Enlarged Prostate (BPH): Symptoms, Risks and Treatment

The prostate

The prostate is a gland in the male reproductive system, just below the bladder. It makes fluid that is part of semen.

What BPH is

An enlarged prostate is larger than normal. It's also called benign prostatic hyperplasia (BPH) — benign meaning not cancer, hyperplasia meaning too much cell growth. BPH isn't cancer and doesn't raise your risk of prostate cancer. The prostate usually keeps growing through adult life, which is why BPH is the most common prostate condition after age 50.

As it grows, the prostate can press on the bladder and pinch the urethra, slowing or blocking urine flow. Over time the bladder muscle can weaken from pushing urine through a narrow urethra, so the bladder may not empty completely. Together, these cause many of BPH's urinary problems.

Causes: researchers aren't sure why the prostate keeps growing; some think hormone changes with aging may be the reason.

Who is more likely to get it

• people 40 or older — the chance rises with age;
• people with a family history of BPH;
• people with obesity, heart disease or circulation problems, type 2 diabetes or erectile dysfunction;
• people who don't get enough physical activity.

Symptoms

• a frequent or urgent need to urinate;
• waking many times at night to urinate;
• flow problems: trouble starting, a weak or stop-start stream, dribbling afterward;
• incontinence;
• feeling the bladder isn't empty;
• pain after ejaculation or during urination;
• urine of an unusual color or smell.

See your provider about any of these — they could come from something more serious.

Get help right away if you:

• can't urinate at all;
• have fever and chills with painful, frequent, urgent urination;
• have blood in your urine;
• have pain in your lower belly and urinary tract.

Complications

Most people with BPH have no other problems, but it raises the chance of:

• Acute urinary retention — suddenly being unable to urinate, a medical emergency. It's common in older males, and more likely with age. It can be set off by some over-the-counter cold or allergy medicines, alcohol, cold temperatures or long periods without moving.
• Urinary tract infections (UTIs).
• Bladder damage and bladder stones.
• Kidney damage.

Diagnosis

Your provider will ask about your medical history — tell them every medicine you take, since some worsen BPH — and your family history, and examine you, perhaps with a digital rectal exam (DRE): a gloved finger in the rectum checks whether the prostate is large, tender or irregular. Tests, if needed:

• urine tests;
• a PSA (prostate-specific antigen) blood test;
• urodynamic tests of how well you hold and release urine;
• cystoscopy, to look inside the urethra and bladder;
• ultrasound of the prostate and urinary tract;
• a prostate biopsy, to diagnose or rule out cancer.

Treatment

Not everyone needs it. The choice depends on how much symptoms bother you, your health, age and prostate size.

• Lifestyle changes for mild symptoms: drink less before bed or going out; cut back on caffeine and alcohol; bladder training and exercises for the muscles that control urine flow; prevent or treat constipation.
• Medicines for mild to moderate symptoms: they stop the prostate growing, shrink it, or relax muscles to improve flow. Sometimes 2 types together work better than one.
• Procedures for moderate to severe symptoms when medicines aren't enough: an instrument passed into the urethra widens it or destroys part of the prostate with heat.
• Surgery when symptoms are severe, other treatments haven't worked, or there's another problem such as bladder damage: removing part or all of the prostate, or cutting it to ease pressure on the urethra — mostly with tools passed through the urethra.

Your provider can explain each option's benefits and side effects.

Prevention

No way to prevent BPH has been found. To look after your prostate: talk with your provider about your risk, get regular checkups, and watch for symptoms so you can be treated early.

Sources

Based on "Enlarged Prostate (BPH)," MedlinePlus, National Library of Medicine, drawing on the National Institute of Diabetes and Digestive and Kidney Diseases (NIH); a work of the United States government in the public domain.