Benign prostatic hyperplasia (BPH), also known as enlarged prostate, is a noncancerous enlargement of the prostate gland that occurs when the cells of the prostate gland multiply. It is typically caused by age and usually does not require treatment, but symptoms can be alleviated with medication and surgery.
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What Is Benign Prostatic Hyperplasia?
Benign prostatic hyperplasia (BPH) is a condition where the prostate gland is enlarged. It is a noncancerous condition. It may also be called benign prostatic obstruction or enlarged prostate, and it is the most common prostate problem among older men.
A walnut-sized organ, the prostate gland is located in front of the rectum and right below the bladder. Its function is to produce part of the seminal fluid, the solution that carries sperm.
This gland surrounds the urethra, the tube that carries urine and semen through the penis and out of the body.
BPH affects the inner part of the prostate first, the part that encircles the urethra as it leaves the bladder. As the prostate grows, it may begin to squeeze the upper part of the urethra and restrict the flow of urine.
How common is benign prostatic hyperplasia?
BHP is common among men 65 and older — some research shows most of the U.S. population of men has an enlarged prostate at some point later in their lives. For men ages 40 to 64, it affects up to 6%, and in men under 40, it is very rare.
What causes benign prostatic hyperplasia?
Experts aren’t exactly sure what causes BPH, but they do know it becomes much more common with age.
Benign prostatic hyperplasia risk factors
The chance of developing BPH increases with age. More than half of men over age 50 have BPH. By age 80, about 80% of men have enlarged prostates.
You may also have a higher risk of BPH if you:
- Are overweight or obese.
- Are not physically active.
- Have a family history of the condition.
- Have erectile dysfunction.
- Have previously been diagnosed with other health conditions, such as heart disease or kidney disease.
Complications of benign prostatic hyperplasia
Dealing with an enlarged prostate can cause complications such as:
- Bladder stones.
- Hematuria, or blood in your urine.
- Kidney disease.
- Urinary retention, when the bladder muscles are too weak to empty completely.
- UTIs.
How can I prevent benign prostatic hyperplasia?
While there is no certain way to prevent BPH, creating healthy habits around diet and exercise can help maintain overall wellness. Still, some conditions, such as BPH, can occur naturally with age.
What Are the Signs and Symptoms of Benign Prostatic Hyperplasia?
About 40% to 50% of men develop symptoms due to BPH.
Symptoms may include:
- Difficulty starting or stopping urination.
- Feeling of being unable to empty the bladder completely.
- Pain when urinating.
- The need to urinate frequently, especially at night (nocturia).
- Weak or intermittent urine flow.
For some men, taking certain medicines can worsen BPH symptoms. Make sure you mention to your doctor if you are currently taking:
- Antidepressants.
- Antihistamines.
- Decongestants.
- Diuretics.
- Tranquilizers.
When should I see a doctor about my benign prostatic hyperplasia symptoms?
If you are experiencing any of the above symptoms, it’s important to schedule an appointment with your health care provider. Early treatment helps reduce symptoms faster.
How Do You Diagnose Benign Prostatic Hyperplasia?
You can expect your doctor to ask you questions about your medical history and symptoms, perform a physical exam, and run some diagnostic testing.
First, your doctor will discuss your physical symptoms and ask questions about your health, such as your activity level, family history of BPH, and medications you are currently taking.
Then, your doctor will perform a physical examination of your abdomen. This may include pressing on and manipulating (palpating) the abdomen and sides to detect signs of kidney or bladder abnormalities. They will also check for signs of anemia or swelling in the legs and arms.
Certain procedures that test reflexes, sensations, and motor responses may be performed in the lower extremities to rule out possible neurologic causes of the bladder dysfunction.
Tests to diagnose benign prostatic hyperplasia
There are several tools and examinations the doctor may use to diagnose or rate the severity of your condition, including:
- Blood test — Measures serum creatinine, which is a marker for kidney trouble. Kidney problems exist in an average of 13.6% of BPH patients. Studies have reported rates ranging from as high as 30% to as low as 0.3%.
- Digital rectal exam — A finger is placed into the rectum to assess the size of the prostate and to detect any abnormal nodules (lumps) that may require further investigation.
- PSA tests for BPH and prostate cancer — A PSA test measures the level of prostate-specific antigen (PSA) in the patient's blood. It is the standard screening test for prostate cancer. A PSA is recommended annually for all men over 50 years of age and for men over 40 who are at high risk for prostate cancer.
- Ultrasound — Uses sound frequencies to give an accurate picture of the size and shape of the prostate gland. Ultrasound is very beneficial when planning surgery, as well as in determining treatment options and gauging their effectiveness. Ultrasound may also be used for detecting kidney damage, tumors, and bladder stones.
- Urethrocystoscopy — Also known as cystourethroscopy, a flexible or rigid fiberoptic tube (endoscope) is inserted into the urethra to allow doctors to view the lower urinary tract. The procedure is not without risks. Complications are uncommon but can include allergic response to anesthetic, urinary tract infection, bleeding, and urine retention.
- Urinalysis — A urine sample undergoes a physical and chemical examination to detect urinary infections.
- Uroflowmetry — The patient urinates into a special toilet equipped with a uroflowmeter to determine the rate of urine flow.
How Do You Treat Benign Prostatic Hyperplasia?
Depending on your age, symptom severity, and health history, your treatment plan may include active surveillance, medication, and minimally invasive or open surgery.
Surveillance to treat benign prostatic hyperplasia
Mild cases of BPH usually require no treatment beyond active surveillance. Monitoring symptoms to see if they worsen is the best thing you can do at this stage.
Some lifestyle habits may help reduce symptoms, such as:
- Being physically active.
- Drinking less liquid before bed.
- Emptying your bladder completely when urinating.
- Limiting consumption of alcohol and caffeine.
- Not holding it when you have to urinate.
Medication to treat benign prostatic hyperplasia
Your doctor may recommend certain medicines to help with your BPH symptoms, such as:
- 5-Alpha reductase inhibitors (5-ARIs) — These can help shrink the prostate.
- Alpha blockers — These help relax the prostate and bladder muscles to help urination.
- Phosphodiesterase-5 inhibitors — These muscle relaxers aid in reducing symptoms.
Minimally invasive procedures to treat benign prostatic hyperplasia
Some minimally invasive surgical therapies (MIST) that your doctor may recommend include:
- Transurethral needle ablation (TUNA)—In this procedure, a urologist inserts a catheter into the urethra through the penis. The catheter sends out small needles into the obstructing prostate tissue. The needles give off high-frequency radio waves that heat and destroy the tissue. Clinical studies have shown that TUNA provides excellent relief of symptoms and minimal side effects.
- Transurethral resection of the prostate (TURP) — The most common surgical procedure for treating BPH, this operation involves the removal of part of the prostate gland surrounding and constricting the urethra. The urologic surgeon passes a narrow tool with a wire loop on the end into the penis and through the urethra to the prostate gland. Electricity is then passed through the wire to heat it and cut the obstructing prostate tissue.
Surgery to treat benign prostatic hyperplasia
If your symptoms are severe and you develop complications, your doctor may suggest a prostatectomy. This surgery removes part or all of your prostate. Your care team may choose to perform this procedure through robotic surgery, laser surgery, or other traditional surgical methods.
