Benign Prostatic Hypertrophy (BPH) refers to the enlargement of the prostate gland in men above the normal size. When this happens, the enlarged prostate can compress the urethra and block urine flow which can result in a number of urinary symptoms that makes life uncomfortable for men. It is an age related problem and easily treated with medications and surgery, in addition to certain lifestyle changes. This brief article will enlighten you on what you need to know about BPH as a man and what you can do about it.
What Causes BPH?
The exact cause of BPH is not really clear to medical experts but BPH is considered a normal part of the aging process in men and is hormonally dependent on testosterone and dihydrotestosterone (DHT) production. Studies show that an estimated 50% of men will develop BPH by age 60 years. This number increases to 90% by age 85 years. Worldwide, approximately 30 million men have symptoms related to BPH.
The prevalence of BPH in white and African-American men is similar. However, studies reveal that BPH tends to be more severe and progressive in African-American men, possibly because of the higher testosterone levels, 5-alpha-reductase activity, androgen receptor expression, and growth factor activity in this population. The increased activity leads to an increased rate of prostatic hyperplasia and subsequent enlargement.
The hyperplasia (abnormal division of cells) results in enlargement of the prostate that may restrict the flow of urine from the bladder, resulting in the clinical manifestations of BPH. Notably, castrated males (ie, who are unable to make testosterone) do not develop BPH.
BPH doesn’t lead to prostate cancer or make you more likely to get it. It rarely leads to other conditions, but it can, and a couple of them are serious. For example, BPH can lead to kidney damage or cause a problem where you can’t pee at all. It may also cause bladder damage, bladder stones and
urinary tract infections.
What is a prostate gland?
The prostate is a walnut-sized gland that forms part of the male reproductive system. It is located in front of the rectum and just very close to the urinary bladder. It continues with the urinary tract and connects directly with the penile urethra. It is therefore a conduit between the bladder and the urethra.
The main function of the prostate gland is to secrete an alkaline fluid that comprises approximately 70% of the seminal volume. The secretions produce lubrication and nutrition for the sperm. The alkaline fluid in the ejaculate results in liquefaction of the seminal plug and helps to neutralize the acidic vaginal environment.
The prostatic urethra is a conduit for semen and prevents retrograde ejaculation (ie, ejaculation resulting in semen being forced backwards into the bladder) by closing off the bladder neck during sexual climax.
What are the Signs and symptoms of BPH?
When the prostate enlarges, it may constrict the flow of urine. Nerves within the prostate and bladder may also play a role in causing the following common symptoms:
- Urinary frequency.
- Urinary urgency.
- Nocturia- Needing to get up frequently at night to urinate.
- Hesitancy – Difficulty initiating the urinary stream; interrupted or weak urine stream.
- Incomplete bladder emptying – The feeling of persistent residual urine, regardless of the frequency of urination.
- Straining – The need to strain or push (Valsalva maneuver) to initiate and maintain urination in order to more fully empty the bladder.
- Decreased force of stream – The subjective loss of force of the urinary stream over time.
- Dribbling – The loss of small amounts of urine due to a poor urinary stream as well as weak urinary stream.
How BPH is Diagnosed
If you are over the age of 50 as a man and you start noticing any urinary difficulties, you should see your doctor who can diagnose whether the cause of your symptoms is BPH or another condition. Your doctor will do a physical exam which may include a digital rectal exam. During this, he puts on a glove and gently inserts one finger into your rectum to check the size and shape of your prostate.
Your doctor may start with one or more of these basic tests:
- Blood tests to check for kidney problems.
- Urine tests to look for infection or other problems that could be causing your symptoms.
- PSA (prostate-specific antigen) blood test. High PSA levels may be a sign of a larger-than-usual prostate. A doctor can also order it as screening for prostate cancer .
- Advanced tests: Based on the results of those tests, your doctor may order additional tests to rule out other problems or to see more clearly what’s happening. These might include ultrasound scan, a biopsy to rule out cancer, or a urine flow test to measure how strong your stream is and how much urine you make.
What are the Treatments for BPH?
How your doctor handles your case varies based on your age, health, the size of your prostate, and how BPH affects you. If your symptoms don’t bother you too much, you can put off treatment and see how it goes.
You may want to start with lifestyle changes which you can control. For example, you can:
- Do exercises to strengthen your pelvic floor muscles.
- Lower the amount of fluids you drink, especially before you go out or go to bed.
- Drink less caffeine and alcohol
For mild to moderate BPH, your doctor might suggest medicine. Some medications work by relaxing the muscles in your prostate and bladder. Others help shrink your prostate. For some men, it takes a mix of medicines to get the best results.
If lifestyle changes and medications don’t work, your doctor has a number of ways to remove part or all of your prostate. Many of these are called “minimally invasive,” meaning they’re easier on you than regular surgery. They may include :
- Water-induced thermotherapy to destroy part of the prostate with heated water.
- Laser therapy to remove part of your prostate.
- Transurethral resection of the prostate, or TURP, in which the doctor uses a scope and cuts out pieces of the gland with a wire loop.
- In some cases, your doctor may also suggest a traditional, open surgery to remove your prostate.