What Is Benign Prostatic Hypertrophy (BPH)
Benign prostatic hyperplasia (BPH) is a common condition that occurs in aging men. It is not a cancerous process. The prostate is a walnut-shaped organ that makes the fluid which composes semen. It rests below the bladder, adjacent to the rectum. It encases the urethra, which is a tube which urine flows through, from the bladder.
Around age 25, the prostate undergoes continued growth, which can lead to bothersome symptoms that may affect quality of life. As the prostate increases in size, the tissue can impinge on the urethra and the bladder wall can thicken as a result. The narrowing of the urethra, which urine flows through, can cause uncomfortable urinary retention.
There are several risk factors for BPH including age over 40 years old, family history of BPH, medical conditions (diabetes, cardiovascular disease, obesity), sedentary lifestyle, and erectile dysfunction.
Common Signs and Symptoms of BPH
There is a wide range of BPH signs and symptoms that affect patients very differently. In general, there are two kinds of symptoms: voiding and storage. Voiding symptoms describe an obstructive process, whereby it is difficult to pass urine. Storage symptoms describe an irritative process, whereby the retention of urine causes issues to the bladder and male reproductive system.
Overall, signs and symptoms of BPH include:
- Urinary frequency: Urinary frequency describes the amount of times a patient needs to urinate. This is one of the most common beginning signs and symptoms of BPH, as the growing prostate increases pressure on the bladder.
- Urinary urgency: Urinary urgency describes the feeling of needing to void, even if physiologically, the bladder is not full. This is also due to the pressure placed on the bladder by a growing prostate which can irritate the bladder and make it feel like one needs to urinate.
- Delayed urine stream: As the prostate grows around the urethra, more force is needed to overcome the pressure of the prostate. This manifests in a delayed urine stream, as increased force is required to begin the urination process.
- Weak or sporadic urine stream: The prostate can impinge on the urethra, as it surrounds it anatomically. As the prostate grows, it pinches on the urethra, which can disrupt the stream of urination.
- Dribbling: As the prostate surrounds the urethra, less control is exerted on the urination stream, which can result in dribbling after urination.
- Nocturia (increased urination during sleep): Similar to increased urinary frequency and urgency, the pressure placed on the bladder by a large prostate can cause frequent urination that disrupts sleep.
- Urinary retention: The inability to empty the bladder can result in urinary retention.
- Urinary incontinence: In some cases, changes in bladder function secondary to BPH may result in an overactive bladder. This can further result in urinary incontinence, or the involuntary release of urine.
- Pain following urination or ejaculation: Increased prostate size may cause urinary tract infection (see below), which may manifest as pain during urination or ejaculation.
- Urinary tract infections: Urinary tract infections are common among men with BPH. This may be due to multiple mechanisms. First, the inability to completely empty the bladder may cause urine stasis in the bladder. Second, irritation to the bladder itself can cause inflammation and cystitis.
Complications from Prostate Issues
There are various complications from prostate issues that can range from mild to severe. Mild issues may be day-to-day hindrances, while severe issues may result in hospitalization. Complications include:
- Acute urinary retention: Acute urinary retention, the sudden inability to void, is a dangerous effect of BPH. In this situation, the bladder must be decompressed using urethral or suprapubic catheterization. There are various reasons causing acute urinary retention, but common ones include prostatic inflammation, constipation, and medications. Up to one-third patients undergoing surgical treatment for BPH may present with acute urinary retention.
- Chronic urinary retention: Chronic urinary retention develops over time, when patients cannot completely empty urinary contents from the bladder. In this situation, patients are often able to void, but there is incomplete voiding.
- Hematuria: Hematuria, or blood in the urine, may be a complication from BPH that may be indicative of a more dangerous underlying disease process. For patients with BPH, hematuria can occur as a result of congested prostatic blood vessels. However, in patients with hematuria, workup for malignancy or urolithiasis (stones) is also warranted.
- Urinary tract infections: When there is constant post-residual volume following incomplete emptying, there is also risk for urinary tract infections. This is due to stasis of urine, which can harbor bacteria.
- Bladder issues: Irritation of the bladder due to incomplete voiding or increased pressure to void can also cause damage to the bladder. Overtime the bladder may atrophy (weaken) and lose the ability to empty.
- Kidney issues: Inability to completely void may also damage the kidneys over time. Patients can experience acute kidney injury, chronic kidney disease, or a combination thereof depending on the chronicity of their disease.
- Bladder calculi: Bladder calculi, or bladder stones, may also occur as a complication of BPH. The presence of stones is associated with urinary tract infections. Bladder stones due to BPH occur in about 1/10th patients and is an indication for surgery.
When to Get Help for BPH Symptoms
The range of symptoms related to BPH is a spectrum. If you are experiencing acute urinary retention, or the inability to pass urine at all, it is critical to seek professional medical help immediately.
Enlarged Prostate (BPH) Treatment Options in Houston
Dr. Maneevese is one of the few providers in Houston that offers PAE, a minimally-invasive procedure to treat BPH. If you or a loved one are experiencing BPH signs and symptoms, reach out to learn more about this procedure.
