Benign prostatic hyperplasia or BPH is the non-cancerous enlargement of the prostate gland. The prostate gland is a walnut-sized gland part of the male reproductive system whose function is to add fluid to the semen. It is located beneath the urinary bladder, and the penile urethra passes through it. Therefore, the enlargement of this gland results in the obstruction to the flow of urine, causing the symptoms of difficulty passing urine, incomplete emptying of the bladder, increased urinary frequency, especially at night, etc. Enlargement of the prostate gland is part of the normal aging of men, and hence a widespread problem.
The exact cause of this enlargement is unknown. However, it is thought to result from hormonal changes with increasing age. The testosterone, a male hormone, is converted to Dihydrotestosterone (DHT) by an enzyme called 5α-reductase, which acts locally on the gland and causes it to grow. Although the testosterone level decreases as the man ages, other agents may also influence the growth. BPH is also linked to metabolic syndrome, a combination of diabetes mellitus, obesity, hypertension, and dyslipidemia.
The prevalence of BPH is similar in white and African-American men; however, it is more severe and progressive in African-American men, possibly due to higher levels of testosterone, 5α-reductase, and DHT.
Age: Aging is the most crucial risk factor for developing BPH. Most of the men older than 50 have enlarged prostates.
Genetics: a family member with BPH increases your risk also.
Obesity: obesity and reduced exercise also puts you at the risk of BPH
Metabolic Syndrome: the presence of diabetes, hypertension, dyslipidemia, heart disease can also increase your risk of BPH.
The signs and symptoms usually result from the pressing of the urethra by the enlarged prostate gland.
Incomplete bladder emptying: no matter how many times you urinate, you may still feel residual urine in the bladder, and dribbling may occur.
Your doctor will ask you questions about your symptoms and examine you for physical signs.
Digital Rectal Examination (DRE): your doctor will insert gloved, lubricated fingers through your anus into the rectum to feel the prostate gland for enlargement, hardness, lumps, or pain.
Urinalysis and Urine Culture: your urine may be collected to check for abnormalities and rule out other conditions.
Blood Tests: Bun, creatinine, and electrolytes can be checked for kidney functions
Prostate-Specific Antigen (PSA): It is a protein made by the prostate. It can be raised in BPH, prostatitis (prostate infection), or prostate cancer.
Some other tests may aid in diagnosing and determining the severity of BPH.
Urine Flow Rate: this test measures the speed and strength of the urinary stream.
Post-Void Residual Urine Volume: this test measures the amount of urine left in the bladder after urination.
Urodynamic Studies: this test measures the pressure in your bladder.
Ultrasound Scans: these scans are done to determine bladder and prostate size.
Cystoscopy: a flexible tube is inserted into the bladder to see the interior and take a biopsy.
CT/MRI Scans: these are not usually recommended for uncomplicated cases but may give a clearer picture of the size and position of the gland when needed or before surgery.
Symptoms similar to BPH can be caused by some other conditions also like:
Symptoms of BPH are irrespective of its size. Some people with larger glands have fewer symptoms, while others may have more. The treatment, therefore, depends upon the severity of the disease, available treatment options, and your preferences.
Watchful Waiting: Sometimes, the condition is tolerable, and no treatment is needed
Interventional Therapy: Your doctor may discuss with you a wide variety of interventional procedures like ablative procedures, lasers, mechanical lifting, minimally invasive surgeries, and open surgeries if medications do not control the symptoms, or there are complications of BPH like urinary tract obstruction, stones, blood in urine, or you wish to discontinue medications for other reasons. They include the following procedures,
Alpha-Blockers: these medicines relax the muscles at the neck of the bladder and improve the urinary symptoms. They include prazosin, alfuzosin, tamsulosin, terazosin. Side effects may include dizziness, lightheadedness, headaches, sexual problems.
5- Alpha-Reductase Inhibitors: these medicines stop the conversion of testosterone into DHT and reduce the prostate’s size. They include finasteride, dutasteride. Adverse effects include ejaculation back into the bladder instead of the penis.
Combination Therapy: alpha-blockers and five alpha-reductase inhibitors are often combined to treat BPH.
Phosphodiesterase Enzyme Inhibitors: this class includes tadalafil and is known to cause smooth muscle relaxation.
The condition itself is benign but may cause serious discomfort and affect the quality of life. If left untreated may result in chronic urine outflow obstruction, urinary infections, urinary stones, and damage to the bladder or kidneys.
There are some changes that you can make to your daily routine to improve BPH symptoms.
Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on May 12, 2023.