Benign prostatic hyperplasia (BPH), often known as prostate gland enlargement, is a common disorder in elderly men. An enlarged prostate gland can produce unpleasant urinary symptoms, such as obstructing urine passage out of the bladder. It can also create difficulties with the bladder, urinary system, or kidneys.
Medication, minimally invasive therapy, and surgery are all viable treatments for prostate gland enlargement. You and your doctor will evaluate your symptoms, the size of your prostate, any other health concerns you may have, and your preferences while deciding on the best alternative.
WHAT ARE THE SYMPTOMS OF BPH?
The intensity of symptoms in men with prostate gland enlargement varies, but they tend to increase over time. The following are some of the most common indications and symptoms of BPH:
- Urge to urinate often or urgently
- Increased nighttime urination (nocturia)
- Difficulty beginning urination
- A weak urine stream or a stream that comes and goes
- Dribbling at the end of urinating
- Inability to empty the bladder entirely
Signs and symptoms that are less prevalent include:
- Infection of the urinary tract
- Inability to urinate
- Urine with blood
The size of your prostate does not always indicate the severity of your problems. Some men with modestly enlarged prostates may experience considerable symptoms, whilst others with severely enlarged prostates may experience just minor urine problems.
Symptoms may ultimately settle and even improve in some men.
Other reasons for urinary symptoms
Conditions that might induce symptoms similar to an enlarged prostate include:
- Urinary tract infection
- Scarring in the bladder neck caused by prior surgery
- Stones in the bladder or kidney
- Issues with the nerves that regulate the bladder
- Inflammation of the prostate (prostatitis)
- Urethral constriction (urethral stricture)
- Prostate and bladder cancer
WHAT ARE THE CAUSES OF BPH?
The prostate gland is beneath the bladder. The urethra (the tube that delivers urine from the bladder to the penis) runs through the middle of the prostate. When the prostate grows in size, it begins to obstruct urine flow.
Most men's prostates continue to develop throughout their lives. This persistent development enlarges the prostate in many men, causing urinary discomfort or considerably blocking urine flow.
It's unclear what causes the prostate to grow. It might, however, be owing to changes in the balance of sex hormones as men age.
WHAT ARE THE RISK FACTORS FOR BPH?
The following are risk factors for prostate gland enlargement:
- Aging: Prostate gland enlargement seldom produces symptoms in males under the age of 40. By the age of 60, one-third of men have moderate to severe symptoms, and half have them by the age of 80.
- Family history: Having a blood relative with prostate difficulties, such as a father or a brother, increases your chances of having problems.
- Heart disease and diabetes: Diabetes, heart disease, and the use of beta blockers have all been linked to an increased risk of BPH, according to research.
- Lifestyle: Obesity raises the risk of BPH, but exercise lowers it.
WHAT ARE THE COMPLICATIONS OF BPH?
An enlarged prostate can cause the following complications:
- Unexpected difficulty urinating (urinary retention): To drain the pee, you may need to have a tube (catheter) put into your bladder. To treat urinary retention, some men with enlarged prostates require surgery.
- Urinary tract infections (UTIs): Inability to completely empty the bladder might raise the risk of urinary tract infection. If UTIs recur regularly, you may require surgery to remove a portion of your prostate.
- Bladder stones: In most cases, this is caused by an inability to completely empty the bladder. Bladder stones can result in infection, bladder discomfort, blood in the urine, and urinary flow restriction.
- Bladder damage: A bladder that hasn't been fully emptied might expand and weaken over time. As a result, the bladder's muscular wall no longer contracts properly, making it more difficult to completely empty your bladder.
- Kidney damage: Urinary retention pressure can directly harm the kidneys or allow bladder infections to reach the kidneys.
The majority of men with an enlarged prostate do not experience these issues. Acute urine retention and renal damage, on the other hand, might pose major health risks.
It is not thought that having an enlarged prostate increases your chance of acquiring prostate cancer.
HOW IS BPH DIAGNOSED?
Your doctor will begin by asking specific questions about your symptoms and performing a physical examination. This preliminary examination will most likely include:
- Digital rectal examination: To examine for prostate enlargement, the doctor puts a finger into the rectum.
- Urine test: A urine sample analysis can help rule out an infection or other illnesses that generate similar symptoms.
- Blood test: The results might point to renal troubles.
- Prostate-specific antigen (PSA) blood test: PSA is a hormone generated in the prostate. When you have an enlarged prostate, your PSA levels rise. Elevated PSA levels, on the other hand, might be caused by recent operations, infection, surgery, or prostate cancer.
Following that, your doctor may suggest more testing to confirm an enlarged prostate and rule out other diseases. Among these tests are:
- Urinary flow test: You pee into a container connected to a machine that monitors the intensity and volume of your urine flow. Test findings might help you evaluate if your disease is improving or worsening over time.
- Postvoid residual volume test: This test determines if you can totally empty your bladder. The ultrasonography test or putting a catheter into your bladder after you urinate to assess how much urine is remaining in your bladder can be used to do the test.
- 24-hour voiding diary: Recording the frequency and volume of urine you pass may be especially beneficial if you pass more than one-third of your daily urinary output at night.
If your illness is more complicated, your doctor may advise you to:
- Transrectal ultrasound: To measure and analyze your prostate, an ultrasound probe is put into your rectum.
- Prostate biopsy: Transrectal ultrasonography directs needles used to collect prostate tissue samples (biopsies). The tissue examination might help your doctor detect or rule out prostate cancer.
- Studies on urodynamics and pressure flow: A catheter is inserted into your bladder through your urethra. Slowly, water — or, less usually, air — is pumped into your bladder. Your doctor will then be able to test bladder pressure and assess how effectively your bladder muscles are performing. These examinations are normally reserved for men who have suspected neurological disorders or who have undergone a previous prostate operation and still have difficulties.
- Cystoscopy: A flexible, illuminated device (cystoscope) is put into your urethra, allowing your doctor to look within your urethra and bladder. Before this test, you will be given a local anesthetic.
WHAT ARE THE TREATMENTS FOR BPH?
Medication, minimally invasive therapy, and surgery are among options for treating an enlarged prostate. The optimum treatment option for you is determined by various criteria, including:
- Your prostate's size
- Your age
- Your general health
- The level of discomfort or annoyance you are feeling
If your symptoms are acceptable, you may choose to postpone therapy and merely monitor them. Some men's symptoms may subside without therapy.
Medication
The most frequent therapy for mild to moderate symptoms of prostate enlargement is medication. Among the alternatives are:
- Alpha blockers: These drugs relax the bladder neck muscles and prostate muscle fibers, making urination simpler. In males with relatively small prostates, alfuzosin (Uroxatral), doxazosin (Cardura), tamsulosin (Flomax), and silodosin (Rapaflo) typically function fast. Dizziness and a harmless condition in which semen travels back into the bladder instead of out the tip of the penis are possible side effects (retrograde ejaculation).
- 5-alpha reductase inhibitors: These drugs reduce prostate size by blocking hormonal changes that induce prostate development. These drugs, which include finasteride (Proscar) and dutasteride (Avodart), can take up to six months to work. Retrograde ejaculation is one of the side effects.
- Combination drug therapy: If either medicine alone is ineffective, your doctor may advise you to take an alpha blocker and a 5-alpha reductase inhibitor at the same time.
- Tadalafil (Cialis): According to research, this medicine, which is commonly used to treat erectile dysfunction, can also be used to treat prostate enlargement.
Minimally invasive or surgical therapy
A minimally invasive or surgical treatment plan may be suggested if:
- Your symptoms range from mild to severe.
- Your symptoms have not been alleviated by medication.
- You have a blockage in your urinary system, bladder stones, blood in your urine, or kidney difficulties.
- You prefer conclusive treatment.
Surgery or less invasive treatment may not be an option if you have:
- A urinary tract infection that has gone untreated
- Urethral stricture disease
- Prostate radiation treatment or urinary tract surgery in the past
- A neurological condition like multiple sclerosis or Parkinson's disease
Any prostate operation might result in negative effects. Complications may occur depending on the technique you choose:
- During ejaculation, sperm flows backward into the bladder rather than out via the penis (retrograde ejaculation)
- Bleeding
- Erectile dysfunction
- Urinary incontinence for a short time
- Urinary tract infection
- In rare cases, bladder control is lost (incontinence)
Minimally invasive or surgical treatments come in a variety of forms.
Transurethral resection of the prostate (TURP)
The surgeon inserts a lighted scope into your urethra and removes everything except the outside section of the prostate. TURP often improves symptoms immediately, and most men experience increased urine flow shortly after the surgery. You may require a catheter to empty your bladder briefly following TURP.
Transurethral incision of the prostate (TUIP)
A lighted scope is introduced into your urethra, and the surgeon makes one or two tiny incisions in the prostate gland to allow urine to move more easily. If you have a tiny or moderately enlarged prostate gland and have health issues that make other operations too hazardous, this surgery may be a possibility for you.
Transurethral microwave thermotherapy (TUMT)
Your doctor inserts a particular electrode into your prostate region through your urethra. The electrode's microwave radiation kills the inner section of the enlarged prostate gland, reducing it and facilitating urine flow. TUMT may only partially reduce your symptoms, and it may take some time to see improvements. Because re-treatment may be required, this procedure is normally reserved for tiny prostates in exceptional cases.
Transurethral needle ablation (TUNA)
A scope is passed through your urethra, allowing your doctor to insert needles into your prostate gland. Radio waves are sent via the needles, heating and eliminating the extra prostate tissue that is obstructing urine flow. TUNA may be an alternative in some circumstances, however it is rarely utilized nowadays.
Laser therapy
Overgrown prostate tissue is destroyed or removed with a high-energy laser. Laser treatment usually improves symptoms immediately and has fewer adverse effects than nonlaser surgery. Laser treatment may be utilized in men who are unable to undergo conventional prostate operations due to the usage of blood-thinning drugs.
Among the laser therapy possibilities are:
- Ablative procedures: To enhance urine flow, these techniques vaporize obstructive prostate tissue. Photoselective vaporization of the prostate (PVP) and holmium laser ablation of the prostate are two examples (HoLAP). Because ablative techniques might induce bothersome urinary symptoms following surgery, another resection procedure may be required at some time.
- Enucleative procedures: Enucleative techniques, such as holmium laser enucleation of the prostate (HoLEP), remove all of the prostate tissue that is obstructing urine flow and prevent tissue regrowth. The tissue taken can be tested for prostate cancer and other diseases. These operations are comparable to open prostatectomy.
Prostatic urethral lift (PUL)
To stimulate the flow of urine, special tags are utilized to pressure the sides of the prostate. If you have lower urinary tract issues, the operation may be advised. Because the effect on ejaculation and sexual function is substantially lower with PUL than with TURP, it may be provided to those men who are concerned about the treatment's influence on erectile dysfunction and ejaculatory difficulties.
Embolization
The blood flow to or from the prostate is selectively stopped in this experimental method, causing the prostate to shrink in size. There is no long-term data on the efficacy of this surgery.
Open or robot-assisted prostatectomy
In order to access the prostate and remove tissue, the surgeon creates an incision in your lower abdomen. If you have a very big prostate, bladder injury, or other complicated conditions, an open prostatectomy is usually performed. The operation normally necessitates a brief hospital stay and is associated with an increased risk of requiring a blood transfusion.
Follow-up treatment
Your post-treatment care will be determined by the procedure utilized to treat your enlarged prostate.
If you have laser ablation, transurethral needle ablation, or transurethral microwave treatment, your doctor may advise you to avoid heavy lifting and strenuous activity for seven days. You may need to limit your activities for six weeks after an open or robot-assisted prostatectomy.
HOME REMEDIES FOR BPH
To alleviate the symptoms of an enlarged prostate, try the following:
- Don't drink too much in the evening: To avoid waking up in the middle of the night, avoid drinking anything for an hour or two before bedtime.
- Caffeine and alcohol should be avoided: They have the potential to increase urine output, irritate the bladder, and aggravate symptoms.
- Plan your bathroom trips: To "retrain" the bladder, try to pee at regular intervals, such as every four to six hours during the day. This is especially effective if you have a high level of frequency and urgency.
- Maintain a nutritious diet: Obesity is linked to enlarged prostate.
- Continue to be active: Urine retention is exacerbated by inactivity. Even little exercise can help minimize urinary issues caused by an enlarged prostate.
- Urinate once, and then shortly after, urinate once more: This is referred to as double voiding.
- Stay warm: Colder temperatures might promote urine retention and make it more difficult to pee.
- Avoid using decongestants or antihistamines: These medications constrict the band of muscles that controls pee flow around the urethra, making it more difficult to urinate.
- When you first feel the urge, go: Waiting too long may cause the bladder muscle to overstretch and cause injury.