Benign Prostatic Hyperplasia (BPH)

Benign prostatic hyperplasia (BPH) is an enlarged prostate gland, which can cause bothersome urinary symptoms. Untreated, prostate gland enlargement can block the flow of urine out of the bladder and cause bladder, urinary tract or kidney problems.

BPH is common in aging men. About half of all men between the ages of 51 and 60 have it and up to 90% of men over age 80 have BPH. BPH is NOT cancer. An enlarged prostate can be a nuisance. But it is usually not a serious problem.

What are the symptoms of BPH?

With BPH, the prostate gets larger and 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.

What causes BPH?

The cause of benign prostatic hyperplasia is not well understood; however, it might be due to changes in the balance of sex hormones as men grow older.

BPH occurs mainly in older men as most men have continued prostate growth throughout their life. In many men, this continued growth enlarges the prostate enough to cause urinary symptoms or to significantly block urine flow.

What are the risk factors for BPH?

The risk factors for prostate gland enlargement include:

• Aging. Men under age 40 rarely present signs or symptoms of an enlarged prostate, yet approximately one-third of men experience moderate to severe symptoms by age 60, and about half experience them by age 80.
• Family history. Having a blood relative, such as a father or brother, with prostate problems means you’re more likely to have problems.
• Ethnic background. Prostate enlargement is less common in Asian men than in white and black men.
• Diabetes and heart disease. Studies have shown that diabetes, as well as heart disease and the use of beta blockers, might increase the risk of BPH.
• Lifestyle. Obesity increases the risk of BPH, while exercise can lower your risk.

How is BPH diagnosed?

Your doctor will start by asking detailed questions about your symptoms and doing a physical exam that includes a Digital Rectal Exam (DRE), where the doctor inserts a finger into the rectum to check your prostate for enlargement.

You may also have:

• Urine test. This exam can help rule out an infection or other conditions that can cause similar symptoms.
• Blood test to check for kidney problems.
• Prostate-specific antigen (PSA) blood test. PSA is a substance produced in your prostate. PSA levels increase when you have an enlarged prostate. However, elevated PSA levels can also be due to recent procedures, infection, surgery or prostate cancer.
• Post-void Residual Volume (PVR). Measures 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.

How is BPH treated?

Generally speaking, you don’t need treatment for BPH unless the symptoms bother you or you have other problems such as backed-up urine, bladder infections, or bladder stones.

Some things you can do that may help reduce your symptoms:
Practice “double voiding.” Urinate as much as you can, relax for a few moments, and then urinate again.
Avoid caffeine and alcohol. They can make you urinate more often.
If possible, avoid medicines that can make urination difficult, such as over-the-counter antihistamines, decongestants (including nasal sprays), and allergy pills. Check with your doctor or pharmacist about the medicines you take.

If home treatment does not help, BPH can be treated with medicine. Medicine can reduce the symptoms, but it rarely gets rid of them. If you stop taking medicine, symptoms return.

If your symptoms are severe, your doctor may suggest surgery to remove part of your prostate. But few men have symptoms or other problems severe enough to need surgery.

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 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.

Some people believe that regular ejaculations will help prevent prostate enlargement. But there is no scientific proof that ejaculation helps.