Slideshow: A visual guide to enlarged prostate (BPH)
What is an enlarged prostate?
The prostate sits below the bladder and produces fluid for semen. An enlarged prostate occurs when a man's prostate gland slowly grows bigger as he ages. More than half of men over age 50 have this condition, also called benign prostatic hyperplasia (BPH). Some men have symptoms and others don't. The exact causes are unknown but one thing is sure: BPH is not cancer and it does not lead to cancer.
Symptom: Frequent need to urinate
Do you have to pee more often these days, especially at night, when you're trying to sleep? That’s a common symptom of BPH affecting about one third of men over 50. It happens when the growing prostate presses on the urethra, the tube that carries urine out of your body. The bladder has to contract more strongly to get urine out. As a result, the bladder may start to contract even when it only contains a little urine, which makes you get the urge to go more often.
Symptom: Difficulty urinating
With an enlarged prostate it may take you longer to get the flow of urine going and the flow may be weaker than it used to be. By 55 this affects about one in four men. You may dribble urine or feel as if there's still some inside even though you're finished urinating. These symptoms happen because the pressure on the urethra makes it narrow, so your bladder must work harder to pass urine.
Symptom: Inability to urinate
This can happen when advanced BPH blocks your urethra entirely - or as a result of a bladder infection. Bladder muscles may also become too weak to force urine out of the body. From any cause, it can lead to permanent kidney damage. You can help prevent this by seeking medical advice as soon as you notice symptoms. If you suddenly can't urinate go to an accident and emergency department immediately.
Who gets an enlarged prostate?
Most men get an enlarged prostate as they age. The prostate gland grows throughout most of a man's life, first at puberty and then from about age 25 onwards. It usually doesn't cause symptoms before the age of 40 but by age 85, up to 90% of men have symptoms. Only about a third of men with an enlarged prostate are bothered by symptoms.
What causes the prostate to grow?
No one knows for sure. It is believed that different hormones such as testosterone, dihydrotestosterone (DHT) and oestrogen may play a role. It is also unclear why some men with BPH will have symptoms while others do not. Vasectomy and sex do not increase the risk of having BPH.
Ruling out prostate cancer
Symptoms of BPH can be scary because some of them are the same as those for prostate cancer, but an enlarged prostate is much more common than prostate cancer and if you have BPH, you are no more likely than other men to develop prostate cancer. Because the two conditions share some symptoms and can occur at the same time, however, your GP will need to evaluate you and you may need to undergo hospital tests.
How will your doctor diagnose BPH?
Your doctor will ask about your symptoms and may recommend these tests:
- A digital rectal examination (DRE) to check for prostate enlargement or irregularities
- A blood test for prostate-specific antigen (PSA)
- An ultrasound scan and a prostate biopsy
- A urine flow study to measure the strength of your urine stream
- A cystoscopy, in which a thin tube is inserted through the penis allowing the doctor to view and evaluate the urethra and the bladder
When does BPH need to be treated?
If you have no symptoms or symptoms are not troubling you, you probably won't need treatment. However, recurring infections, kidney damage, difficulty urinating or a leaky bladder can really impact your quality of life. In these cases, medicine or an operation may help.
Treatment: Watchful waiting
If your symptoms are mild, you and your GP may choose active monitoring of your condition. With this approach you'll probably need to visit the doctor one or more times a year. If your symptoms don't get worse that may be all you ever need to do. Up to a third of all mild cases of BPH have symptoms that clear up on their own.
Treatment: Lifestyle changes
These strategies may help:
- Cut down or cut out alcohol and caffeine.
- Drink small amounts of liquid throughout the day rather than large amounts all at once.
- Avoid fluids at bedtime.
- Avoid decongestants and antihistamines.
- Go when you have the urge and when a toilet is handy.
- Double void: Empty your bladder, wait a moment, then try to empty it again.
- Relax. Stress can trigger the urge to pee.
- Exercise regularly.
- Your GP can explain a technique called urethral milking that involves massage to eliminate the last drops of urine when you go to the toilet.
Treatment: Medicine combinations
Some men benefit from taking more than one medication for their enlarged prostate. In fact, combining a medicine that relaxes the bladder muscles with one that slows prostate growth may work better than either medication alone. Medicines used to manage an overactive bladder may also be added to standard BPH treatment.
Treatment: Complementary medicine
In some studies, saw palmetto extract has shown promise in treating BPH symptoms, such as frequent urination and trouble starting and maintaining flow, but other studies have found it to be no better than a placebo. More research is needed. Saw palmetto products have been registered under the MHRA traditional herbal registration scheme to relieve the symptoms of urinary tract discomfort in men with an enlarged prostate or BPH. Check with your GP before taking it.
Treatment: Surgery
When medicine doesn't do the job, a number of surgical procedures can help ease obstruction of the urethra. Transurethral needle ablation (TUNA), also known as radiofrequency ablation, removes some of the prostate tissue, and may require temporary use of a catheter after treatment. Other procedures include the use of laser, stenting, or an implant.
Treatment: Surgery
The most common operation is a transurethral resection of the prostate, or TURP, which is done under general anaesthesia, or an epudural which anaesthetises the bottom half of your body. An instrument is inserted through the tip of the penis and into the urethra to remove parts of the enlarged prostate, relieving pressure on the urethra.
Will BPH affect my sex life?
There is some evidence that older men with severe BPH symptoms may be more likely to have problems in the bedroom, compared to other men their age. Some of the medicines commonly used to treat BPH have been associated with problems getting an erection and ejaculating. If you develop sexual issues, talk to your doctor. A change in medicines may be enough to resolve these problems.
Medically Reviewed by Dr Rob Hicks on April 22, 2014
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REFERENCES:
BMJ: Prostate, enlarged – How common are enlarged prostates?
Thorpe A, Neal D. Benign prostate hyperplasia. Lancet. 2003; 361: 1359-1367.
British Medical Journal: Enlarged prostate treatments.
National Institute for Health and Clinical Excellence. Lower urinary tract symptoms: the management of lower urinary tract symptoms in men.
British Medical Journal: Prostate, enlarged – What treatments work for an enlarged prostate
British Medical Journal: 5-alpha reductase inhibitors
NHS Choices: Benign prostatic hyperplasia - Treating prostate enlargement
British Medical Journal: Transurethral needle ablation (TUNA)
American Academy of Family Physicians: "Benign Prostatic Hyperplasia."
American Urological Association: "Benign Prostatic Hyperplasia," "Diagnosis of BPH," "Management of BPH."
Harvard Healthbeat, USA: "4 tips for Coping With an Enlarged Prostate."
Johns Hopkins Health Alert, USA: "BPH and Sexual Dysfunction: What's the Link?"
US National Cancer Institute: "What You Need To Know about Prostate Cancer: Symptoms," "Prostate Changes That Are Not Cancer."
US National Institute of Diabetes and Digestive and KidneyDiseases: "Prostate Enlargement: Benign Prostatic Hyperplasia," "Urinary Retention."
The Prostate Institute, USA: "BPH Symptoms."
MHRA Traditional Herbal Registration Scheme.
University of Maryland Medical Center, USA: "Benign prostatic hyperplasia -- Lifestyle Changes," "Saw Palmetto."
This tool does not provide medical advice. See additional information:
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for general information purposes only and does not address individual circumstances. It is not a substitute for professional medical advice, diagnosis or treatment and should not be relied on to make decisions about your health. Never ignore professional medical advice in seeking treatment because of something you have read on the BootsWebMD Site. If you have a medical problem please contact your GP. In England call 111. In Scotland call NHS 24. In Wales, call NHS Direct Wales. In the case of medical emergencies, always dial 999.
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