Living with BPH: recognising and treating enlarged prostate symptoms

Benign prostatic hyperplasia (BPH) is a prevalent condition that occurs in men, especially as they get older. It can cause urinary difficulties, such as frequent urination, weak stream, and incomplete bladder emptying. Leading consultant urological surgeon Mr Arun Jain provides a guide to the condition, explaining how to recognise the symptoms, diagnosis and treatment options.

What is benign prostatic hyperplasia?

Benign prostatic hyperplasia, or BPH, is a benign (non-cancerous) enlargement of the prostate gland. The prostate is a small gland located below the bladder and in front of the rectum, playing a crucial role in the male reproductive system by producing a fluid that nourishes and transports sperm. It is not unusual for the prostate to grow larger as men grow older. When this enlargement is significant, it can lead to BPH.

Symptoms of BPH

The symptoms of BPH are primarily related to the urinary system. As the prostate enlarges, it can press against the urethra (the tube that carries urine from the bladder out of the body). Symptoms of BPH result from a complex interplay of urethral resistance from prostate enlargement, compensatory changes in bladder function compounded by age related changes in functioning of bladder and nervous system. Most common symptoms include:

• Frequent urination: Especially noticeable at night (nocturia), needing to urinate more often than usual.
• Urgency: A sudden, strong need to urinate immediately.
• Weak urine stream: Difficulty starting urination or a weak flow of urine.
• Incomplete emptying: Feeling that the bladder is not completely empty after urinating.

These symptoms can range in severity and may greatly affect a person’s quality of life. Other bladder, prostate and systemic diseases can also lead to similar symptoms. It is therefore important to seek specialist advice.

Causes and risk factors

The exact cause of BPH is not fully understood. Prevalence of BPH increases with age peaking at 88% in men in their 80s. It is believed to be linked to changes in hormone levels as men age. Testosterone, the primary male hormone, decreases, while another hormone, dihydrotestosterone (DHT), increases and may contribute to prostate growth. Additionally, family history, obesity, and other health conditions can increase the risk of developing BPH.

Diagnosing BPH

Diagnosis of BPH typically involves a combination of medical history, physical examination, and diagnostic tests. A digital rectal exam (DRE) allows the doctor to feel the prostate for enlargement. Other tests may include:

• Urinalysis: To check for signs of infection or other conditions.
• Prostate-specific antigen (PSA) test: Measures the level of PSA in the blood, which can be elevated in BPH, prostate cancer, or other prostate conditions.
• Uroflowmetry: Measures the flow rate of urine to assess the severity of urinary obstruction.

Treatment options

Treatment for BPH depends on the severity of symptoms and how much they affect your life. Options include:

• Watchful waiting: For mild symptoms, regular monitoring and lifestyle changes such as reducing fluid intake before bedtime may be recommended.
• Medications: Alpha-blockers relax the muscles of the prostate and bladder neck to improve urine flow, while 5-alpha-reductase inhibitors reduce prostate size by lowering hormone levels.
• Minimally invasive procedures: Techniques such as ReZum (steam injection), transurethral microwave thermotherapy (TUMT) and transurethral needle ablation (TUNA) use heat to shrink excess prostate tissue.
• Surgery: For severe cases, surgical procedures like transurethral resection of the prostate (TURP), Holmium laser enucleation of prostate (HOLEP) etc. may be necessary to remove part of the prostate.

Managing BPH

Living with BPH involves regular check-ups to monitor the condition and adapting lifestyle habits. Maintaining a healthy weight, staying active, and avoiding caffeine and alcohol while maintaining a good fluid intake can help manage symptoms. Open communication with your urologist ensures the best approach to treatment and improves overall well-being.

Understanding BPH and its management options empowers you to make informed decisions about your health. Always seek medical advice if you experience symptoms of BPH, as similar symptoms can be caused by other urinary tract or systemic illnesses and early intervention may significantly improve your outcome or quality of life.

If you would like to book a consultation with Mr Jain, do not hesitate to do so by visiting his Top Doctors profile today.