BPH (benign prostatic hyperplasia) is a condition in which the prostate gland becomes very enlarged, which may cause problems with urination. Some signs and symptoms of BPH are the same as prostate cancer. However, having BPH does not seem to increase the chances of developing prostate cancer. A man who has BPH may also have undetected prostate cancer at the same time or may develop prostate cancer in the future. The National Cancer Institute and the American Cancer Society recommend that all men over 50 consult their doctors to schedule a digital rectal exam and a PSA (prostate-specific antigen) blood test once a year to screen for prostate cancer.
Why does BPH occur?
The prostate goes through two main periods of growth. In early puberty, your prostate doubles in size. Then, around age 25, your prostate starts grow again and continues to grow throughout most of your life.
The continuing enlargement of the prostate does not usually cause problems until later in life. According to the National Institute of Diabetes and Digestive and Kidney Diseases:
- BPH rarely causes symptoms before age 40
- more than half of men in their 60s have some symptoms of BPH
- as many as 90 percent of men in their 70s and 80s have symptoms of BPH
What happens when the prostate enlarges?
As the prostate enlarges, it presses against the bladder and urethra, blocking or narrowing the urethra and causing urination problems. At the same time, the bladder wall becomes thicker and irritated, and begins to contract - even when it contains only small amounts of urine - causing both frequency and urgency of urination. As the bladder continues to weaken, it may not empty completely, leaving some urine behind and leading to a frequent sensation of needing to urinate, slow urinary flow and waking up frequently at night to urinate.
What are symptoms of BPH?
Signs and symptoms of BPH can mimic prostate cancer, but BPH isn't life-threatening. It's still important to see your medical professional right away to seek a diagnosis and treatment.
Common signs and symptoms of BPH include:
- leaking or dribbling of urine
- more frequent urination, especially at night
- urgency to urinate
- urine retention (inability to urinate)
- a hesitant, interrupted or weak stream of urine
These problems may lead to one or more of the following conditions:
- incontinence, (urinary leakage)
- kidney damage
- bladder damage
- urinary tract infections
- bladder stones
- complete inability to urinate
The symptoms of benign prostatic hyperplasia may resemble other conditions or medical problems. Always consult your doctor for a diagnosis.
How is BPH diagnosed?
Diagnosing BPH in its earlier stages can lower the risk of developing complications. Delay can cause permanent bladder damage for which BPH treatment may be ineffective. In addition to a complete medical history and physical examination, diagnostic procedures for BPH may include the following:
- Digital rectal exam: A procedure in which the doctor inserts a gloved finger into the rectum to examine the rectum and the prostate gland for signs of cancer.
- Intravenous pyelogram: A series of X-rays of the kidney, ureters and bladder with the injection of a contrast dye into the vein to detect tumors, abnormalities, kidney stones, or any obstructions, and to assess renal blood flow.
- Cystoscopy (also called cystourethroscopy): An examination in which a scope - a flexible tube and viewing device - is inserted through the urethra to examine the bladder and urinary tract for structural abnormalities or obstructions, such as tumors or stones .
- Urine flow study: A test in which the patient urinates into a special device that measures how quickly the urine is flowing. A reduced flow may suggest BPH.
What is the treatment for BPH?
Specific treatment for BPH will be determined by your doctor based on:
- your age, overall health and medical history
- extent of the disease
- your tolerance for specific medications, procedures or therapies
- expectations for the course of the disease
- your opinion or preference
When the prostate is mildly enlarged, treatment may not be needed, but this determination can only be made by your doctor after careful evaluation of your individual condition. Beaumont doctors specialize in different treatments for BPH ranging from minimally invasive options, including laser surgery, to the latest surgical techniques available. Beaumont experts are also able to offer lifestyle support to help manage BPH and improve quality of life.
Prostate surgery only removes the enlarged tissue pressing against the urethra, with the rest of the inside tissue and the outside capsule left intact. Types of surgery often include:
- Transurethral procedures: "Transurethral" techniques require no external incision, as the surgeon gains access to the prostate by inserting an instrument through the urethra.
- Transurethral resection of the prostate (T.U.R.P .): A resectoscope - an instrument about 12 inches long and 1/2 inch in diameter and contains a light, valves for controlling irrigating fluid and an electrical loop that cuts tissue and seals blood vessels - is inserted through the penis. The surgeon uses the resectoscope's wire loop to remove the obstructing tissue one piece at a time. The pieces of tissue are carried by the fluid into the bladder and flushed out at the end of the operation. This procedure is done in an operating room, takes approximately an hour and normally requires an overnight stay in the hospital.
- Transurethral incision of the prostate: This procedure widens the urethra by making small cuts in the bladder neck, where the urethra joins the bladder, and in the prostate gland itself.
- Laser surgery: Using laser instruments to cut away obstructing prostate tissue. This is very similar to a standard TURP, but in properly selected patients, can be done as an outpatient with more rapid recovery.
- Open surgery: Surgery that requires an external incision; often performed when the gland is very enlarged, when there are complicating factors, or when the bladder has been damaged and needs to be repaired. This can be done with the daVinci robotic system and normally requires a 2-3 day stay in the hospital.
- Balloon urethroplasty: A thin tube with a balloon is inserted into the opening of the penis and guided to the narrowed portion of the urethra. The balloon is inflated to widen the urethra and ease the flow of urine. This procedure is rarely, if ever performed anymore, due to other more advanced options.
- Transurethral microwave thermotherapy: The device uses microwaves to heat and destroy excess prostate tissue to reduce urinary frequency and urgency.
- Medications: Medications can be used to shrink or stop the growth of the prostate without the need for surgery. Medications can also be used to make the muscles surrounding the urethra looser so urine flows more easily. This is normally the standard first-line therapy offered to most patients who are beginning to manifest BPH symptoms.
- Transurethral hyperthermia: An investigative procedure that uses heat, usually provided by microwaves, to shrink the prostate.
- Prostatic stents: An investigative procedure where stents are inserted through the urethra to the narrowed area. These stents are allowed to expand, like a spring, pushing back the prostatic tissue and widening the urethra. This is primarily used only for severe scarring, and is rarely used today.
- Diet: Consuming foods containing soy, drinking green tea and taking saw palmetto supplements may benefit the prostate, although this is not yet proven. Avoiding spicy foods, decreasing the intake of alcohol, coffee and other fluids, particularly after dinner, is often helpful in lessening signs and symptoms of BPH. Men with diets high in zinc, butter and margarine are at higher risk for developing BPH, while individuals who eat lots of fruits are thought to have a lower risk for BPH.
- Avoiding medications that worsen symptoms: Decongestants and antihistamines can severely slow urine flow in some men with BPH, while some antidepressants and diuretics can also aggravate symptoms. Consult your doctor if you're taking any of these medications and discuss changing dosages or switching medications, if possible.
- Kegel exercises: Building the pelvic muscle through repeatedly tightening and releasing it, also known as Kegel exercises, can be helpful in decreasing urine leakage. Doctors recommend practicing this exercise while urinating in order to isolate and train the specific muscle. To perform a Kegel, contract the muscle until the flow of urine decreases or stops and then release the muscle. It's recommended that men with BPH repeat five to 15 contractions, holding each for 10 seconds, three to five times a day. Consult your doctor for more information.