Benign Prostatic Hyperplasia: Symptoms, Causes

Written by Medicover Team and Medically Reviewed by Dr Mayur Dalvi , Urologists

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1. Causes 2. Find a Doctor 3. Diagnosis 4. Treatment 5. FAQs

When the prostate and surrounding tissues enlarge, it is known as benign prostatic hyperplasia (BPH). BPH is harmless, which indicates that neither it is cancer nor does it cause cancer. However, BPH and cancer can occur simultaneously, the first happening when the prostate doubles in size during early adolescence. As a man ages, the prostate has two major growth phases. The prostate increases in size during the first stage of puberty, and the second starts at 25 and lasts most of a man's lifetime.

As the prostate gland grows it squeezes the urethra. A thickening of the bladder wall occurs. The bladder may weaken and lose its capacity to empty urine with time. The bladder still has urine in it. It causes various lower urinary tract symptoms (LUTS) of BPH. If you suffer renal failure or cannot pass urine (a condition known as retention), you need to get medical help.

What Are the Symptoms of Benign Prostatic Hyperplasia?

Several signs of benign prostatic hyperplasia can interfere with urine flow. It is possible to experience multiple symptoms simultaneously. Some of the typical symptoms include:

Decreased flow of urine
A sensation of incomplete bladder emptying
Frequent urination
Urinary hesitation
Dribbling at the end of urine flow
Urge to urinate frequently
Increased need to get up at night to urinate
Pain while urinating or ejaculation
Urine that looks different

If your condition worsens with time. You might experience:

Development of a bladder stone
Bladder infection
Damage to the kidneys due to backpressure caused by the retention of large amounts of urine in the bladder
Blood in urine
Pus in urine
Experiencing pain in the lower part of the abdomen or genitals during urination
Inability to urinate
Chills or fever while urinating

BPH can lead to infection and bladder damage in extreme situations, and blood can be seen in the pee in certain conditions. If neglected for an extended period, it can harm the kidneys, resulting in chronic kidney disease and renal failure.

What Are the Causes of Benign Prostatic Hyperplasia?

Doctors do not know precisely why BPH happens. It is hypothesized that a significant cause of BPH is the hormone testosterone, which is produced by the testicles. In addition to a small amount of estrogen, men continuously have testosterone, the primary hormone. The body's ability to make testosterone declines with age. As a result, the level of estrogen in the body rises. This imbalance between estrogen and testosterone has been linked in studies to benign prostatic hyperplasia. The prostate's high estrogen level activates prostate hormones that promote prostate cell development.

Dihydrotestosterone (DHT), a hormone byproduct of testosterone, is also thought by experts to be extremely important for the development of the prostate gland. According to research, older people still produce DHT, which builds up in the prostate despite declining testosterone levels, and this rise in DHT may promote prostate cell development.

When to See a Doctor for Benign Prostatic Hyperplasia?

If you're experiencing urinary symptoms, schedule an appointment with a urologist or your primary care physician for proper evaluation. Early diagnosis and treatment of benign prostatic hyperplasia can significantly improve your quality of life.

You should see a doctor if you have:

Frequent urination, especially at night, that disrupts your sleep or daily activities
Weak urine stream, difficulty starting urination, or feeling that your bladder doesn't empty completely
Sudden worsening of urinary symptoms or complete inability to urinate

Get medical help immediately if:

You cannot urinate at all despite feeling the urgent need to go
You notice blood in your urine along with fever, chills, or severe pain
You experience severe lower abdominal pain with the inability to pass urine

These could be signs of a serious complication like acute urinary retention, which needs urgent care.

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How is Benign Prostatic Hyperplasia Diagnosed?

To rule out conditions that mimic the symptoms of benign prostate hyperplasia, your doctor will take into account your symptoms and perform some tests.

Digital rectal exam: This examination gives an idea of the prostate's average size or whether it is enlarged more than usual.
Cystoscopy: This technique enables a medical professional to examine the lining of your urethra and bladder. This procedure is used to examine and treat problems in the bladder or urethra.
Intravenous pyelogram (IVP): A form of x-ray called an intravenous pyelogram (IVP) captures images of the urinary system. IVP is less frequently used nowadays because better alternatives are available.
Urine tests: Your doctor may recommend urine testing. By doing so, they can rule out urine infections or other urinary disorders that have similar symptoms.
Prostate-specific antigen (PSA) test: The substance your prostate secretes is known as a prostate-specific antigen. Although it performs better in detecting prostate cancer, it is not 100% accurate. A recent operation, surgery, or illness can increase PSA levels.
Urinary flow test: This examination measures urine flow. You'll be asked to relieve yourself into a receptacle connected to a machine. This device will assess the volume and force of your urine flow and evaluate if your condition improves or worsens over time.
Postvoid residual volume: This test determines if you can urinate while completely emptying your bladder. Once you've finished peeing, a catheter can be inserted into your bladder to do the test through ultrasonography. This will make it possible to measure how much pee is still in your bladder.
Prostate biopsy: A prostate biopsy is recommended after other diagnostic tests indicate a prostate gland problem. It is used to diagnose prostate cancer.
Urodynamic and pressure-flow studies: These examinations are performed to assess the efficiency of the bladder muscles.

What is the Treatment of Benign Prostatic Hyperplasia?

The severity of the symptoms often determines the type of treatment. Sometimes, no treatment may be needed. Doctors could elect to monitor the prostate if the patient has minimal or no symptoms. A yearly prostate exam and an assessment of symptoms may be part of this monitoring. Various therapies are offered if necessary.

Medication

Medications that treat BPH include:

Alpha-blockers: They increase urine flow by unwinding the urethral and bladder neck muscles. Dizziness and low blood pressure are possible side effects.
5-alpha reductase inhibitors: These can shrink the prostate and lessen urological symptoms. According to the study, they may also lower the risk of prostate cancer by roughly 25%. A doctor may occasionally recommend a combination of medicines.

Minimally invasive surgery

Surgery may be possible if the medicine is ineffective. Frequently, this will include a minimally invasive technique, like

A prostatic urethral lift: The surgeon inserts implants that elevate the prostate so that it does not obstruct the urethra using a needle.
Convective water vapor ablation: During this procedure, unwanted prostate tissue is eliminated using steam. A surgeon inserts a needle into the prostate to provide heat energy from the steam.
Transurethral microwave therapy (TUMT): Through the urethra, the physician inserts a catheter equipped with an antenna. The unwanted tissue is eliminated by the microwaves the antenna emits.
Catheterization: A tube that allows urine to pass through the bladder will be placed by a doctor. Bladder drainage is made possible through catheterization. Although these therapies often increase urine flow, subsequent therapy may be required. Taking medication may help reduce the risk of BPH recurring.

Surgery

Surgery may be required to remove any tissue obstructing blood flow in a patient with severe symptoms. There are several types of surgery, some of which are more invasive than others.

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What Are the Risk Factors of Benign Prostatic Hyperplasia?

Benign Prostatic Hyperplasia risk factors include:

Age: BPH is most commonly seen in men over 50.
Family history: A man's risk of developing BPH increases if a close relative has the condition.
Hormonal imbalances: Testosterone and dihydrotestosterone levels play a role in the development of BPH.
Obesity: Obesity in Men who are overweight or obese have a higher risk of developing BPH.
Lifestyle factors : A sedentary lifestyle and a high-fat diet & low in fiber have been linked to an increased risk of BPH.
Medical conditions : Chronic conditions like heart disease and diabetes may increase the risk of BPH.
Certain medications: Long-term use of medicines such as alpha-blockers and 5-alpha reductase inhibitors may increase the risk of BPH.
Smoking: It has been linked to an increased risk of BPH and may worsen symptoms.
Alcohol consumption: Heavy alcohol consumption has been associated with an increased risk of BPH.

What Are the Complications of Benign Prostatic Hyperplasia?

Complications of an enlarged prostate can include:

Sudden inability to urinate (urinary retention): To empty the urine from your bladder, patients might need to have a catheter placed. Surgery is required in some men with an enlarged prostate to treat urinary retention.
Urinary tract infections (UTIs): The chance of developing a Urinary tract infection (UTI) may rise if you cannot fully empty the bladder. Patients may require surgery to remove a portion of the prostate if UTIs happen regularly.
Bladder stones: Bladder stones are caused by an inability to empty the bladder. Infection, bladder irritation, blood in the urine, and urinary flow restriction are all consequences of bladder stones.
Bladder damage : A partly empty bladder can stretch and get weaker over time. It's more difficult to empty your bladder as a result of the muscular wall of the bladder failing to relax correctly.
Kidney damage : Urinary retention can increase bladder pressure, which can harm the kidneys directly or allow bladder infections to spread to them.
The majority of men with enlarged prostates do not experience these issues. Acute urine retention and renal damage can pose real health risks.

What is the Prevention of Benign Prostatic Hyperplasia?

There is no known way to prevent Benign Prostatic Hyperplasia (BPH); however, the following lifestyle changes may help reduce the risk or slow down the progression of the condition:

Maintaining a healthy diet and weight
Regular exercise
Limiting alcohol and caffeine consumption
Avoiding prescription medications that can worsen BPH symptoms, such as decongestants and antihistamines
Managing stress through relaxation techniques or counseling.

It is always best to consult a healthcare professional for personalized recommendations and treatment options.

References

https://www.urologyhealth.org/urology-a-z/b/benign-prostatic-hyperplasia-(bph)

Frequently Asked Questions

1. What is Benign Prostatic Hyperplasia (BPH)?

Benign Prostatic Hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland that commonly occurs as men age. The enlarged prostate can cause urinary symptoms due to its proximity to the urethra.

2. What are the common symptoms of BPH?

Common symptoms of BPH include frequent urination, difficulty starting or stopping urination, weak urine flow, urgency, dribbling at the end of urination, and the feeling of incomplete bladder emptying.

3. Is BPH the same as prostate cancer?

No, BPH is not the same as prostate cancer. A non-cancerous enlargement of the prostate gland is known as BPH, while prostate cancer involves the growth of malignant cells within the prostate.

4. How is BPH diagnosed?

BPH is usually diagnosed through a combination of medical history evaluation, physical examination, and tests like a digital rectal exam (DRE), prostate-specific antigen (PSA) blood test, and imaging studies such as ultrasound or MRI.

5. What treatment options are available for BPH?

Treatment options for BPH range from watchful waiting (monitoring without immediate treatment) to medication and surgical procedures. Medications include alpha-blockers and 5-alpha reductase inhibitors, while surgical options include minimally invasive procedures like transurethral resection of the prostate (TURP) and laser therapies.