Enlarged prostate gland: The prostate gland is located underneath the bladder and is about the size of a chestnut. In this cut section, you can see that part of the urethra is encased within the prostate gland. As a man ages, the prostate typically enlarges in size in a process called benign hypertrophy, which means that the gland got larger without becoming cancerous.
The enlarged prostate crowds its anatomical neighbors, particularly the urethra, causing it to narrow. The narrowed urethra results in several of the symptoms of benign prostatic hypertrophy, or BPH. Symptoms may include a slowed or delayed start in urination, the need to urinate frequently during the night, difficulty in emptying the bladder, a strong, sudden urge to urinate, and incontinence. Less than half of all men with BPH have symptoms of the disease, or their symptoms are minor and do not restrict their life style.
BPH is a normal physiological process of aging and treatment options are available. The choice of the appropriate treatment is based on the severity of the symptoms, the extent to which they affect lifestyle, and the presence of other medical conditions. Men with BPH should consult with their physician yearly to monitor the progression of the symptoms and decide the best course of treatment as needed.
Benign prostatic hyperplasia (BPH), also called prostate enlargement, is a noncancerous increase in size of the prostate. Symptoms may include frequent urination, trouble starting to urinate, weak stream, inability to urinate, or loss of bladder control. Complications can include urinary tract infections, bladder stones, and chronic kidney problems.
The cause is unclear. Risk factors include a family history, obesity, type 2 diabetes, not enough exercise, and erectile dysfunction. Medications like pseudoephedrine, anticholinergics, and calcium channel blockers may worsen symptoms. The underlying mechanism involves the prostate pressing on the urethra. Diagnosis is typically based on symptoms and examination after ruling out other possible causes.
Treatment options including lifestyle changes, medications, a number of procedures, and surgery. In those with mild symptoms weight loss, exercise, and decreasing caffeine intake is recommended. In those with more significant symptoms medications may include alpha blockers such as terazosin or 5α-reductase inhibitors such as finasteride. Surgical removal of part of the prostate may be carried out in those who do not improve with other measures. Alternative medicine such as saw palmetto do not appear to help.
About 105 million people are affected globally. BPH typically begins after the age of 40. Half of males age 50 and over are affected. After the age of 80 about 90% of males are affected. Although prostate specific antigen levels may be elevated in males with BPH, the condition does not increase the risk of cancer.
Signs and symptoms: BPH is the most common cause of lower urinary tract symptoms (LUTS), which are divided into storage, voiding, and symptoms which occur after urination. Storage symptoms include the need to urinate frequently, waking at night to urinate, urgency (compelling need to void that cannot be deferred), involuntary urination, including involuntary urination at night, or urge incontinence (urine leak following a strong sudden need to urinate). Voiding symptoms include urinary hesitancy (a delay between trying to urinate and the flow actually beginning), intermittency (not continuous), involuntary interruption of voiding, weak urinary stream, straining to void, a sensation of incomplete emptying, and terminal dribbling (uncontrollable leaking after the end of urination, also called post-micturition dribbling). These symptoms may be accompanied by bladder pain or pain while urinating, called dysuria.
Bladder outlet obstruction (BOO) can be caused by BPH. Symptoms are abdominal pain, a continuous feeling of a full bladder, frequent urination, acute urinary retention (inability to urinate), pain during urination (dysuria), problems starting urination (urinary hesitancy), slow urine flow, starting and stopping (urinary intermittency), and nocturia. BPH can be a progressive disease, especially if left untreated. Incomplete voiding results in residual urine or urinary stasis, which can lead to an increased risk of urinary tract infection.
Management: Lifestyle alterations to address the symptoms of BPH include physical activity, decreasing fluid intake before bedtime, moderating the consumption of alcohol and caffeine-containing products and following a timed voiding schedule. Patients can also attempt to avoid products and medications with anticholinergic properties that may exacerbate urinary retention symptoms of BPH, including antihistamines, decongestants, opioids, and tricyclic antidepressants.
Medications: The two main medication classes for BPH management are alpha blockers and 5α-reductase inhibitors.