Understanding Benign Prostatic Hyperplasia (BPH)

About the Prostate

The prostate is a small gland found in males and plays a role in semen production. It is positioned beneath the bladder and in front of the rectum, wrapping around the urethra that transports urine and semen out of the body.

About Benign Prostatic Hyperplasia (BPH)

Benign Prostatic Hyperplasia (BPH) is a non-cancerous prostate gland enlargement. This disorder is more commonly seen in men that are over the ages of 50. 

Essentially, this enlargement occurs when there is an obstruction in the passageway when the urine excretes out from the bladder, and it requires more pressure for urine to exit through.

This eventually causes the bladder to lack control and loses its function to fully be emptied. As the urethra is pinched, the bladder needs to work harder, causing the bladder muscles to become weak over time.

Men who have BPH may also experience erectile dysfunction and ejaculatory problems. Although BPH does not create these problems on its own, some of the treatments used for BPH can cause erectile dysfunction.

Benign Prostatic Hyperplasia Symptoms

There common signs and symptoms of BPH may include:

• Greater pressure and straining are needed to begin urinating.
• Hesitant and interrupted urination.
• A sensation of the bladder being not completely emptied after urination.
• Sudden inability to urinate (acute retention of urine).
• Sudden urgent need to urinate.
• Urinating more frequently, especially at night.
• Urine leakage.

Haematuria (blood in urine) may be a sign of BPH, but most men with BPH do not have haematuria.

Benign Prostatic Hyperplasia Causes and Risk Factors

There is still no clear cause of BPH. This condition can develop over time due to the buildup of the male hormone known as dihydrotestosterone (DHT), where it is included in the growing process of the prostate. The reason for high levels of DHT is not recorded. There is a theory that old age comes with hormonal imbalance that could be the cause for this disorder.

The risk factors of BPH include:

1. Ageing: An enlarged prostate gland seldom causes symptoms in individuals under the age of 40. Chances of having an enlarged prostate and its related symptoms will increase once you reach your 40s.
2. Family history: If you have a blood relative with prostate problems, the likelihood of you having problems with your prostate is higher.
3. Diabetes and heart disease: Studies show that diabetes and heart disease might raise the risk of having BPH.
4. Lifestyle: Obesity increases the risk of BPH, but the risk can be lowered through the help of exercising. 

Benign Prostatic Hyperplasia Complications and Related Diseases

If BPH is left untreated, it can cause further blockage in your urethra, and your symptoms may deteriorate. Untreated BPH may also cause:

Urinary incontinence

Urinary incontinence (UI) is a condition of losing control of your bladder or having the inability to control urination. It can be improved with proper treatment and care.

Bladder and urethra damage

A bladder that is not fully empty can expand and weaken over time, resulting in the bladder’s muscular wall being unable to adequately squeeze to force urine out, thus making it harder to empty the bladder completely. This may lead to bladder damage eventually.

Urethral stricture is the narrowing of the urethra - the tube that transports urine from the bladder through the penis and out the urethral meatus (the opening at the tip of the penis) during urination. Many men with urethral stricture will experience escalating discomfort with urinating and a slowing of the urinary stream. This can occur slowly and result in the need to exert extra pressure or effort to get urine out.

Bladder stones

Bladder stones are solid clumps of minerals that develop in your bladder. They form when urine stays in your bladder for a long time. If you have bladder stones, the most common symptom you will experience is abdominal pain, but it can also cause issues when urinating. 

Kidney infection (pyelonephritis)

Kidney infections is a type of urinary tract infection that typically shifts from your bladder to your kidneys. What causes kidney infections is commonly bacteria. Fever, trouble peeing, lower back pain, and pain when you pee are common symptoms of a kidney infection.

Kidney damage

The inability to urinate causes pressure in the bladder, harming the kidneys or increasing the odds of bladder infections reaching the kidneys.

Benign Prostatic Hyperplasia Diagnosis

Your doctor will go through your medical history, ask you relevant questions, and conduct a physical examination. A digital rectal exam is often part of the physical examination.

During the examination, your doctor will carefully insert their gloved finger into your rectum during a digital rectal exam. They will feel the edges and surface of your prostate, estimate your prostate’s size, and identify any hard spots that could be cancer.

Your doctor may also order:

• A survey to evaluate how severe your symptoms are.
• A urine flow test to measure the speed of your urine stream.
• A study to examine how much urine stays in your bladder after you have finished urinating.
• A cystoscopy to look into your bladder.

According to research, having BPH does not raise your risk of developing prostate cancer. However, both BPH and prostate cancer share similar symptoms. If you have BPH, it is possible that you have undetected prostate cancer as well, please consult a doctor as soon as possible.

Benign Prostatic Hyperplasia Treatment

There are a few treatments available to treat BPH. Your doctor will evaluate your condition and suggest the best treatment, depending on your age, the severity of BPH, and your general health.

The treatment options include:

1. Water Vapour Therapy (Rezūm)

Water Vapour Therapy (Rezūm) is a minimally invasive procedure for men seeking to treat BPH without drugs or surgery.

This treatment uses water vapour to reduce prostate tissue associated with BPH and provide lasting symptom relief from BPH symptoms safely and effectively.

During the Rezūm procedure, water vapour is released throughout the targeted prostate tissue using a special device. When the steam contacts the tissue and turns back into water, all the stored energy is released, killing excess prostate cells, and causing it to shrink, thus enlarging the opening of the urethra so that urine can flow freely. The amount of water vapour is adjusted depending on the size of the prostate.

Most patients can return to regular activities within a few days.

2. Drug treatment

This includes two broad categories of medication:

• Drugs that relax the prostate to reduce the blockage of the bladder opening.
• Drugs that block the production of the male hormone (DHT) which is a known contributor towards prostate enlargement.
3. Laser vaporisation

This treatment is for patients with smaller prostate glands, whereby laser energy is delivered, through the urethra, to the prostate gland in order to destroy tissue that is contributing to the enlarged prostate.

4. Surgical treatment 

This treatment removes the enlarged parts of the prostate that are pressing against the urethra. There are different surgical methods that can be used:

• Open surgery is used when the prostate is too large.
• Transurethral incision of the prostate.
• Transurethral resection of the prostate.
• Watchful waiting if your symptoms are less severe.

Benign Prostatic Hyperplasia Prevention

Making lifestyle changes that improve your prostate and heart health is the most effective methods to lower your risk of getting BPH.

Exercising at least half an hour each day may help prevent BPH or slow the growth of the prostate. What is important is maintaining normal cholesterol, blood pressure, and blood sugar levels.

Read more: Key Health Conditions Every Man Should Know About

Make an Appointment at Gleneagles Hospitals

If you suspect that you are experiencing symptoms of Benign Prostatic Hyperplasia (BPH), get in touch with us to find out more about our Urology Services at your nearest Gleneagles Hospital.

You may also contact the Health Screening Centre at your nearest Gleneagles Hospital for health screening appointments.