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Benign prostatic hyperplasia (BPH) is a health issue that becomes more common with age. It's also called an enlarged prostate. The prostate is a small gland that helps make semen. It's found just below the bladder. And it often gets bigger as you get older. An enlarged prostate can cause symptoms that may bother you, such as blocking the flow of urine out of the bladder. It also can cause bladder, urinary tract or kidney problems.
Common symptoms of BPH include:
The symptoms of BPH tend to slowly get worse. But sometimes they stay the same or even improve over time.
The size of the prostate doesn't always determine how serious the symptoms are. Some people with slightly enlarged prostates can have major symptoms. Others who have very enlarged prostates can have minor problems. And some people with enlarged prostates don't have any symptoms at all.
Some other health problems can lead to symptoms that are like those caused by enlarged prostate. These include:
Talk to your doctor about your symptoms, even if they don't bother you. It's important to find out if there are any causes that could be treated. Without treatment, the risk of a dangerous blockage of the urinary tract can rise.
If you can't pass any urine, get medical help right away.
The prostate gland is located beneath the bladder. The tube that moves urine from the bladder out of the penis is called the urethra. This tube passes through the center of the prostate. When the prostate gets bigger, it starts to block urine flow.
The prostate is a gland that typically keeps growing throughout life. This growth often enlarges the prostate enough to cause symptoms or to block urine flow.
It isn't clear what causes the prostate to get bigger. It might be due to changes in the balance of sex hormones as you grow older.
Risk factors for an enlarged prostate include:
Aging. An enlarged prostate gland rarely causes symptoms before age 40. After that, the chance of having an enlarged prostate and related symptoms starts to rise.
Family history. Having a blood relative with prostate problems makes you more likely to have problems with your prostate.
Diabetes and heart disease. Studies show that diabetes might raise the risk of BPH. So might heart disease.
Lifestyle. Obesity raises the risk of BPH. Exercise can help lower the risk.
Complications of an enlarged prostate can include:
Not being able to pee. This also is called urinary retention. You might need to have a tube called a catheter placed into your bladder to drain the urine. Some people with an enlarged prostate need surgery to get relief.
Urinary tract infections (UTIs). Not being able to fully empty the bladder can raise the risk of infection in the urinary tract. If you often get UTIs, you might need surgery to remove part of the prostate.
Bladder stones. These are most often caused by being unable to fully empty the bladder. Bladder stones can cause illness, bladder irritation, blood in the urine and blocked urine flow.
Bladder damage. A bladder that doesn't empty fully can stretch and weaken over time. As a result, the muscular wall of the bladder no longer squeezes properly to force urine out. And this makes it harder to fully empty the bladder.
Kidney damage. Pressure in the bladder from not being able to pee can damage the kidneys or let bladder infections reach the kidneys.
Treatment for BPH lowers the risk of these complications. But urinary retention and kidney damage can be serious health threats.
Your health care provider likely will start by asking questions about your symptoms. You'll also get a physical exam. This exam is likely to include:
After that, you might need other tests that can help confirm an enlarged prostate. These tests include:
Prostate-specific antigen (PSA) blood test. PSA is a protein made in the prostate. PSA levels go up when the prostate becomes enlarged. But higher PSA levels also can be due to recent procedures, illnesses, surgery or prostate cancer.
Urinary flow test. You pee into a container attached to a machine. The machine measures how strong your urine flow is and how much urine you pass. Test results can show over time whether your condition is getting better or worse.
Postvoid residual volume test. This test measures whether you can empty your bladder fully. The test can be done using an imaging exam called ultrasound. Or it can be done with a tube called a catheter placed into your bladder after you pee to measure how much urine is left in the bladder.
24-hour voiding diary. This involves noting how often and how much you pee. It might be extra helpful if you make more than a third of your daily urine at night. If your health problem is more complex, you may need tests including:
Transrectal ultrasound. A device that uses sound waves to make pictures is inserted into the rectum. It measures and checks the prostate.
Prostate biopsy. Transrectal ultrasound guides needles that are used to take tissue samples of the prostate. Checking the tissue can help your provider find out if you have prostate cancer.
Urodynamic and pressure flow studies. A catheter is threaded through the urethra into the bladder. Water — or, less often, air — is slowly sent into the bladder to measure bladder pressure and check how well the bladder muscles work.
Cystoscopy. A lighted, flexible tool is placed into the urethra. It lets a provider see inside the urethra and bladder. Before this test, you will be given a medicine that keeps you from feeling pain.
Many treatments are available for enlarged prostate. These include medicines, surgery and procedures that involve smaller, fewer or no cuts. The best treatment choice for you depends on:
If your symptoms don't get in the way of your life, you might decide to put off treatment. Instead, you could wait to see if your symptoms change or get worse. For some people, symptoms of BPH can ease without treatment.
Taking medicine is the most common treatment for mild to moderate symptoms of an enlarged prostate. Options include:
Alpha blockers. Alpha blockers work by relaxing the smooth muscle of the bladder neck and prostate. This makes peeing easier. Alpha blockers include alfuzosin (Uroxatral), doxazosin (Cardura), tamsulosin (Flomax) silodosin (Rapaflo) and terazosin. They often work quickly in people with somewhat smaller prostates. Side effects might include dizziness. They also may include a harmless issue in which semen goes back into the bladder instead of out the tip of the penis. This is called retrograde ejaculation.
5-alpha reductase inhibitors. These medicines shrink the prostate. They do this by preventing hormone changes that cause the prostate to grow. Examples include finasteride (Proscar) and dutasteride (Avodart). They might take up to six months to work well and can cause sexual side effects.
Combination therapy. Your health care provider might suggest that you take an alpha blocker and a 5-alpha reductase inhibitor at the same time if either medicine alone doesn't help enough.
Tadalafil (Cialis). This medicine is often used to treat erectile dysfunction. Studies suggest it also can treat an enlarged prostate.
Dr Sushrut Fuladi is a well-known Consultant Nephrologist and Renal Transplant Physician with expertise in treating patients of Acute Kidney Injury, Chronic Kidney Disease, Hypertension and Diabetes related renal disorders, and renal replacement therapies.
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