Benign Prostatic Hyperplasia (BPH) is a condition in which the prostate gland becomes enlarged. The prostate is a walnut-shaped gland that is part of the male reproductive system. It surrounds the urethra at the neck of the bladder. The function of the prostate is to produce the liquid that enables the flow of semen. There are 2 main stages in the growth of the prostate gland. The first occurs around the time of puberty when the gland doubles in size. This is normal. The second stage begins around the age of 25 and continues to gradually increase in size for the rest of the man’s life. While the enlargement happens in all men, about 50% to 60% of them do not develop any symptoms of the condition and it does not trouble them. Others will find that the condition has an impact, of varying severity, on their lives.
It is important to note that BPH is not the same as prostate cancer, although the two conditions may co-exist.
BPH Symptoms
Because the enlarged prostate partially restricts the flow of urine from the bladder, the following symptoms commonly arise:
- The bladder cannot be fully emptied during urination
- This results in a need to urinate more frequently as the bladder’s capacity to accept and hold more urine is reduced
- The need to urinate frequently is worse at night
- Difficulty in initiating urination
- A restricted flow of urine, or an uneven flow that stops and starts
- When urination is over, a few drops continue to dribble out
Less common symptoms of BPH are:
- Blood in the urine
- Inability to urinate
- Recurring urinary tract infections
Typically, the symptoms of BPH increase with age, but in a few cases they remain static or may even improve with time. The size of the prostate does not affect the severity of the symptoms. Some men with only slight enlargement may have severe symptoms while those with greatly enlarged prostates may experience only slight symptoms.
Diagnosis
Some medications may mimic the symptoms of BPH. These include the use of opioids, cold and allergy medication and some medicines used to treat depression. If you are experiencing any of the symptoms of BPH, the problem must be diagnosed without delay so that other causes may be ruled out and the required treatment can begin.
BPH diagnosis includes:
- A rectal examination so the doctor can feel the prostate to evaluate how much it is enlarged
- A urine test to check for any other ailments that could affect the prostate.
- A blood test to look for kidney problems
If these tests are inconclusive, the following tests may be done:
- Prostate-specific antigen (PSA) blood test to check the levels of this protein which increases when the prostate is enlarged
- A urinary flow test to see the strength of the urine flow and the amount that is passed
- An ultrasound test to see how much residual urine remains after voiding.
- You may be asked to maintain a 24 urination diary to record the frequency of urination in a day and how much is passed each time this will provide the doctor with additional inputs to aid the diagnosis
If any complications in the condition are suspected the following tests may be done:
- A transrectal ultrasound to measure the size of the prostate
- A prostate biopsy
- A urodynamic and pressure flow study may be done to measure bladder pressure and the strength of the bladder muscles
- Cystoscopy where a flexible tool with a camera at the tip is inserted to allow the doctor to see inside the bladder and urethra
Living With BPH
If the symptoms of BPH are relatively mild, the following tips may help in further reducing the severity of the condition:
- Nervousness and stress can increase the need to urinate frequently. Regular exercise and relaxation methods like meditation and yoga may help in reducing the frequency of urination
- When urinating, take some extra time to empty the bladder as much as possible. This will postpone the need to urinate again
- Avoid drinking fluids, especially alcohol and caffeinated drinks like tea, coffee and aerated drinks in the evenings as these may stimulate the kidneys to produce more urine, increasing the frequency of nighttime urination
- If you are taking either prescription or over-the-counter medications, these could add to the problem. Tell your doctor about the medications you are using. The doctor may adjust the dosage, change the schedule or prescribe alternatives that could lower the frequency of urination
- Pelvic floor exercises may help in increase the strength of the bladder muscles to enable it to hold urine for longer periods of time before needing to urinate.
Treatment
There are many treatment options available for BPH, including both medication and/or surgery. The decision on which course of treatment is best for a patient will depend on his age, overall health, the size of the enlarged prostate and how severe the symptoms are. If the symptoms are very slight and do not affect normal activities, the doctor may advise postponing the treatment, as in a few cases, the symptoms dissipate on their own without the need for any treatment. However, if the doctor feels that dealing with the condition should not be delayed, then medication will be prescribed as the first stage of treatment. If this is effective, no further treatment may be required. However, if the condition is not alleviated, then surgery may be advised. Various surgical procedures may be used. The doctor will decide depending on the specifics of each case.
If you have BPH or are suspected of suffering from it, it is important not to delay the diagnosis. Once the condition is confirmed, treatment may begin and often the earlier the treatment, the more effective it is. A person who suffers from BPH will find that once the condition has been treated, the freedom from worrying about frequent urination will greatly improve the quality of life. Even if the tips given here on living with BPH bring some relief, being examined at a hospital with a specialized Urology Department will provide details on the extent of the problem so that additional measures may be taken, if required.