Benign prostatic hyperplasia (BPH), commonly known as an enlarged prostate, can result in disrupted urine streams or frequent urination.
What is benign prostatic hyperplasia (BPH)?
The prostate is a plum-sized gland located in front of the rectum, just below your bladder where urine is stored. The prostate gland surrounds the urethra, which is the canal through which urine passes out of your body. The urethra also secretes fluid that forms part of semen.
The prostate gland often enlarges with age. This condition is known as benign prostatic hyperplasia (BPH). It is also known as benign prostatic enlargement (BPE), benign prostatic hypertrophy, or simply an enlarged prostate.
BPH is extremely common. Half of all men over 50 develop symptoms of BPH, but only 10 percent need medical or surgical intervention.
As the prostate enlarges, its capsule (layer of tissue surrounding it) stops it from expanding outwards. This causes the prostate gland to press inwards against the urethra like a clamp on a garden hose.
As a result, the bladder wall thickens and the bladder contracts even with small amounts of urine, causing more frequent urination. Eventually, the bladder weakens and loses the ability to empty itself, resulting in residual urine left in the bladder.
Causes of BPH
benign prostatic hyperplasia (BPH) occurs because of a complex interaction between the male hormone dihydroxytestosterone (DHT, active component of testosterone), small amounts of oestrogen (female hormone), and other growth factors.
This results in an imbalance of cell growth and death, and subsequent prostate growth and enlargement.
Risk factors of BPH
- Increasing age is a risk factor for BPH.
- There is no convincing evidence that diet or lifestyle are risk factors for the condition.
Symptoms
Prostate enlargement in BPH is often non uniform, causing irregularity and compression of the urinary tract. This results in obstruction, or blockages, to the path of urine flow which in turn results in problems with emptying urine in the bladder.
Symptoms can vary depending on the degree of obstruction. There may be no bothersome symptoms in very mild cases. With more serious obstruction, affected men may experience symptoms such as:
- Slow urine flow
- Difficulty in passing urine, at times having to strain to expel urine
- Sensation of incomplete bladder emptying
- Frequent urination
- Waking up many times to pass urine at night
In the most severe of cases, BPH can cause complications such as urinary tract infections, blood in urine, bladder stones, inability to pass urine and damage to the kidneys.
It is important to note that these symptoms can also be caused by other urinary tract conditions, including cancerous and non-cancerous ones. If you experience any of these symptoms, you should consult your family physician who may refer you to see a Urologist.
Diagnosis
In the clinic, your doctor will speak to you to find out more about the symptoms you are experiencing. Your doctor will then do a set of routine physical examinations and tests, which may include:
- Bedside ultrasound: This is a scan used to assess your bladder, prostate, and kidneys. Measurements of your prostate will be taken. There is no radiation in an ultrasound scan.
- Digital rectal examination: A physical examination that involves the doctor inserting a gloved finger into your rectum to feel the prostate, giving him/her a general idea of the condition of the gland.
- Uroflowmetry: You may be brought into a private cubicle and asked to urinate into a device to measure your flow of urine.
- Prostate specific antigen (PSA): This is a blood test to measure the level of serum PSA, which is a prostate cancer marker. Your doctor will discuss with you what the test result means, and if you need further tests to rule out prostate cancer.
At the end of the consultation, your doctor will discuss the treatment options for BPH and tailor one that is suitable for you.
How to treat?
Treatment for BPH will depend on the severity of the condition and how badly your symptoms are affecting you. Treatment is also determined by your lifestyle priorities, such as how important it is to maintain your sexual functions.
For very mild BPH: Lifestyle changes include managing intake of fluids and reducing caffeine and salt intake.
If you require medications, you may be prescribed one of the following groups, or both:
- Alpha blocker
This group includes Terazosin, Tamsulosin, Alfuzosin and others. They work by relaxing the smooth muscles around your prostate and urethra, allowing urine to pass through more easily. Common side effects include blocked nose, giddiness related to posture and abnormal ejaculation. - 5-alpha-reductase inhibitor
Dutasteride and finasteride are medications that belong to this group. They work by gradually reducing the size of the prostate over a longer period (more than 6 months).
Common side effects include erectile dysfunction and reduced libido.
Other medications may be prescribed depending on your symptoms. Your doctor may discuss surgery with you if your BPH condition is more serious or medications are not effective or suitable.
When is surgery required?
Your doctor may discuss BPH surgery if:
- Your symptoms are moderate to severe,
- You have have urinary complications from prostate enlargement,
- Medications are not suitable for you, or
- Should you make a personal choice to have surgery upfront
There are various reasons that medications may not be suitable for you, such as being no longer effective, side effects being too bothersome, or interactions with other medical conditions.
Longstanding and untreated severe BPH can cause urinary complications such as urinary tract infections (UTI), blood in urine (haematuria), bladder stones, inability to pass urine and damage to the kidneys.
Ref: G25 (ed)
Related article:
Prostate Cancer: How to Prevent
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