Benign Prostatic Hyperplasia or BPH
About BPH – A common part of aging
It is common for the prostate gland to become enlarged as a man ages. Doctors call this condition benign prostatic hyperplasia (BPH), or benign prostatic hypertrophy (although the process is one of hyperplasia rather than hypertrophy). Benign means "not cancer," and hyperplasia means proliferation of cells beyond what is normal – thus BPH is a noncancerous growth of the prostate gland with the result being that the prostate becomes enlarged. BPH is not linked to cancer and does not increase your risk of getting prostate cancer.
As a man matures, the prostate goes through two main periods of growth. The first occurs early in puberty, when the prostate doubles in size. At around age 25, the gland begins to grow again with the fastest growth occurring during middle age. This second growth phase often results, years later, in BPH.
Though the prostate continues to grow during most of a man's life, the enlargement doesn't usually cause problems until late in life. BPH rarely causes symptoms before age 40, but about 50% of men over 50, more than half of men in their sixties, and as many as 90 percent in their seventies and eighties have some symptoms of BPH.
As the prostate enlarges, the layer of tissue surrounding it stops it from expanding, causing the gland to press against the urethra like a clamp on a garden hose. The bladder wall becomes thicker and irritable. The bladder begins to contract even when it contains small amounts of urine, causing more frequent urination. Eventually, the bladder weakens and loses the ability to empty itself, so some of the urine remains in the bladder. The narrowing of the urethra and partial emptying of the bladder cause many of the problems associated with BPH.
The above image shows a normal prostate (left) and BPH (right). The flow of urine from the bladder is not blocked by a normal prostate. An enlarged prostate presses on the urethra and the bladder, blocking the normal flow or urine from the bladder. This is a file from the Wikipedia Commons.
The above image shows a normal prostate (left) and BPH (right). The flow of urine from the bladder is not blocked by a normal prostate. An enlarged prostate presses on the urethra and the bladder, blocking the normal flow or urine from the bladder. This is a file from the Wikipedia Commons. Since BPH occurs in almost all men as they age, it is usually not a serious problem. It can, however, be a nuisance leading most men to want to treat the symptoms associated with an enlarged prostate. BPH does not cause prostate cancer, but prostate cancer often times causes symptoms similar to those of BPH. If you are experiencing symptoms similar to those of BPH it is important to be checked by a doctor to be certain they are not due to something more serious than BPH.
Why BPH occurs
Causes of BPH
BPH is a normal part of the aging process for men. The actual cause is unknown, although it is believed to be caused by cell growth and changes in hormone balance. More than half of men in their sixties and as many as 90 percent in their seventies and eighties have some symptoms of BPH No definite information on risk factors exists. For centuries, it has been known that BPH occurs mainly in older men and that it doesn't develop in men whose testes were removed at a young age (for example as a result of testicular cancer). Similarly, if the testicles are removed after a man develops BPH the prostate often begins to shrink in size. For this reason, some researchers believe that factors related to aging and the testes may spur the development of BPH. Throughout their lives, men produce testosterone, an important male hormone, and small amounts of estrogen, a female hormone. As men age, the amount of active testosterone in the blood decreases, leaving a higher proportion of estrogen. Studies done on animals have suggested that BPH may occur because the higher amount of estrogen within the gland increases the activity of substances that promote cell growth. Another theory focuses on dihydrotestosterone (DHT), a substance derived from testosterone in the prostate, which may help control its growth. Most animals lose their ability to produce DHT as they age. However, some research has indicated that even with a drop in the blood's testosterone level, older men continue to produce and accumulate high levels of DHT in the prostate. This accumulation of DHT may encourage the growth of cells. Scientists have also noted that men who do not produce DHT do not develop BPH.
Some studies have shown that family history, or genetics, is also a risk factor for BPH. This appears to be truer for men with an early onset of severe BPH. For more information on this please Click Here.
Much work remains to be done to fully understand the causes of BPH.
Symptoms of Benign Prostatic Hyperplasia or BPH
Many men with benign prostatic hyperplasia have no symptoms. For others, when symptoms do appear they can range from mild or barely noticeable to severe. Symptoms associated with BPH are often times referred to as LUTS, or lower urinary tract symptoms. LUTS is a recent term for what used to be known as prostatism Many symptoms of BPH stem from obstruction of the urethra and gradual loss of bladder function, which results in incomplete emptying of the bladder. The symptoms of BPH are classified as problems with emptying the bladder or bladder storage. They include:
Emptying the bladder
- Difficulty starting a urine stream
- A feeling that you can not empty your bladder completely
- Week urine stream
- Painful ejaculation
- Dribbling during urination
- An urge to urinate shortly after urinating
- Pain during urination (dysuria)
Bladder storage
- A frequent need to urinate
- Getting up during the night to urinate (nocturia)
- A sense of urgency to urinate
When the symptoms above are experienced as a result of BPH, they are generally balanced between the two types – both problems with emptying the bladder and bladder storage. Other conditions that can cause similar symptoms include urinary tract infections (UTI), prostatitis, and prostate cancer. Only your doctor can diagnose what is causing the symptoms that you are feeling.
The size of the prostate does not always determine how severe the obstruction or the symptoms will be. Some men with greatly enlarged glands have little obstruction and few symptoms while others, whose glands are less enlarged, have more blockage and greater problems.
Potentially serious complications can occur if the bladder does not empty completely after urination. This can cause the growth of bacteria which can lead to frequent urinary tract infections (UTI). This can also lead to the formation of stones in the bladder due to the accumulation of minerals and chemicals.
In rare cases, the bladder can become blocked making it extremely difficult or impossible to urinate causing urinary retention or ischuria. This too can lead to bladder infections or stones, as well as incontinence, kidney damage, or blood in the urine.
Sometimes a man may not know he has any obstruction until he suddenly finds himself unable to urinate at all. This condition, called acute urinary retention, may be triggered by taking over-the-counter cold or allergy medicines. Such medicines contain a decongestant drug, known as a sympathomimetic. A potential side effect of this drug may prevent the bladder opening from relaxing and allowing urine to empty. When partial obstruction is present, urinary retention also can be brought on by alcohol, cold temperatures, or a long period of immobility.
While symptoms described above most often suggest BPH, they can also signal other more serious conditions including prostate cancer. More serious conditions can only be ruled out by a doctor’s examination. Detecting BPH in its earlier stages also helps avoid some of the complications described above.
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When to see a doctor
You should see a physician when you are experiencing any of the symptoms listed above, or if your symptoms change and get worse. You should also see a doctor if:
- You have pain in the lower back that is not related to an injury or physical motion
- There is blood, or pus, in your urine or semen
- Chills, fever, or pain the lower back or genital area
If you have acute symptoms, such as acute urinary infection (where you are not able to urinate) you should immediately go to the closest emergency facility.
The prostate is not part of the urinary system, but because it surrounds the urethra and sits just below the bladder, it can cause urinary problems. That's why your primary doctor will often refer you to a urologist when you are experiencing prostate problems.
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