What is benign prostatic hyperplasia?

Benign prostatic hyperplasia (BPH) is also called benign prostatic hypertrophy. It means that the prostate gland has become very large and may cause problems passing urine. BPH is not cancer. It's a common part of aging.

The prostate gland is part of the male reproductive system. It’s located in front of the rectum and below the bladder. It wraps around the urethra. This is the tube that carries urine out of the body. The prostate's job is to make some of the fluid that protects and nourishes sperm cells in semen. This makes the semen more liquid.

In the U.S., studies have shown BPH prevalence to be as high as 70% in those between 60 and 69 years of age and more than 80% in those over 70 years.

Some symptoms of BPH and prostate cancer are the same. But BPH isn't cancer, and it doesn't develop into prostate cancer.

What causes BPH?

The cause of BPH isn't known. The prostate goes through two main periods of growth. In early puberty, it doubles in size. Then around age 25, the prostate starts to grow again. It continues to grow for most of a man's life.

The continuing growth of the prostate may not cause problems until much later in life, when the second period of growth may result in BPH. It's a common problem for men, starting in their 60s. And it is more likely for men in their 70s and 80s to have some symptoms of BPH.

Risk factors may include obesity, a family history of BPH, being over age 40, physical inactivity, erectile dysfunction, heart disease, and type 2 diabetes.

What are the symptoms of BPH?

As the prostate grows, it presses against the urethra, the tube that carries urine out of the body. This interferes with urination. At the same time, the bladder wall becomes thicker and irritated, and it starts to contract, even when it contains only small amounts of urine. This can cause more frequent urination. These changes cause the bladder muscle to weaken. It may not empty fully and can leave some urine behind. This leads to symptoms.

The most common symptoms of BPH are:

• Leaking or dribbling of urine.

• Trouble starting the urine stream.

• More frequent urination, especially at night (nocturia).

• Urgency to urinate.

• Holding urine (can't pass urine).

• An interrupted, weak stream of urine.

The symptoms of BPH may look like other conditions or health problems. Always talk with a doctor for a diagnosis.

How is BPH diagnosed?

Diagnosing BPH in its earlier stages can lower the risk of complications. Your doctor will review your health history and do a physical exam. Other tests may include:

• Urine tests, to check for infection.

• PSA blood test (prostate-specific antigen test).BPH can raise levels of PSA (prostate-specific antigen). PSA is a protein made by the prostate and can be measured with a blood test. When the prostate is healthy, there's very little PSA in the blood. An increased PSA level doesn't mean you have cancer. But the higher the PSA level, the higher the chance of having cancer.

• Digital rectal exam.The doctor puts a gloved finger into your rectum to feel the part of the prostate next to the rectum.

• Ultrasound (sonography).This is an imaging test that uses high-frequency sound waves to create images of the prostate and nearby organs on a computer screen.

• Cystoscopy.A thin, flexible tube and viewing device (cystoscope) is put into the penis and through the urethra. It lets the doctor look at the bladder and urinary tract for structure changes or blockages.

• Urine flow study.In this test, you urinate into a device that measures how quickly the urine is flowing. Reduced flow may suggest BPH.

• Post-void residual.This is a test like an ultrasound that measures the amount of urine in the bladder after urination.

How is BPH treated?

With time, BPH symptoms often need some kind of treatment. When the prostate is just mildly enlarged, treatment may not be needed. In fact, research has shown that, in some mild cases, some of the symptoms of BPH get better without treatment. You and your doctor will discuss the need to start treatment after careful evaluation of your symptoms.

Active surveillance means that your doctor will do regular checkups to watch for developing problems, but you won't have other treatments.

Treatment for BPH may include surgery and nonsurgical treatments.

What are possible complications of BPH?

Delay in treatment of BPH can cause:

• Loss of urine control.

• Kidney damage.

• Blood in the urine.

• Bladder damage.

• Urinary tract infections.

• Bladder stones.

• An inability to pass urine at all (acute urinary retention).

Get medical care right away if you have:

• A complete inability to urinate.

• A painful, frequent, and urgent need to urinate, along with a fever and chills.

• Blood in your urine.

• Great discomfort or pain in the lower abdomen and urinary tract.

Living with BPH

Management of BPH may include:

• Lifestyle changes.Limit fluids in the evening, empty your bladder before going to bed, and don’t take water pills (diuretics) that are active at night. Talk with your doctor before changing the timing of your medicines. Losing weight and staying physically active may also help.

• Dietary changes.Stay away from or reduce the amount of alcohol, coffee, and other fluids. This is especially important after dinner. A higher risk for BPH has been linked to a diet high in zinc, butter, and margarine. Eating a healthy diet high in fruits and vegetables may also help.

• Stopping certain medicines.Decongestants and antihistamines can slow urine flow in some men with BPH. Some antidepressants and diuretics can also make symptoms worse. Talk with your doctor if you are taking any of these medicines.

• Pelvic floor exercises.These are repeated tightening and releasing of the pelvic muscles. They can help prevent leaking urine. Practice these exercises while urinating to train the specific muscle. To do them, contract the muscle until the flow of urine decreases or stops. Then release the muscle.

Key points about BPH

• BPH means that the prostate gland has become very large. It may cause problems passing urine.

• The cause of BPH isn't known. Growth of the prostate may not cause problems until much later in life.

• As the prostate enlarges, it presses on the urethra. This causes symptoms, such as changes in urination.

• BPH may not need treatment. If needed, treatment includes medicines. It also includes various procedures and surgeries to remove the part of the prostate that’s pressing on the urethra.

• Management of BPH may include lifestyle changes, including dietary changes and specific exercises.

Next steps

Here are some tips to help you get the most from a visit to your doctor:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your doctor tells you.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your doctor gives you.

• Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are and when they should be reported.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you don't take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your doctor if you have questions. Ask how to contact your doctor with urgent concerns on weekends, holidays, and after office hours.