Old Friends

ENLARGED PROSTATE

What is Benign Prostatic Hyperplasia (BPH)?

Benign prostatic hyperplasia (BPH) is when the prostate and surrounding tissue expands. The prostate goes through two main growth periods as a man ages. The first is early in puberty, when the prostate doubles in size. The second begins around age 25 and continues during most of a man's life. As you age, your prostate may get larger. BPH is when it gets large enough to cause problems.

While the prostate is usually the size of a walnut or golf ball in adult men, it can grow to be as large as an orange. As the gland enlarges, it can squeeze the urethra. The bladder wall becomes thicker. Over time the bladder may weaken and lose the ability to empty fully. Urine then remains in the bladder. These problems cause many of the lower urinary tract symptoms (LUTS) of BPH. If you are not able to pass urine at all (called retention) or if you have renal failure, immediate attention is required. But, other symptoms like weak urine stream or the need to push or strain can many times be monitored.

BPH is benign. This means it is not cancer, nor does it lead to cancer. Still, BPH and cancer can happen at the same time. BPH itself may not require any treatment, but if it begins to cause symptoms, treatment may help. It is also of great value to know that BPH is common. About half of all men between ages 51 and 60 have BPH. Up to 90% of men over age 80 have it.

How Does the Prostate Work?

The prostate is part of the male reproductive system and its main job is to make fluid for semen. It is about the size of a walnut and weighs an ounce or so. It sits below the bladder and in front of the rectum. It goes around a tube called the urethra. The urethra carries urine from the bladder and out through the penis.

Symptoms

When the prostate is enlarged, it can bother or block the bladder. Needing to pass urine often is a common symptom of BPH. This might be every 1 to 2 hours, mainly at night.

Other symptoms include:

  • Incomplete emptying: the feeling your bladder is full, even after passing urine.

  • Frequency: the need to pass urine often, about every one to two hours.

  • Intermittency: the need to stop and start several times when passing urine.

  • Urgency: feeling the urgent need to pass urine as if you can’t wait.

  • Weak stream: a weak urine flow.

  • Straining: trouble starting to pass urine or the need to push or strain to pass urine.

  • Nocturia: the need to wake up at night more than two times to pass urine.

If BPH becomes severe, you might not be able to pass urine at all. This is an emergency that must be treated right away.

 

How Can BPH Affect Your Life?

In most men, BPH gets worse with age. It can lead to bladder damage and infection. It can cause blood in the urine and cause kidney damage.

 

Causes

The causes of BPH are not clear. It mainly occurs in older men. Hormone changes are thought to play a role.

Hormones from the testis may be the main factor. For example, as men age, the amount of active testosterone in the blood declines. Estrogen levels stay the same.

BPH may occur when these hormone changes trigger prostate cell growth. Another theory is about the role of dihydrotestosterone (DHT). This male hormone supports prostate development. Some studies show that older men have higher levels of DHT. Testosterone levels go down.

Who is at Risk for BPH?

There are many risk factors for BPH. Men who are at a higher risk include:

  • Men over the age of 50 as the risk for BPH rises with age

  • Men whose fathers had BPH

  • Men who are overweight or obese

  • Men who don't stay active

  • Some men with erectile dysfunction (ED)

 

Can BPH be Prevented?

There is no sure way to prevent BPH. Still, losing weight and eating a well-balanced diet, rich in fruits and vegetables, may help. Too much body fat, may increase hormone levels and other factors in the blood, and stimulate the growth of prostate cells. Staying active also helps control weight and hormone levels.