Enlarged Prostate Gland

WHAT IS BENIGN PROSTATIC HYPERPLASIA (BPH)?

Benign prostatic hyperplasia (BPH) is a condition that occurs in men, in which the prostate is enlarged.
The prostate is a walnut-shaped gland lying just underneath the bladder. It surrounds the urethra in the area where it joins the bladder. The urethra is the tube passing from the bladder through to the tip of the penis that drains the bladder of urine.
BPH is benign, meaning that the enlargement of the prostate is not related to cancer. In fact, in many men, BPH is a normal part of aging.
Because the prostate surrounds the neck of the bladder and the urethra, when it enlarges it may affect the ability to pass urine normally.

WHO IS LIKELY TO DEVELOP BPH?

BPH is more common in men over the age of 40, especially those with a family history of BPH. It is also more common in men who are overweight and who don’t participate in regular exercise, or who have other medical conditions, such as diabetes or cardiovascular disease.^p2a

WHAT ARE THE SYMPTOMS OF BPH?

Not all men with BPH develop symptoms and, if they do occur, the severity of symptoms is often unrelated to the size of the prostate.
BPH causes lower urinary tract symptoms (LUTS), which may include:

Urinary frequency: needing to pass urine 8 or more times a day
Urinary urgency: an uncomfortable feeling of urgently needing to pass urine and not being able to wait
Difficulty in being able to start passing urine, despite needing to go
Weak or interrupted stream of urine
Dribbling after finishing passing urine
Not being able to pass urine despite needing to go (urinary retention)
Incontinence: accidental leakage of urine
Pain during passing urine, or pain after ejaculation
Urine with an unusual colour or smell

Some medicines can make the symptoms of BPH worse, or cause symptoms in men who previously had none. Some of these include over-the-counter cold or allergy medicines containing pseudoephedrine, oxymetazoline or antihistamines. Alcohol, cold weather and physical inactivity may also precipitate symptoms. All of these factors may make it very difficult to pass urine, a condition known as acute urinary retention. In severe cases, it may be necessary to seek medical assistance in order to empty the bladder.

HOW DO I KNOW IF I SHOULD BE TREATED FOR BPH?

Below is a simple questionnaire to determine whether you have symptoms of BPH and, if you do, how severe they are. Tick the boxes that apply to you and add up the scores inside each of the boxes you have ticked to get a total score. Discuss the results with your healthcare provider.^{2 p 771}

Men with symptoms of BPH should see their doctor¹^p4a
Symptoms of BPH can be extremely uncomfortable and sometimes embarrassing. It is not necessary to suffer, because they can be treated with medication.
However, sometimes LUTS may be an indication of something more serious. Urinary tract infection, including kidney infection, prostatitis (inflammation of the prostate) and prostate cancer may also cause LUTS. All of these require urgent medical attention.

HOW IS BPH DIAGNOSED?

To make the diagnosis of BPH, your doctor will ask you detailed questions about your symptoms and your general health and perform a general examination. It may be necessary to perform a digital rectal examination, in which a finger is inserted into the rectum to feel the part of the prostate that lies adjacent to the rectum. This enables the examiner to determine whether the prostate is enlarged or has any other abnormalities that might indicate further tests are necessary.
If necessary your doctor may refer you to a urologist. Additional test that might be required include

Urine analysis
Prostate specific antigen (PSA) – a blood test to screen for cancer, infection or inflammation
Ultrasound
Urodynamic tests – test to determine how well the bladder is working and whether, and how much, urine remains in the bladder after passing urine
Cystoscopy – using a camera to look directly inside the urethra and bladder
Not being able to pass urine despite needing to go (urinary retention)
Incontinence: accidental leakage of urine
Pain during passing urine, or pain after ejaculation
Urine with an unusual colour or smell

HOW IS BPH TREATED?

1. Lifestyle changes ^p7b
Simple lifestyle changes may help to reduce symptoms of LUTS. They include reducing fluid intake, especially before going to bed or going out in public, avoidance of caffeine and alcohol, avoidance of medications that may precipitate or worsen symptoms of LUTS, bladder training and pelvic floor muscle exercises, and preventing constipation (e.g., increasing fiber intake).
2. Medication ^p8
i) Medications to treat BPH (e.g., 5-alpha reductase inhibitors): these medication prevent progression of prostate growth and, in some men, cause the prostate to reduce in size.
ii) Medications to treat LUTS (e.g., alpha blockers, phosphodiesterase-5 inhibitors): these medications relax the smooth muscles of the prostate and bladder neck where it joins with the urethra, helping to improve urine flow and make it easier and more comfortable to pass urine.
iii) Combinations of medicines for BPH and LUTS.
3. Minimally invasive procedures and surgery ^{p9,10 as indicated}
Some men may require a procedure to reduce the size of the prostate. Depending on the size of the prostate and symptoms, this is most usually done by reaching the prostate through the urethra, thereby avoiding open surgery.

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