What is Prostate Related Urinary Symptoms / BPH?
The prostate is a gland found in men that is located at the base of the bladder. Its function is to secrete fluid that makes up part of the semen (sperm fluid). The prostate wraps around the urethra, which is the canal in the penis that drains urine from the bladder. In young men, the prostate is about the size of a walnut. As men get older, the prostate also becomes enlarged. This process is called benign (non-cancerous) enlargement of the prostate or benign prostatic hyperplasia (BPH). As such, the prostate can cause compression of the urethra at that level, resulting in bladder symptoms.
How common is BPH?
BPH related bladder symptoms are very common; it is estimated that about 40% of men over the age of 65 will suffer from them. This can significantly impact on a person’s quality of life. The prevalence increases with age. Other factors that may increase the risk of BPH are race, environment, diet, and genetics. BPH is more common in Western societies compared to Asian. It is less common in those who eat large amounts of vegetables. It also seems to run in the family, and the incidence increases if a first degree relative (father or brother) has it.
What kind of symptoms can I get with BPH?
Bladder symptoms associated with prostatic enlargement are called lower urinary tract symptoms (LUTS). This can be divided into two main groups – voiding symptoms and storage symptoms. The voiding symptoms are caused by the obstruction from the enlarged prostate. When this happens, the bladder can become overactive (see overactive bladder) secondary to the obstruction and result in storage symptoms.
Needing to wait for the stream to start (hesitancy)
The stream starts and stops intermittently
Having to push and strain to pass urine
Dribbling at the end of urination
Sensation of incomplete bladder emptying
Going frequently to pass urine
Having a strong need to void that cannot be deferred (urgency)(Video) Benign Prostatic Hyperplasia (BPH): Everything You Need To Know
Waking up at night to pass urine (nocturia) – see night-time symptoms
Leakage of urine when one does not get to the toilet in time (urge incontinence)
The International Prostate Symptom Score (IPSS) is a validated short questionnaire that is very useful in determining how severe a patient’s bladder symptoms are. A score of 0 – 7 indicates mild symptoms, 8 – 19 indicates moderate symptoms and 20 – 35 indicates severe symptoms. Do the questionnaire to see what your score is.
In advanced cases, BPH can also cause more complicated symptoms. They are:
Acute urinary retention:
The patient blocks up completely and cannot pass urine. A urinary catheter would have to be inserted to drain the bladder.
Blood in the urine (haematuria):
An enlarged prostate often has engorged vessels that can bleed into the bladder and gets mixed in with the urine. This can be precipitated by straining (eg. constipation) or being on blood thinning medications. This is often scary and alarming for the patient. If severe, a patient would have to be admitted for continuous bladder washout (a closed catheter system which allows fluid to be trickled into the bladder and drained at the same time – this can stop further bleeding in the urine).
Kidney damage from bladder obstruction (obstructive uropathy):
Blockage at the bladder outlet can result in a bladder that builds up with urine and pressure such that the urine can cause back-pressure up the ureters (tubes that drain the kidneys to the bladder) and kidneys. This can cause kidney damage and is potentially dangerous.
Chronic urinary retention:
If a patient has experienced prostate related bladder problems for a long time, the bladder will eventually overstretch, resulting in its inability to completely empty itself (see underactive bladder). This means that there will always be some urine left behind after each void, and this residual urine can in turn form bladder stones or urinary tract infections. It can also cause continuous leakage of urine called overflow incontinence.
What is PSA?
Prostate specific antigen (PSA) is an enzyme secreted by prostate cells that liquefies semen to allow sperm to swim freely. PSA is present in the blood in low levels in men with healthy prostates, and is elevated in men with prostate cancer or other prostate disorders. In other words, it is not a diagnostic test for prostate cancer but is useful in detecting it. BPH can also cause PSA to increase; the estimated PSA increase is 0.3 ng/mL per gram of BPH tissue.
What will happen if BPH is not treated?
BPH is a disease that progresses slowly. The average increase in prostate volume is 1 – 2 cc/year. In men with mild symptoms, 57% worsen in 4 years; however, only 10% will require surgical intervention. In men with severe symptoms, 39% will undergo prostate surgery within 4 years.
Symptoms at initial diagnosis
Symptoms 4 years after diagnosis
The risk of BPH progression is higher in men with older age, more severe symptoms, larger prostate size, and higher PSA.
What other prostatic conditions can cause bladder symptoms?
Other things that the prostate may develop are infection or swelling (prostatitis) and prostate cancer.
Prostatitis can also cause bladder symptoms as well as a deep-seated discomfort located in the area between the scrotum and the anus (perineum or where the prostate is located). This can generally be treated with antibiotics.
Prostate cancer however, often does not cause any symptoms. If the prostate is large enough, it can cause the same bladder symptoms as that of BPH.
How is BPH diagnosed?
After a careful history is obtained, a digital rectal examination (DRE) is performed. This involves a lubricated, gloved finger in the rectum, with the patient either lying on his left side all curled up or bent over in a standing position. DRE can tell us about the size, consistency, and symmetry of the prostate gland. The abdomen will also be palpated and the external genitalia examined.
The following investigations are useful when diagnosing BPH:
A urine test should be done to rule out infection or bladder cancer, which can mimic the same symptoms as that of BPH. An infection can cause the PSA to rise.
PSA is an optional test in the investigation of BPH. Its role in prostate cancer screening remains controversial. In patients with a single, slightly raised PSA level, it is often difficult to distinguish between BPH and prostate cancer. PSA can provide a useful indication of prostate volume, which can then predict those who are most likely to experience BPH progression.
Urine flow rate & residual volume measurements
A patient is asked to void into a bucket that is electronically calibrated such that urinary flow parameters can be measured. It can measure the peak flow rate, average flow rate and volume voided. The pattern of the tracing of the flow rate is also clinically useful. The peak flow rate can indicate the degree of obstruction; with a voided volume of > 150ml, a peak flow rate of <15 ml/sec suggests obstruction. A peak flow rate of < 10 ml/sec suggests marked obstruction. However, it must be noted that an underactive bladder (one that does not contract strongly) can also cause a low peak flow rate.
The residual volume is measured with a bedside ultrasound probe, which is applied to the bladder area after a void. This is useful in determining whether a patient can empty his bladder well. Patients with a high residual volume are more likely to develop acute urinary retention and need surgery later on.
A formal ultrasound of the urinary tract is useful to measure the prostate volume, residual volume and exclude kidney obstruction and bladder stones.
Urodynamics (bladder pressure studies)
Urodynamics studies are not routinely done in the investigation of BPH. It is used mainly to assess the degree of bladder obstruction, the presence of an overactive bladder, and how well the bladder can contract. This information can give a prognosis as to whether the patient will benefit from invasive surgery like a TURP (transurethral resection of the prostate).
A cystoscopy (internal inspection of the bladder with a tube-like camera) is also an optional procedure in the investigation of BPH. It can look for other causes of obstruction including urethral strictures (scarring of the canal in the penis which drains the bladder), a tight bladder neck, or a bladder stone. It can also assess the degree of obstruction caused by the prostate; some small prostates may have a large internal median lobe that can cause obstruction. In the bladder, it can look for signs of obstruction like an overstretched bladder with diverticuli (outpouchings). If there is a history of blood in the urine, it can differentiate bleeding from the prostate vs a bladder tumour.
What are the treatments?
Not all patients need treatment, especially if their symptoms are not too bothersome. As discussed above, about a third of patients with symptoms remain unchanged after 4 years. Therefore, observation is a reasonable option in patients with uncomplicated BPH.
In those who are more bothered, or those with complicated symptoms, medications or surgery can be offered.
There are a few classes of drugs that are useful for the treatment of BPH.
Alpha blockers (eg. Minipress, Flomaxtra)
This is considered the first line medical treatment for BPH. It gives the best results in terms of relieving obstruction. It acts by relaxing the bladder neck and the prostate.
Side effects include dizziness, tiredness, blocked nose and retrograde ejaculation (semen going backwards into the bladder during ejaculation as a result of relaxation of the bladder neck).
5 alpha reductase inhibitors (eg. Proscar, Avodart):
These drugs act by shrinking the prostate volume over time (about 3 to 6 months). They are not as effective as improving flow symptoms as alpha blockers, but they can reduce the risks of surgical intervention and acute urinary retention in men with large prostates. They can reduce prostatic bleeding too.
Side effects are erectile dysfunction, decreased sex drive, reduced ejaculate volume and rarely, breast enlargement.
Because these drugs reduce the PSA level by about half, a baseline PSA must be done prior to starting them.
Anticholinergics (eg. Ditropan, Vesicare):
These bladder-calming medications are useful in treating the storage symptoms associated with an overactive bladder secondary to obstruction. They do not help much with the voiding symptoms as described above.
Side effects include dry mouth, dry eyes, constipation, confusion, urinary retention.
In some patients, combination therapy with the above drugs may be more beneficial than single-drug therapy.
Phytotherapy (plant extracts eg. saw palmetto, African plum) drugs are herbal medications that are widely available over the counter and in supermarkets. However, many trials have shown them to be no more effective than placebo. Therefore, these drugs are generally not recommended by urologists for the treatment of BPH.
In those who fail medication treatment or in those with advanced BPH, surgery may be indicated.
TURP (transurethral resection of the prostate) or prostate ‘reboring’:
This operation is done internally with no open cuts. A resecting loop is passed down a cystoscopic instrument with a camera and the prostate is excised in chips. This opens up the passageway for the urine to flow through. About 90% of patients will find an improvement in their symptoms.
The classic method of resection is with diathermy (electric current). However, newer techniques using laser (Green light laser TURP) now have an increasing role.
It is performed under general or spinal anaesthesia. The operation time is about 60 minutes. The estimated length of stay in the hospital is 2 – 3 days.
Complications include ‘water intoxication’ from the absorption of fluid during the surgery, bleeding (transfusion rate < 10%), infection, incontinence (1%), erectile dysfunction (2 – 4%) and retrograde ejaculation (> 70%).
The prostate can regrow over time; about a fifth of patients will need a revision-TURP within 8 years.
Bladder neck incision (BNI)
If the prostate gland itself is small and does not look too obstructive during cystoscopy and the reason for the obstruction is attributed to a tight bladder neck, a BNI procedure can be done.
This is also done internally with a cystoscopic instrument. It is effective in relieving symptoms and has lower complication rates than a TURP.
Open simple prostatectomy
In men with very large prostates (> 100g), they run the risk of developing ‘water intoxication’ complication from a prolonged TURP operation.
In this case, the inner parts of the prostate gland are removed through a lower abdominal incision. It is also useful if the patient has a large bladder stone that needs removal at the same time.
It is more effective in relieving symptoms (98%) than a TURP, and the results are more durable.
However, there is a higher risk of needing a blood transfusion (<30%) and erectile dysfunction (19%) as compared to a TURP. There is a longer stay in the hospital too.
Symptoms of benign prostate enlargement
If the prostate becomes enlarged, it can place pressure on the bladder and the urethra, which is the tube that urine passes through. This can affect how you pee and may cause: difficulty starting to pee. a frequent need to pee.
BPH is considered a normal condition of aging. Although the exact cause is unknown, changes in male sex hormones that come with aging may be a factor. Any family history of prostate problems or any abnormalities with your testicles may raise your risk for BPH.What is the best treatment for BPH? ›
Medication is the most common treatment for mild to moderate symptoms of prostate enlargement. The options include: Alpha blockers. These medications relax bladder neck muscles and muscle fibers in the prostate, making urination easier.Is BPH a serious problem? ›
BPH is not life-threatening, but it can be bothersome. There are also some complications that can occur. These include: Inability to urinate.Do symptoms of BPH come and go? ›
An enlarged prostate, also known as benign prostatic hyperplasia or BPH, is not cancerous, but over time it can cause bothersome urinary symptoms. The symptoms of an enlarged prostate may be mild or come and go, and as a result, most men wait several months, even years, before seeing a doctor.How long do BPH symptoms last? ›
The most common side effects of these treatments include peeing more than normal and discomfort or irritation while your prostate heals. After a minimally invasive procedure, you should be able to return to your normal activities in a few days. You should see improvements in your symptoms within three to six weeks.Can BPH symptoms go away? ›
One-third of men with mild BPH find that their symptoms clear up without treatment. They may just watch and wait. However, when enlarged prostate symptoms are bothersome or are affecting your quality of life or overall health, it's time to talk to your doctor about the treatment options.Can you live a normal life with BPH? ›
BPH might be life-disrupting, but with the right care and the correct approach to fluids, it's possible for most men to minimize their symptoms and live comfortably with an enlarged prostate.What is the first line treatment for BPH? ›
Terazosin and doxazosin were initially developed to treat high blood pressure but were later found to be useful for men with BPH. Alpha blockers begin to work quickly and are usually recommended as a first-line treatment for men with mild to moderate symptoms.Should I worry about BPH? ›
Do not ignore painful or burning urination, painful ejaculation, blood in the urine or semen, frequent pain in the lower back, hips, pelvic or rectal area. Possible complications from untreated BPH include the following: Decreased kidney function. Urinary retention.
- Diuretics. Diuretics, or water pills, are medications that remove extra fluid from the body. ...
- Antidepressants. ...
- Non-steroidal anti-inflammatory drugs (NSAIDs) ...
- Antihistamines. ...
- Nasal decongestants. ...
- Other drugs that may aggravate BPH.
Alpha-blockers, such as tamsulosin (Flomax) or terazosin (Hytrin), which relax muscle tissue. 5-alpha reductase inhibitors, such as dutasteride (Avodart) and finasteride (Proscar), which shrink the prostate.How do you test for BPH? ›
Other tests such as urine flow study, digital rectal exam, prostate-specific antigen (PSA) blood test, cystoscopy, ultrasound or prostate MRI may be used to confirm the diagnosis. Treatment for BPH may depend on the severity of the symptoms and range from no treatment to medication or surgery.What makes BPH worse? ›
Some symptoms may get worse because of cold weather or as a result of physical or emotional stress. Some over-the-counter medicines also can make BPH worse, such as diphenhydramine (e.g., Benadryl), pseudoephedrine (e.g., Sudafed) and oxymetazoline spray (e.g., Afrin).What is the latest treatment for enlarged prostate 2022? ›
Entadfi is expected to be available in early 2022. Credit: Getty Images. The Food and Drug Administration (FDA) has approved Entadfi (finasteride and tadalafil) for the treatment of the signs and symptoms of benign prostatic hyperplasia (BPH) in men with an enlarged prostate for up to 26 weeks.What foods reduce BPH? ›
Eat a low-fat diet. Eat a large variety of vegetables each day. Eat a few servings of fruit daily, and be sure to include citrus fruits. Participate in moderate to vigorous physical activity most days of the week.What are the 5 warning signs of BPH? ›
Signs and symptoms of an enlarged prostate include blood in the urine, urinary retention, frequent urination, A slow flow or dribbling urine The need to urinate urgently, and Problems starting a urinary stream. An enlarged prostate is not malignant prostate cancer, which means that it is non-cancerous or benign.At what age is BPH common in men? ›
But because enlarged prostate, or benign prostatic hyperplasia (BPH), is a common condition that affects men as they age, it's important to know the facts. About 50% of men between the ages of 51 and 60 have BPH, and that number jumps to 70% among men aged 60 to 69 and around 80% of men over 70 years of age.What are the stages of BPH? ›
|Stage||Significant obstruction||Bothersome symptoms|
|IV||Complications of BPH|
It can cause pain in the lower back, in the groin, or at the tip of the penis. Treatment may require a combination of medicines, surgery, and lifestyle changes.
- Keep yourself active. Lack of physical activity can make you retain urine. ...
- Do Kegel exercises. Stand at or sit on the toilet and contract the muscle that allows you to stop and start the flow of pee. ...
- Meditate. Nervousness and tension cause some men to urinate more often. ...
- Try double voiding.
Can an Enlarged Prostate Be Cured? For most patients, BPH (enlarged prostate) is curable. Some people see a significant reduction in symptoms with medication alone. If medicine does not work, or your prostate is too large, surgery will often remove enough of the prostate to provide you with relief.How do you recover from BPH? ›
You may need a catheter to help you drain your bladder for several days following the procedure. You'll also need to recover at a hospital or at home for up to three days, and your activities may be limited for as long as two months. Your physical activity will also be limited for several weeks until you've healed.How is BPH permanently treated? ›
Although there is no cure for benign prostatic hyperplasia (BPH), also known as enlarged prostate, there are many useful options for treating the problem. Treatments focus on prostate growth, which is the cause of BPH symptoms. Once prostate growth starts, it often continues unless medical therapy is started.What happens if you dont treat BPH? ›
First, although it has nothing to do with cancer, untreated BPH has the potential to lead to serious complications, ranging from urinary tract infections and stones in the bladder or kidney to urinary retention and kidney damage.How do you shrink BPH naturally? ›
Natural remedies for an enlarged prostate
- Saw palmetto (Serenoa repens) ...
- Rye grass pollen (Secale cereale) ...
- Stinging nettle. ...
- Pygeum africanum (Prunus africana) ...
- Lycopene. ...
- Green tea. ...
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.Does BPH always progress? ›
Furthermore, if the symptoms associated with BPH are left untreated, serious complications, such as acute urinary retention, may ensue. Evidence is emerging from long-term clinical studies to suggest that BPH is a progressive disease, with some patients progressing much more rapidly than others.What is the most common surgery for BPH? ›
Transurethral resection of the prostate (TURP): This is the most common treatment for BPH. During this procedure, your urologist will insert a rigid instrument called a resectoscope into the urethra.Which class of drugs are most commonly used to treat BPH? ›
Alpha blockers are a class of BPH medications that work to relax the prostate muscles. They address one of the most common symptoms that BPH causes, the irregular flow of urine. They may also reduce the risk of urinary tract infections and other related symptoms of an enlarged prostate.
Surgery is usually recommended in treating moderate to severe BPH-symptoms under these conditions: You're not able to pee at all. Lifestyle changes, medicines, or minimally invasive treatments didn't work for you. You find blood in your urine that is not getting better.Can stress cause BPH symptoms? ›
In addition, it turns out that stress may also worsen the symptoms of BPH, according to Harvard Medical School. Although the exact relationship between stress and BPH is unclear, it's possible that stress may cause levels of certain hormones to shift, which in turn results in prostate enlargement.What will a urologist do for enlarged prostate? ›
A urologist uses the device to lift and move the enlarged prostate tissue out of the way so it no longer blocks the urethra (the passageway that urine flows through). Tiny implants are then used to hold the tissue in place, leaving an unobstructed pathway for urine to flow through normally.What drugs make BPH worse? ›
- amoxapine (Asendin)
- doxepin (Sinequan)
- imipramine (Tofranil)
- nortriptyline (Pamelor)
When stressed, the body can begin to release the testosterone and DHT hormones. These hormones can cause the prostate gland to enlarge. Additionally, the adrenaline released when stressed can cause contraction of the muscles in the bladder and prostate.What medications increase PSA? ›
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and naproxen.
- Cholesterol-lowering statins, such as Lipitor (atorvastatin) and Zocor (simvastatin)
- High blood pressure drugs known as thiazide diuretics.
This medicine may rarely cause a severe allergic reaction (swelling of face, tongue, or throat, difficulty breathing, and blistering of the skin. Check with your doctor immediately if this occurs. You should seek medical attention right away if you experience a prolonged erection while using this medicine.How can I shrink my prostate over the counter? ›
A range of 100 to 960 mg daily has been used to treat enlarged prostate, but according to the National Institutes of Health , a few studies have shown it to be effective. As a result, saw palmetto is one of the most commonly recommended natural remedies.
Take the first dose at bedtime to minimize the chances of getting dizzy or fainting. After the first dose, take your regularly scheduled dose 30 minutes after the same meal each day.What are mild symptoms of BPH? ›
- Having a frequent or urgent need to urinate.
- Waking up many times to urinate.
- Having problems with urine flow, such as: Trouble starting to urinate. A stream that's weak, slow, or stops and starts. ...
- Pain after ejaculation or during urination.
- Urine with an unusual color or smell.
An enlarged prostate often feels uniformly enlarged, firm and even rubbery. DRE is also conducted to assess for prostate cancer in which nodules may be felt on the prostate. Prostate Specific Antigen (PSA) is a marker in the blood stream that provides insight on the prostate, specifically for cancer and growth.Do blood tests show BPH? ›
Initial Tests For BPH
A PSA blood test looks for levels of a Protein Specific Antigen found only in the prostate gland. This protein should be at a low level for a healthy prostate. Higher levels can indicate an inflammation known as prostatitis, BPH, or prostate cancer. This is a routine test for men over age 50.
The former includes urinary frequency, nocturia, urinary urgency, and incontinence. These are caused by detrusor enlargement and increased bladder sensation which occur in association with urethral resistance increased by urethral compression resulting from BPH.How does enlarged prostate cause overactive bladder? ›
BPH causes your bladder to work harder to expel urine. That eventually can weaken the bladder. Over time, other symptoms develop, such as a frequent or urgent need to urinate and a weak urine flow.Can enlarged prostate cause UTI symptoms? ›
Benign prostate enlargement can sometimes lead to complications such as a urinary tract infection (UTI) or acute urinary retention. Serious complications are rare.Why does BPH cause dysuria? ›
BPH-induced dysuria may be caused by urinary infection resulting from obstruction and stasis. It may also be caused by inflammation of the distended urethral mucosa. Over time, chronic obstruction of urinary outflow as a result of BPH can cause bladder hyperplasia, trabeculation and, eventually, decompensation.How does BPH affect daily life? ›
The symptoms of BPH, which include difficulty urinating, urgency with leaking or dribbling, and nocturia, can adversely affect sexual functioning and other aspects of quality of life (QOL), but treatment may also compromise QOL by resulting in sexual dysfunction.How can you prevent BPH? ›
Weight loss, regular physical activity, vegetable consumption, alcohol intake, 5α-reductase inhibitors, avoidance of overweight and reduction of fatty food can reduce the probability of histological and clinical BPH.What medication can stop frequent urination? ›
- Tolterodine (Detrol)
- Oxybutynin, which can be taken as a pill (Ditropan XL) or used as a skin patch (Oxytrol) or gel (Gelnique)
- Solifenacin (Vesicare)
- Fesoterodine (Toviaz)
- Mirabegron (Myrbetriq)
- Urinary urgency. Urinary urgency is a sudden, uncontrollable need to pee. ...
- Frequent peeing. A frequent need to pee means you have to go to the bathroom more often than usual.
- Urge incontinence. ...
Our urologists treat patients with OAB with combinations of behavioral therapy, medication, and in severe cases, a therapy called Interstim, to treat overactive bladder. Another option is the injection of Botox into the bladder to relax and paralyze the overactive muscle.How does enlarged prostate make you feel? ›
having a weak flow of urine. "stop-start" peeing. needing to pee urgently and/or frequently. needing to get up frequently in the night to pee.What are the first signs of prostate infection? ›
- Pain or burning sensation when urinating (dysuria)
- Difficulty urinating, such as dribbling or hesitant urination.
- Frequent urination, particularly at night (nocturia)
- Urgent need to urinate.
- Cloudy urine.
- Blood in the urine.
- Pain in the abdomen, groin or lower back.
Some symptoms of BPH are not as common, and they could signal that your condition is more complicated or advanced. Those signs include: Burning or pain when you pee. Blood in your urine.What pain is associated with BPH? ›
However, if BPH causes pain, it usually occurs with urination (dysuria). Prostatitis may cause painful urination, painful ejaculations, and generalized groin/abdominal pain. Prostatitis pain may be more constant and may be due to the inflammation of the prostatic tissue and/or adjacent tissues.