Benign Prostatic Hyperplasia (BPH) 101: Causes, Symptoms, Treatment

Benign prostatic hyperplasia (BPH) or prostate gland enlargement is when men’s prostate gland is enlarged. It becomes more common as men get older. Learn more about BPH, its causes, symptoms and treatment here in Malaysia.

by Raihan Rahman

Benign prostatic hyperplasia (BPH)

Benign prostatic hyperplasia (BPH) is a condition commonly occurring among older men, whereby their prostate gland gets enlarged. In fact, men undergo two periods of prostate growth; the first happens during puberty, while the second phase starts around the age of 25 and grows gradually. Therefore, men are expected to have a larger prostate as they get older. 

A prostate enlargement becomes a problem when it begins to interfere with your urinary functions. BPH is different from prostate cancer, as it is non-cancerous (benign) and does not indicate a serious threat to your health

However, if symptoms begin to appear, early consultation with the doctor is required to prevent further health risks in your urination processwhich tends to get uncomfortable or possibly painful in day-to-day life. 

What and where is the prostate gland?

The prostate gland is one of the organs in the male reproductive system shaped like a walnut, whose main function is to produce fluid for semen to travel easily. The gland is situated under your bladder, surrounding the urethra that carries urine or semen into the penis and out of your body

What happens when the prostate gland gets enlarged?

When the prostate increases in size, it squeezes the urethra causing a narrowing. Due to this pressure, the bladder wall naturally gets thickened in order to work harder than usual when releasing urine into the urethra. Imagine your hand holding a water hose; when you slightly press against it, there will be a pressure building up to push out the water but only a little amount gets to pass through.

Over time, the bladder will become weak and lose its ability to completely empty out urine due to constant exertion. As a result, there will be urine residues left in the bladder which later may lead to leakage and incontinence (loss of control of urine)—both are the main symptoms of benign prostatic hyperplasia. 

Causes of Benign Prostatic Hyperplasia 

The specific causes of BPH remain unclear, although hormonal changes are often pointed out as a possible factor. 

One of the affected hormones may be dihydrotestosterone (DHT), a sex hormone that exists in both men and women. This hormone is mainly responsible for developing male characteristics such as deep voice, body hair and pubic hair, as well as the maturation of male reproductive organs including the prostate gland. While it is natural to have your prostate enlarged especially during puberty, a rise in DHT levels may worsen the enlargement. 

Imbalance in testosterone and oestrogen levels may also serve as another factor. The level of active testosterone gradually decreases as men age, making oestrogen levels comparatively higher. Higher levels of oestrogen are known to trigger the growth of prostate cells, thus leading to enlargement.    

Signs & Symptoms of Benign Prostatic Hyperplasia 

Each man experiences prostate enlargement differently; some have a bigger enlarged prostate but with no serious symptoms, while others with a much smaller one suffer from major urinary problems. Although the size of your prostate enlargement does not usually mean the symptoms are severe, being aware of the common signs of BPH can be helpful as a precaution. 

The common symptoms of BPH often involve:

  • Frequent urges to urinate about every 1 to 2 hours.
  • Having to wake up at night several times to urinate.
  • Inability to completely empty your bladder or feeling like there is a little amount of unreleased pee left in the bladder even after urinating.
  • Post micturition dribbles, or having small amounts of urine leaking after urination.
  • Difficulty starting urinating.
  • Having to strain or push out when passing urine.
  • Weak or slow urine flow.
  • Inability to hold in pee, hence the need to urinate immediately.
  • Frequently pausing and starting again while peeing, resulting in interrupted urine flow.

If the following severe symptoms occur, seek immediate medical help:

  • Feeling of pain or burning sensation when urinating
  • Inability to urinate at all
  • Signs of blood in the urine

To be safe, whenever you notice any abnormalities or have slight problems upon urinating, do consult with your doctor without hesitation. Ignoring minor symptoms may add up to other alarming issues in your urinary tracts such as infection, blockage, and bladder damage. 

Who is more likely to develop BPH?

The following groups are those who tend to be more at risk of getting BPH:

  • If your age is 40 years and above.
  • If any of your male family members have a history of BPH.
  • If you are a patient with obesity, type 2 diabetes, or heart and circulatory disease.
  • If you suffer from erectile dysfunction.
  • If you do not exercise regularly.

Diagnosis of Benign Prostatic Hyperplasia

First and foremost, your medical provider will ask several questions to gather information on your personal background and medical history, including your family’s. Then, you may be asked to describe your symptomsarising issues when urinating, the intensity of pain or discomfort, as well as the period of having the symptoms. 

Your doctor will then proceed with physical examinations and other tests, if necessary. 

Physical tests 

A digital rectal exam (DRE) is sort of the male version of a women’s pap smear. This procedure takes about only one to two minutes and may cause slight discomfort. The doctor inserts a lubricated and gloved finger into your rectum (the organ that holds your poop) to feel the back of the prostate gland. The aim is to examine any presence of abnormalities, lumps, tenderness, or hard mass. 

A cystoscopy exam is performed to diagnose the problems in your urethra and bladder. It is done by inserting a tiny camera into the urethra until it reaches the inside of your bladder. 

Urine tests

There are various types of urine tests conducted to find out if the urethra has any obstructions such as:

  • Urinalysis: A sample of your urine is checked to detect signs of blood, infection, and changes in protein or glucose levels. 
  • Uroflowmetry: A test to evaluate the speed, duration, and volume of your urine flow.
  • Urodynamic: A procedure to assess how well your bladder and urethra work during urination. 
  • Post-void residual volume: A test to measure how much urine is left in the bladder after urination. A large amount of residual may signify urinary retention (bladder’s inability to empty all the urine).

Scans

The purpose of scans is to view the size of the prostate enlargement in a more accurate way and is usually done through ultrasounds. If surgery is needed, magnetic resonance imaging (MRI) and computed tomography (CT) may be performed to get clearer results.

Blood Tests

Blood tests can also help to check the level of prostate-specific antigen (PSA), a type of protein produced by your prostate gland. A rise in PSA level may indicate a presence of benign prostatic hyperplasia.

Treatment for Benign Prostatic Hyperplasia

Watchful Waiting

Most cases of BPH are mild and only require close observation by the doctor without receiving any active treatments. You will need to attend follow-up visits for a yearly physical exam and tests to track the progress of your symptoms or any possible new ones. Throughout this period of observation, avoid consuming medications that can worsen your prostate enlargement. 

Your doctor may also recommend making some lifestyle changes for example:

  • Trying out exercises to strengthen pelvic floor muscles like the Kegel exercise.
  • Limit your water intake especially before going to sleep.
  • Avoid consumption of alcohol and caffeine. 
  • Practice a balanced diet to prevent constipation.

Medications

Medical providers may prescribe medications for men with moderate to severe symptoms, who refuse to proceed with surgeries. The primary goal of medical treatments is to reduce or stop the growth of prostate enlargement, as well as minimise the severity of BPH symptoms. 

However, it is important to note that long-term medications can have adverse effects on your health. Consult with your doctor first and take into account all considerations before deciding.   

There are two major types of medication used to treat BPH which are:

  • Alpha-blockers 

This group of drugs functions to relax the tension of the muscle in your bladder and prostate, thus relieving any blockage or obstruction. As a result, your urine will flow more smoothly and will be less likely to urinate frequently.

As alpha-blockers work instantly within a few days, these drugs often serve as the first choice of treatment for BPH. Side effects to look out for include sudden low blood pressure and a feeling of lightheadedness. Some examples of alpha-blockers are Terazosin (Hytrin), Doxazosin(Cardura) and Alfuzosin (Xatral). 

  • 5-alpha reductase inhibitors

These drugs help to shrink the prostate gland by preventing the production of dihydrotestosterone (DHT), the male hormone that supports prostate growth. Ideal for men with larger prostates, 5-alpha reductase inhibitors can improve your bladder’s ability to empty urine fully.

It may take about six months to become effective, with side effects including erectile dysfunction, reduced sexual urges, and difficulty of ejaculating. Examples of drugs are Finasteride (Proscar) and Dutasteride (Avodart). 

Surgery

Surgeries are recommended as a last resort for men with moderate and severe symptoms, whose medications are proven ineffective. Although surgery serves as a quick fix to your benign prostatic hyperplasia, your doctor will probably put out a disclaimerthat there is still a small chance your prostate enlargement may regrow later.

Minimally invasive surgery

Less invasive surgery does not involve major cuttings on your body, like how regular surgery works. For BPH specifically, it only entails removals of some parts of your enlarged prostate through suction, heat, or steam therapy. 

Hence, you may recover much faster as compared to the major open surgery and an overnight stay in the hospital is often deemed unnecessary.

Several types of minimally invasive surgeries to consider include:

  • Prostatic Urethral Lift: A needle is used to place small implants in your prostate to ‘suck’ and shrink the enlargement. 
  • Water Vapour Thermal Therapy: Use of steam from a combination of radiofrequency and water to kill some of the prostate cells.  
  • Transurethral Microwave Therapy: A flexible tube is inserted into your urethra to the prostate, where the microwaves radiate heat to destroy some tissues of the enlargement.

More invasive surgery

If neither medications nor the less invasive surgeries show any improvements, your medical provider would probably begin to suggest options for more invasive surgery. This type of major surgery usually requires incisions (cuts) or laser techniques.

The most common major procedure for BPH is Transurethral Resection of the Prostate (TURP). During this surgery, you will be put under anaesthesia while a surgical instrument called a resectoscope is being inserted through your penis into the urethra. The loop at the end of the resectoscope emits an electric current resembling a laser to cut through the enlarged tissues of your prostate. TURP only takes around 1 hour to complete, but you will need to stay for a few days in the hospital to be monitored. 

Living with Benign Prostatic Hyperplasia 

As BPH affects your urination, having trouble when passing urine can be such a restless experience to endure every single day. For our ageing seniors, they tend to keep these conditions like leakage of urine to themselves due to feelings of embarrassment. While this seems to be normal, leaving it uncleaned over time can be a trigger for infection.

Perhaps your loved ones are in need of active surveillance to assist them in managing their urination process. If you are searching for trusted and licensed caregivers to do just that, book a free consultation with us at Homage to discuss how we can provide support.    


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References

Benign Prostatic Hyperplasia. (2022, April 2). TeachMe Surgery. https://teachmesurgery.com/urology/prostate/benign-prostatic-hyperplasia/

John Hopkins Medicine. (n.d.). Benign Prostatic Hyperplasia (BPH). https://www.hopkinsmedicine.org/health/conditions-and-diseases/benign-prostatic-hyperplasia-bph

McVary, K. T. (2020, November 4). Patient education: Benign prostatic hyperplasia (BPH) (Beyond the Basics). UpToDate. https://www.uptodate.com/contents/benign-prostatic-hyperplasia-bph-beyond-the-basics

National Institute of Diabetes and Digestive and Kidney Diseases. (n.d.). Prostate Enlargement (Benign Prostatic Hyperplasia). https://www.niddk.nih.gov/health-information/urologic-diseases/prostate-problems/prostate-enlargement-benign-prostatic-hyperplasia

Urology Care Foundation. (2021, September). Benign Prostatic Hyperplasia (BPH). https://www.urologyhealth.org/urology-a-z/b/benign-prostatic-hyperplasia-(bph)

Woo, S. (2012, April 26). Benign Prostatic Hyperplasia. MyHealth Malaysia. http://www.myhealth.gov.my/en/benign-prostatic-hyperplasia-2/ 

About the Writer
Raihan Rahman
Raihan loves psychological thriller books and horror movies but sleeps with a night light, lest the monsters get her.
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