes hindered and symptoms are often difficult to ignore.

One of the most common symptoms of BPH is the frequent feeling of needing to urinate, even as often as every one or two hours, according to the Urology Care Foundation (UCF). This frequency may increase during the nighttime and is known as nocturia. Other symptoms include:

  • A weak or dribbling flow of urine.
  • An extremely urgent feeling to urinate.
  • Difficulty beginning to urinate.
  • The need to stop and start while urinating .
  • Straining or pushing while urinating.
  • The feeling of a full bladder, even right after using the bathroom.
  • Pain or discoloration of urine.

There are occasional instances when BPH may cause a man to be unable to urinate at all. If this happens, it must be treated right away, reported the UCF.

Diagnosing BPH

Unfortunately, there is no guaranteed way to prevent the onset of this condition, according to the UCF. Natural aging, a family history of BPH and erectile dysfunction (ED) are all risk factors that cannot be prevented. However, obesity and a lack of exercise may contribute to an increased risk. Consequently, ensuring that you eat a healthy, balanced diet and engage in regular physical activity may help to prevent it.

To asses the severity of BPH, the American Urological Association developed the self-administered symptom questionnaire known as the BPH Symptom Score Index. After the patient’s score is reviewed by his physician, a medical history will be taken, followed by a physical exam that includes a digital rectal exam (DRE). Other tests and procedures may include:

  • An ultrasound of the prostate.
  • A prostate-specific antigen (PSA) test to screen for prostate cancer.
  • A urine test (urinalysis).
  • Bladder cancer screening.
  • 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.

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Treatment

Although most men will not experience any issues, BPH typically becomes worse with age, and symptoms may sometimes lead to complications. These complications can include urinary tract infections (UTIs), acute urinary retention, chronic urinary retention and bladder stones, according to the NIDDK. In the worst cases, blood in the urine, bladder damage and infection and even kidney damage can occur.

Mild symptoms of BPH do not usually require treatment

Typically, mild or non-bothersome symptoms of BPH will not require treatment, according to the American Academy of Family Physicians (AAFP). For men who do require treatment, there are a number of options available ranging from lifestyle changes and watchful waiting, to medical therapies and surgical procedures. Surgery may be an option if other medical treatments do not work.

Watchful waiting is recommended for those with mild symptoms of BPH.

1. Watchful waiting/active surveillance: With watchful waiting, no active treatment is given but the BPH is monitored and a yearly exam will be conducted, according to the UCF. Diet and medication may be altered to help to control symptoms.

Watchful waiting is recommended for those with mild symptoms of BPH.

2. Medical therapies: There are three types of medical therapies available to those with BPH including alpha blockers, 5-alpha reductase inhibitors and combination therapy.

  • Alpha blockers: This option is best for men who have moderate to severe BPH. Alpha blockers are a medication in pill form that help to relax the muscles of both the prostate and the bladder. This reduces blockage and improves urine flow. And though they do not reduce the size of the prostate, alpha blockers reduce the symptoms of BPH. These pills work almost immediately, though side effects include difficulty ejaculating, dizziness, fatigue and lightheadedness, reported the UCF.
  • 5-alpha reductase inhibitors: These inhibitor medications work to block the production of dihydrotestosterone, which helps to slowly decrease the size of the prostate, according to the AAFP. As the prostate shrinks, urine flow will improve. Older men and those with very large prostates are good candidates for this treatment option. Though they lower the risk of complications and need for surgery, they must be taken indefinitely. Moreover, the side effects include decreased sex drive and erectile dysfunction.
  • Combination therapy: This treatment option combines both alpha blockers and 5-alpha reductase inhibitors. According to the UCF, these pills work better together than alone, but taking both will likely increase the number of side effects.

3. Surgery: BPH patients with moderate to severe symptoms that develop related complications should be referred for surgical consultation, according to the AAFP. Other good candidates for surgery are those who did not have success with medical therapies. Both minimally invasive surgeries and more involved surgeries that can remove obstructing prostate tissue are available. Choosing the right surgery for you will depend on personal preference, the size of your prostate and your health.

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