BPH, also known as benign prostatic hypertrophy, is a benign enlargement of the prostate gland. This is a typical component of the aging process and is frequent in senior males. The prostate gland has been shown to expand during a man’s life. It expands greatly twice in life. It enlarges first during puberty, when it doubles in size, and then later in life, when it causes symptoms at the age of 40 or more. Half of the men in their sixties will have symptoms due to an enlarged prostate. This enlargement that occurs later in life causes the prostate to press upon the urinary bladder or urethra, the tube through which urine is passed out. It can obstruct urine passage and cause difficulties with the urethra, bladder, or kidneys. BPH is not a cancer, nor does it increase the risk of prostate cancer.
Symptoms
The commonest symptoms of BPH are those relating to urination. The frequency, urgency, and ease of passage of urine may change. There may be more frequent urination, more so in the night, and this may disturb sleep. Some people have an urgent desire to pass urine and are unable to hold urine for an extended period of time. Others report leaking or dribbling, which occurs when urine passes without effort. Urination may be difficult to initiate, and one may need to strain more to pass urine. The stream of urine may not form, be weak, or be interrupted while clearing the bladder. Even after passing urine, you may have the urge to pass more. It may take more than one effort to achieve an easy sensation of an empty bladder.
Sometimes the affected person will just not pass any urine at all, which can be uncomfortable. This is called acute urinary retention. Left unattended, the problems can grow to a urinary tract infection when there is burning and pain in urination, fever, and distress. Stones may form in the urinary tract and either due to irritation by a stone or consequent to damage to blood vessels due to increasing pressures in the urinary tract, there can be blood in urine.
The symptoms are not governed by the size of the prostate. A very large gland may cause little or no complaints and a smaller gland can cause distressing symptoms.
Risk Factor
The only risk factor for BPH is aging. There are no other risk factors that have been identified. It may run in families, when numerous men in a household are affected. Whites are more likely than blacks to suffer from BPH.
The exact cause of BPH is unknown. It is not known to occur in men who have had their testicles removed. BPH is thought to be caused due to changes in hormonal environments as one age. The levels of the male hormone, testosterone, decrease as they age, while the levels of the female hormone, estrogen, begin to grow. Estrogen, on the other hand, is not a dominant hormone in men. Enlargement can also be caused due to changes in local hormones in the prostatic tissues.
Diagnosis
The doctor may ask you some questions related to the process of urination. If the doctor suspects a prostate problem, he or she may wish to feel it by putting a finger through the rectum. A simple chemical and laboratory examination of urine is a simple preliminary test that can help rule out an illness. A blood test may be performed to detect Prostate-specific antigen (PSA), a protein produced by the prostate that increases when the gland is inflammatory, infected, or irritated. The flow and pressure of the act of urination can be measured through urine flow testing. To obtain pictures of the prostate, an ultrasonic probe may be placed into the rectum. Furthermore, needles may be inserted through the prostate under ultrasound guidance to snip a portion of tissue for examination.
This is called a biopsy of prostate. The postvoid residual volume test will allow to measure if any urine is left in the bladder after passing urine, i.e., it enables diagnosis of incomplete bladder emptying. A flexible telescope called a cystoscope may be passed up the urinary opening in the penis to look at the inside of the urethra and bladder. A dye may be injected into a blood vessel and the filtration and excretion of the dye in the kidneys and the urinary system may be studied by taking repeated x-rays or by obtaining CT scans. This is called intravenous pyelogram (IVP) or CT urogram.
Medical help should be sought for even mild or trivial symptoms in elderly men. Any change in frequency, urgency, or straining required to pass urine, pus or blood in urine, and any burning, pain, or fever should be evaluated by a medical practitioner.
Treatment
BPH can be treated with various modalities like medications, surgery, and minimally invasive surgery. Treatment is determined by the size of the prostate, general health, age, and preferences of the patient, as well as how bothersome the symptoms have been.
The swollen portion of the prostate may be surgically removed. The most common procedures are transurethral resection of the prostate (TURP), which involves cutting the prostate with a flexible tube passed up the urethra, transurethral incision of the prostate (TUIP or TIP), which involves making small cuts in the prostate to relieve urinary tract obstruction, and open prostatectomy, which involves approaching an enlarged prostate through an incision in the abdomen.
Microwaves, needles, hot water, lasers, or high-intensity ultrasound waves are used in minimally invasive surgery to destroy the swollen gland. These include procedures such as transurethral microwave thermotherapy (TUMT), transurethral needle ablation (TUNA), water-induced thermotherapy, and high-intensity focused ultrasound.
Medical therapy is an effective first-line treatment for moderate symptoms caused by an enlarged prostate and can postpone surgery. Medicines such as alpha blockers act on particular receptors on the prostate gland and block them, allowing the muscles in the bladder neck and muscle fibers in the prostate to relax thereby making urination easy. These are quick acting and may improve symptoms within few days. Another class of medicines called the 5 alpha reductase inhibitors shrink the prostate by preventing hormonal changes that cause prostate growth. These medicines are finasteride and dutasteride. These are best used for the larger prostates and take several weeks to improve symptoms and arrest the enlargement of prostate. Combining medicines to include one from each class can provide additional benefits.
Outlook
You can exercise some caution and learn how to make your life better. Help yourself. Urinate at first urge, urinate often even without an urge, avoid drinking tea or coffee, especially after dinner, reduce stress and tension, and avoid medicines that can impair bladder evacuation, such as cough and cold medications and antihistamines. Exercise regularly and keep warm. You can certainly age more gracefully!
