In older men, benign prostatic hyperplasia (BPH) is a common condition. Known also as enlarged prostate, this gland produces semen. It is located below the bladder and surrounds the urethra, which carries urine out of the body. In older men, the prostate can become larger and squeeze the urethra. Symptoms include difficulty starting or stopping urination, frequent or urgent urination, weak stream, dribbling, or incomplete bladder emptying. BPH is not cancerous or increases the risk of prostate cancer. However, it can result in complications such as urinary tract infections, bladder stones, kidney damage, or urinary retention as well as affect quality of life.
In addition to changes in male hormones that occur with aging, the exact cause of BPH is unknown. Some factors that may increase the risk of developing BPH include:
Family history of prostate problems
Obesity
Diabetes
Heart disease
Lack of physical activity
Some common symptoms of BPH vary from person to person and may change over time.
Urinating frequently or urgently, especially at night
An inability to start or stop the flow of urine
Urine stream that is weak or interrupted
An incomplete bladder emptying feeling
Urine dribbling or leaking
Urinating by straining or pushing
Urination pain or burning
Urine with blood
Some less common symptoms are:
Urinary incontinence
Infection of the urinary tract
Stones in the bladder
Damage to the kidneys
Some men with a slightly enlarged prostate may have significant symptoms, whereas others with a very enlarged prostate may have mild symptoms or none at all.
You will be asked about your medical history, symptoms, and medications you are taking, as well as a physical exam, which includes a digital rectal exam (DRE). During this test, your doctor inserts a gloved finger into your rectum to feel the size and shape of your prostate. In addition to confirming the diagnosis, your doctor may also order some tests to rule out other possible causes of your symptoms.
Urine test: To check for blood, bacteria, or signs of infection in your urine.
Blood test: To measure the level of prostate-specific antigen (PSA), a protein produced by the prostate that may be elevated in men with BPH or prostate cancer.
Uroflowmetry: To measure the speed and volume of your urine flow.
Postvoid residual (PVR): To measure the amount of urine left in your bladder after you urinate.
Ultrasound: To create an image of your prostate and bladder using sound waves.
Cystoscopy: To examine the inside of your urethra and bladder using a thin, flexible tube with a light and a camera at the end.
The treatment for BPH depends on several factors, such as:
The severity of your symptoms
The size of your prostate
Your age and overall health
Your preference and expectations
The main goals of treatment are to relieve your symptoms, improve your urinary function, and prevent or treat any complications. The treatment options for BPH include:
It is possible to monitor your condition without any active treatment if your symptoms are mild or do not bother you too much. This involves regular check-ups with your doctor as well as lifestyle changes such as:
During the night, drink fewer fluids
Caffeine and alcohol should be avoided
Decongestants and antihistamines should be limited
Regular exercise
Stress management
You may benefit from medication if your symptoms are moderate or severe. The most common types of medication for BPH are:
These drugs relax the smooth muscles around the bladder neck and prostate, which makes urinating easier. Examples include alfuzosin, doxazosin, tamsulosin, and terazosin.
The 5-alpha reductase inhibitors block the conversion of testosterone to dihydrotestosterone (DHT), a hormone that stimulates prostate growth, thereby reducing prostate size and improving symptoms.
It is sometimes necessary to prescribe both types of drugs together in order to achieve the best results.
Taking medication can help relieve your symptoms, but it may not cure your condition. You may need to take medication for a long time, and you may experience side effects such as:
Dizziness
Headache
Low blood pressure
Nasal congestion
Sexual dysfunction
In the event that medication does not work or causes unacceptable side effects, or if you suffer from severe symptoms or complications, you might need surgery to remove part or all of your prostate. The most common surgeries for BPH are:
TURP: Transurethral resection of the prostate involves inserting a thin instrument called a resectoscope through your urethra and cutting away excess prostate tissue with an electric loop.
An alternative to TURP, transurethral incision of the prostate involves making one or two small cuts in the prostate to widen the urethra and improve urine flow.
Various types of laser surgery are available, including holmium laser enucleation of the prostate (HoLEP) and photoselective vaporization of the prostate (PVP).
In addition to providing long-term relief from your symptoms, surgery can also cause a number of complications, including the following:
Bleeding
Infection
Retrograde ejaculation
Erectile dysfunction
Urinary incontinence
Urethral stricture
It may be possible for you to consider some newer procedures that destroy or compress excess prostate tissue with heat, water, or implants if you are not a good candidate for surgery or prefer a less invasive option. The procedure is usually performed in an outpatient setting and usually has fewer risks and a faster recovery than surgery. However, it may not be as effective or durable as surgery. Examples include:
Microwave transurethral therapy (TUMT) involves inserting a microwave antenna through your urethra and heating up your prostate tissue.
A transurethral needle ablation (TUNA) involves inserting thin needles into your urethra and delivering radiofrequency energy to destroy your prostate.
It involves injecting steam into your prostate tissue to cause cell death and shrinkage.
A prostate urethral lift (UroLift) involves inserting tiny implants into your prostate to lift and hold the enlarged tissue away from the urethra.
The procedure involves injecting tiny particles into the arteries that supply blood to your prostate in order to block them and reduce its size.
BPH is a natural part of aging for most men. However, some lifestyle changes may reduce your risk or delay the onset of symptoms. These include:
Consuming fruit, vegetables, whole grains, and lean proteins as part of a healthy diet
Red meat, dairy products, saturated fats, and processed foods should be limited
Avoiding excess alcohol and caffeine and drinking plenty of water
Avoiding secondhand smoke and quitting smoking
Keeping a healthy weight and body mass index (BMI)
Staying physically active and exercising regularly
Managing chronic conditions like diabetes, hypertension, and high cholesterol
Maintaining good prostate health by getting regular checkups and screenings
A common condition in older men is benign prostatic hyperplasia (BPH), which is characterized by an enlarged prostate, which squeezes the urethra and causes urination problems. BPH does not increase prostate cancer risk. However, it can affect the quality of life and lead to complications such as urinary tract infections, bladder stones, kidney damage, or urinary retention. BPH can be diagnosed by a doctor based on a medical history, physical examination, and various tests. It is possible to prevent or delay BPH by adopting a healthy lifestyle and getting regular check-ups and screenings for prostate health. BPH can be treated by watchful waiting, medication, surgery, or minimally invasive procedures.
