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Overview

Benign Prostatic Hyperplasia (BPH) is the medical term for enlargement of a man's prostate gland whose primary purpose is to produce most of the fluids in semen. It is a common condition affecting 50 per cent of men by age 65 and up to 90 percent by age 80. While BPH often results in urinary problems these can be managed or treated.

Causes

The prostate gland is located below the bladder (where urine is stored) and the urethra (the tube urine passes through) that extends from the bladder runs through the prostate.. A young man's prostate is walnut-sized about 25 to 30 cubic centimeters. However most men experience a second period of prostate growth in their mid- to late 40s. The causes are unclear but researchers believe that with age the prostate becomes more susceptible to the effects of testosterone and other male hormones. Once the gland has increased in size by about 25 per cent it puts excess pressure on the urethra making urination more difficult and sometimes painful. When the urethra that carries urine from the bladder is constricted it is difficult for the bladder to completely empty.

While the main risk factor for prostate enlargement is aging researchers also know there is a heredity link and that it is more common in men of European descent. While there is no evidence to support a link between sexual activity and BPH for some unknown reason married men are more likely to experience this condition.

Symptoms

Only about 50 per cent of men with an enlarged prostate experience symptoms that are bothersome enough to seek medical treatment. In those who do symptoms usually appear gradually over time. You might find you are getting out of bed more often at night to urinate. When you do go to the bathroom you may find it difficult to start the urine flow and there may be dribbling when you are finished. The size and strength of the urine stream may decrease. These symptoms are not unique to BPH and in fact can be a sign of a much more serious problem or lead to serious complications such as:

• Acute Urinary Retention a condition that results in a complete inability to urinate.
• Chronic Urinary Retention a partial blockage of urine flow that causes urine to remain in the bladder. In rare cases this may lead to kidney damage.
• Urinary Tract Infection which can cause pain or burning during urination foul-smelling urine or fever and chills.

See your doctor if you are experiencing any urinary problems.

The symptoms of BPH tend to wax and wane over time. A small percentage of men have symptoms that get more severe and this leads to Acute Urinary Retention described above.

Treatment

To make a proper diagnosis your doctor may perform a rectal exam to check the size of the prostate gland. He may also check your urine for signs of infection or send you for a blood test. Sometimes he may require an ultrasound or a biopsy of the prostate in order to make a proper diagnosis.

Treatment for an enlarged prostate is determined by the severity of your symptoms. If you experience urinary bleeding persistent urinary tract infections or bladder and kidney damage your doctor generally will recommend further investigations. Medications for BPH have become much more helpful in the last decade but some men do end up requiring a surgical procedure to remove some of the prostate and give the pee tube (the urethra) some more room. Every treatment has potential side effects and each patient needs to weigh these against the overall benefits.

If your prostate is enlarged but you experience little or no discomfort treatment often isn't necessary. Sometimes your doctor will want to wait and see before recommending any course of action.

Here are some suggestions from urologists that may make it easier to live with the symptoms of BPH during this so-called "watchful waiting" phase.

• When urinating don't rush. Try to relax while using the bathroom. Anxiety can cause prostate and bladder muscles to tense reducing urinary flow.
• Double void. This means urinating as much as possible waiting a few moments then urinating again.
• Try sitting on the toilet instead of standing while you urinate.
• Turn on a faucet. The sound of running water can help stimulate urine flow.

Don't limit fluid consumption to avoid urinating. You run the risk of dehydration which can lead to serious medical problems. Instead:

• Spread your fluid intake throughout the day.
• Avoid beverages that contain caffeine or alcohol. These substances will increase your frequency of urination.
• If the need to urinate often wakes you at night limit your fluid consumption in the evening especially near bedtime.

Certain medications can make urination more difficult. You should avoid taking nonprescription decongestants antihistamines nasal sprays and allergy pills. Certain tranquilizers and antidepressants list urinary retention as a side effect.