Enlarged Prostate: Benign Prostatic Hyperplasia (BPH)
Benign prostatic hyperplasia (BPH) is a common urologic condition caused by the non-cancerous enlargement of the prostate gland as men get older. As the prostate enlarges, it can squeeze down on the urethra. This can cause men to have trouble urinating and can lead to symptoms of BPH. The symptoms associated with BPH are known as lower urinary tract symptoms (LUTS).
What are the symptoms associated with BPH?
Since the prostate is just below the bladder, its enlargement can result in symptoms that irritate or obstruct the bladder. Common symptoms are:
- The need to frequently empty the bladder, especially at night
- Difficulty in beginning to urinate
- Dribbling after urination ends
- Decreased size and strength of the urine stream
- The sensation that the bladder is not empty, even after a man is done urinating
- Inability to postpone urination once the urge to urinate begins
- Pushing or straining in order to urinate
In extreme cases, a man might not be able to urinate at all, which is an emergency that requires prompt attention.
Diagnosis of BPH/LUTS
As a man ages, his prostate may become larger and start to cause urinary symptoms and other problems. But what are some of those problems? How will a man know if he has an enlarged prostate (also known as BPH)? When should a man see his doctor? What kinds of tests will the doctor perform? The following guide should help answer your questions and help you make an informed decision about what your next steps should be.
What are the risk factors for BPH?
Risk factors for developing BPH include:
- Erectile dysfunction
- A family history of BPH
- Increasing age
- Lack of physical activity
How is BPH diagnosed?
In order to help assess the severity of such symptoms, the American Urological Association (AUA) BPH Symptom Score Index was developed. This diagnostic system includes a series of questions that ask how often the urinary symptoms identified above occur and the amount of bother from these symptoms. This helps measure how severe the BPH is, ranging from mild to severe.
When a doctor evaluates someone for possible BPH, the evaluation will typically consist of a thorough medical history, an examination of the urinary sediment (urinalysis), a physical examination (including a digital rectal exam or DRE), and use of the AUA BPH Symptom Score Index. In addition, the doctor will generally do a urine test called a urinalysis.
There are a series of other studies that may or may not be offered to a patient being evaluated for BPH depending on the patient’s current medical condition. These include:
- Cystoscopy– a direct look into the urethra and/or bladder using a small flexible scope
- Measurement of post-void residual volume (PVR) – the amount of urine left in the bladder after urinating
- Prostate specific antigen (PSA) – a blood test to screen for prostate cancer
- Ultrasound of the kidney or the prostate – to view the enlargement
- Urinary cytology – a urine test to screen for bladder cancer
- Urodynamic pressure-flow study – tests the pressure inside the bladder during urination
- Uroflowmetry, or urine flow study – a measure of how fast urine flows when a man urinates
When should I see a doctor about BPH?
A man should see a doctor if he is bothered by any of the symptoms mentioned above. In addition, he should see a doctor immediately if he has blood in the urine, pain or burning with urination, or is unable to urinate.
What are some of the medical treatments available for BPH?