Benign Prostate Hyperplasia (BPH)
What is BPH?
BPH — or benign prostatic hyperplasia — is the medical term for an enlarged prostate (the prostate is the male sex gland that produces the fluid for semen . An enlarged prostate is not cancerous and is the most common prostate health problem among men over 50.
How common is it? Half of all men between the ages of 50 and 60 will develop it, and by the age of 80 about 90% of men will have BPH.
The symptoms of BPH may be uncomfortable and may include frequent urination, incomplete emptying of the bladder, a weak urine stream, or difficulty starting urination.
Why is BPH so common?
BPH is a condition associated with aging, probably due to hormonal changes. Among men over 50, prostate enlargement may continue through the rest of their lives.
How can BPH symptoms include both a difficulty in starting urination and an uncontrollable urge to urinate?
Just as BPH symptoms vary with the individual, they also differ as the condition progresses. The discomfort and complications associated with an enlarged prostate are related to a combination of problems that develop over time.
In the early phase of prostate enlargement, a man may find it very hard to urinate because the bladder muscle has to work harder to push urine through the narrower urethra. This extra force may eventually thicken the bladder muscle, making the bladder overly sensitive to the presence of fluid and resulting in an urgent and frequent need to urinate.
Over time, the bladder muscle may weaken, so that urine is not completely excreted. Any unusual variation, or difficulty in the pattern of urination, is a red flag that a prostate problem may exist.
Can enlarged prostate lead to cancer?
Although it is possible to have both conditions at the same time, there is no known link between BPH and prostate cancer.
Does an enlarged prostate interfere with sexual activity?
An enlarged prostate usually does not interfere with the ability to have sex. However, embarrassing BPH symptoms may discourage a man from pursuing sexual activity.
There are three factors that increase your risk of developing BPH:
- Age – Starting at age 45, the risk of developing BPH increases.
- Family History – If any immediate blood relative was diagnosed with BPH, you are more likely to develop the condition.
- Medical Conditions – Some research indicates that conditions such as obesity may contribute to the development of BPH.
What are the symptoms of BPH?
BPH symptoms may include:
- Frequent, often-urgent need to urinate, especially at night
- Need to strain or push to get the urine flowing
- Inability to completely empty the bladder
- Dribbling or leaking after urination
- Weak urine stream
As the prostate slowly continues to get bigger, symptoms may slowly get worse and interfere with sleep, physical comfort, and routine activities. It may also interfere with sexual function.
There is no connection between BPH and cancer; however, the urinary symptoms associated with BPH can bring on serious conditions. This is why it’s important to see your health care provider to figure out the cause of your symptoms.
How is BPH diagnosed?
A doctor typically takes a detailed medical history, conducts a physical exam and discusses any changes in the patterns of urination or urinary habits. To evaluate the severity of symptoms, the American Urological Association (AUA) BPH Symptom Score Index may be used. A physician may also administer simple tests that measure urine flow and evaluate the size and health of the prostate.
The doctor may order a Prostate-Specific Antigen (PSA) blood test to help rule out prostate cancer. The doctor may also perform a digital rectal exam (DRE) to determine the size of the prostate and to find any abnormalities. While this exam may be uncomfortable, it is an essential part of maintaining good health.
To determine if you have BPH, you can take a seven-question quiz developed by the American Urological Association. This simple quiz will help assess the severity of your BPH symptoms.
Whether your symptoms are mild, moderate or severe, it is recommended that you schedule an appointment with a physician to discuss your condition and appropriate treatment options. This quiz cannot diagnose an enlarged prostate and is not meant to replace the expert care and advice of a qualified physician.
If a man thinks he has BPH, what should he do?
A man who thinks he may be experiencing the symptoms of an enlarged prostate should consult with a physician. With several treatments now available, there is no reason to suffer in silence. BPH can usually be managed with medication; surgery can almost always be avoided.
Treatments for BPH
Many men don’t think to ask about treatments for BPH because they assume the treatments will lead to compromises in their quality of life, including sexual function. Treatment is strongly recommended for BPH symptoms that interrupt your life. If BPH is left untreated, it can lead to future health risks, such as the inability to urinate, urinary tract infections, bladder, kidney, or urethra damage, bladder stones, and incontinence
What are the treatment options?
Treatment options include active surveillance (sometimes called watchful waiting), drug therapy and surgery.
What is active surveillance (watchful waiting)?
Active surveillance (watchful waiting) means keeping an eye on the BPH symptoms without receiving any form of treatment. For men with minimal to mild BPH symptoms that do not interfere with daily routines, this may be a preferred choice. As part of watchful waiting, men continue to have annual examinations to determine if their symptoms change over time.
What kinds of medications are used to treat BPH?
Drugs called alpha-blockers are the most common treatment prescribed to manage BPH symptoms. By relaxing the muscles around the prostate so that there is less pressure on the urethra, alpha-blockers usually work quickly to improve urinary flow. Common side effects can include stomach or intestinal problems, a stuffy nose, headache, dizziness, tiredness, a drop in blood pressure and ejaculatory problems.
Alpha-blockers include Cardura® (doxazosin mesylate), Flomax® (tamsulosin hydrochloride), Hytrin® (terazosin hydrochloride), and Uroxatral® (alfuzosin hydrochloride).*
Another type of drug, called a 5-alpha-reductase inhibitor, is also sometimes prescribed. Designed to shrink the prostate gland, it may take three to six months to effectively relieve symptoms. Side effects may include an inability to achieve an erection, decreased sexual desire and a reduced amount of semen. Examples of 5-alpha reductase inhibitors are Avodart™ (dutasteride) and Proscar® (finasteride).**
No matter what kind of drug is prescribed, patients and physicians need to be aware of potential drug interactions with treatments used to manage other conditions common among aging men, such as erectile
dysfunction and hypertension.
There are also various combination therapies available, such as an alpha blocker with a 5-alpha-reductase inhibitor and an alpha blocker and a drug called an anticholinergic. Talk with your healthcare provider to determine which treatment option may be appropriate for you.
What are other BPH treatment options?
Surgery is usually used only in those patients with major BPH complications such as frequent urinary tract infections or bladder stones. There are several non-surgical approaches that use heat therapy to make the size of the prostate smaller. This will widen the urethra so you can urinate easily again. These heat treatments include microwave therapy, radiofrequency therapy, electrovaporization, and laser therapy. In the most extreme cases, open surgery may be required.
Surgery treats BPH symptoms by reducing the size of the prostate, but it does not prevent the cause of the disorder; surgery might need to be repeated within a few years. Side effects of surgery may include urgency and frequency of urination for some period after surgery, difficulty in achieving an erection, blood in your urine, blood clots, sexual dysfunction, recurring urinary tract infections, inability to hold your urine (incontinence) or a narrowing of the urethra (scarring).
If BPH is left untreated, an enlarged prostate may lead to an inability to urinate, incontinence, bladder stones, kidney infections, or damage to the bladder, kidneys, and urethra.
Living With BPH
Since the symptoms of BPH occur gradually, men often change their daily routines to accommodate their symptoms instead of finding ways to live their life without interruptions.
Can I Live a Normal Life?
Yes! Although BPH can cause you to have some uncomfortable symptoms, it’s important to try to minimize the impact it has on your life.
- Stay active – being inactive can cause problems emptying your bladder
- Try to empty your bladder when going to the bathroom
- Try to urinate on a schedule every day, whether or not you feel you have to go
- Stop drinking liquids after 8 pm to prevent the urges to urinate at night
- Limit drinking alcohol
Can It Affect My Sex Life?
You might avoid treating certain BPH symptoms because you’re concerned about side effects related to sex. If you are experiencing certain sexual problems, they might be related to lower urinary tract symptoms (LUTS) associated with BPH.
As men get older, some changes in sexual function, like a decrease in libido and erectile dysfunction, do happen; however, experts have found a link between LUTS due to BPH and certain sexual problems.
It’s important to talk to your doctor about any sexual issues you are having that might be linked to BPH so you may be treated properly.
How does BPH affect urinary function?
Sitting just below the bladder, the prostate gland surrounds the upper part of the urethra (the tube that drains urine away from the bladder to the penis for excretion). As the prostate grows larger, it presses against the urethra, narrowing the passage through which urine flows. Problems with urine flow may result as the urethra narrows due to prostate enlargement.