Benign Prostatic Hyperplasia

Prostate gland enlargement is a common condition as men get older. Also called benign prostatic hyperplasia (BPH), prostate gland enlargement can cause bothersome urinary symptoms.

Symptoms

Common signs and symptoms of BPH include:

  • Frequent or urgent need to urinate
  • Increased frequency of urination at night (nocturia)
  • Difficulty starting urination
  • Weak urine stream or a stream that stops and starts
  • Dribbling at the end of urination
  • Straining while urinating
  • Inability to completely empty the bladder

Less common signs and symptoms include:

  • Urinary tract infection
  • Inability to urinate
  • Blood in the urine

When to see a doctor

If you’re having urinary problems, discuss them with your doctor. Even if you don’t find urinary symptoms bothersome, it’s important to identify or rule out any underlying causes. Untreated, urinary problems might lead to obstruction of the urinary tract.

If you’re unable to pass any urine, seek immediate medical attention.

Causes

The prostate gland is located beneath your bladder. The tube that transports urine from the bladder out of your penis (urethra) passes through the center of the prostate. When the prostate enlarges, it begins to block urine flow.

Most men have continued prostate growth throughout life. In many men, this continued growth enlarges the prostate enough to cause urinary symptoms or to significantly block urine flow.

It isn’t entirely clear what causes the prostate to enlarge. However, it might be due to changes in the balance of sex hormones as men grow older.

Risk factors

Risk factors for prostate gland enlargement include:

  • About one-third of men experience moderate to severe symptoms by age 60, and about half do so by age 80.
  • Family history.
  • Ethnic background.
  • Diabetes and heart disease.
  • Obesity increases the risk of BPH, while exercise can lower your risk.

Complications

Complications of enlarged prostate can include:

  • Sudden inability to urinate (urinary retention).
  • Urinary tract infections (UTIs).
  • Bladder stones.
  • Bladder damage.
  • Kidney damage.

Tests and diagnosis

Your doctor will start by asking detailed questions about your symptoms and doing a physical exam. This initial exam is likely to include:

  • Digital rectal exam
  • Urine test
  • Blood test
  • Prostate-specific antigen (PSA)
  • Neurological exam

After that, your doctor might recommend additional tests to help confirm an enlarged prostate and to rule out other conditions. These additional tests might include:

  • Urinary flow test
  • Postvoid residual volume test
  • 24-hour voiding diary

Treatments and drugs

Medication

Medication is the most common treatment for mild to moderate symptoms of prostate enlargement. The options include:

  • Alpha blockers which include alfuzosin , doxazosin , tamsulosin , and silodosin.
  • 5-alpha reductase inhibitors.
  • Combination drug therapy. Your doctor might recommend taking an alpha blocker and a 5-alpha reductase inhibitor at the same time if either medication alone isn’t effective.
  • Tadalafil.

Minimally invasive or surgical therapy

There are several types of minimally invasive or surgical therapy.

  • Transurethral resection of the prostate (TURP)
  • Transurethral incision of the prostate (TUIP)
  • Transurethral microwave thermotherapy (TUMT)
  • Transurethral needle ablation (TUNA)
  • Laser therapy

Lifestyle and home remedies

To help control the symptoms of an enlarged prostate, try to:

  • Limit beverages in the evening. Don’t drink anything for an hour or two before bedtime to avoid middle-of-the-night trips to the toilet.
  • Limit caffeine and alcohol.
  • Limit decongestants or antihistamines.
  • Go when you first feel the urge.
  • Try to urinate at regular times — such as every four to six hours during the day — to “retrain” the bladder.
  • Follow a healthy diet. Obesity is associated with enlarged prostate.
  • Stay active.
  • Urinate — and then urinate again a few moments later. This practice is known as double voiding.
  • Keep warm. Colder temperatures can cause urine retention and increase the urgency to urinate.

 

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