Prostate problems: benign prostatic hypertrophy
What is benign prostatic hypertrophy (BPH)?
Benign means not malignant, that is, non-cancerous; prostatic refers to a man's prostate gland (a small walnut-sized gland near the opening of the bladder which makes some of the fluid in semen); hypertrophy means an abnormal increase in the number of cells in one part of the body, causing an overgrowth of that part of the body. So BPH, as it is sometimes known, is a non-cancerous overgrowth of cells in the prostate.
Because the prostate surrounds the urethra (the tube that goes out of the bladder into your penis), if it gets too big and squeezes the urethra, you can have problems passing water. A man's prostate usually becomes larger in middle to old age. Prostates get a little bigger in all men over 45 to 50 years of age. They get big enough to interfere with passing urine in about 25 per cent of men over 55 and 50 per cent of men over 75.
How did I get BPH?
No one knows why it happens: it may be related to hormonal changes with increasing age. Some drugs such as alcohol, those used to treat depression or Parkinson’s disease, diuretics (fluid tablets), some heart drugs, antihistamines, and some cough and cold remedies can make the problem worse.
How is BPH diagnosed?
The doctor will ask you about your symptoms and what medications, if any, you are taking. You will then have a digital rectal examination (DRE) where the doctor inserts a gloved finger into your back passage. Because the prostate is near the back passage, if it has got bigger, the doctor will feel a bulge. You may be sent to a specialist (urologist) for further tests including measuring your urine flow, X-ray or ultrasound or some laboratory tests. A blood test for prostate specific antigen (PSA) may also be done, and your urine will be checked for infection.
What will I feel?
It is rare for men under 50 to 55 years to have any problems even if they have slightly larger prostates. The first sign of trouble is usually a difficulty in passing urine: it may be hard to start, and the stream may not be very strong. You may have trouble emptying your bladder completely and therefore have to go more often, which can disturb your sleep. You may feel a strong urge to urinate but not have much to pass, or dribble a bit after you have finished, wetting your pants. Very occasionally, there can be blood in the urine. You may get a bladder infection because the flow is not good, or your urine may be suddenly blocked completely.
What makes BPH better?
- Avoiding or cutting down on alcohol.
- Not drinking anything for 3 hours before bedtime.
- Always going to the toilet immediately when you feel the urge, even at night.
- Ensuring your bladder empties completely; don’t rush.
How can my doctor help me?
Your doctor may decide to simply ‘watch and wait’. This decision is based on your age, severity of symptoms and your general health.
Drugs may be prescribed to:
- improve urine flow (for example, prazosin, tamsulosin, terazosin);
- reduce the size of the prostate (for example finasteride); or
- treat any infections.
If symptoms are very troublesome and not improving, you may need to have surgery.
Several complementary medicines have been used to relieve the symptoms. Most have not been well studied. They include:
- fruit of the saw palmetto (Serenoa repens, Sabal serrulata). Preliminary evidence suggests this is effective, and may be as effective as the drug finasteride;
- root of the South African star grass (Hypoxis rooperi);
- bark of the African plum tree (Pygeum africanum);
- root of the stinging nettle (Urtica dioica);
- pollen from rye (Secale cereale);
- pumpkin seeds (Cucurbita pepo); and
- beta-sitosterol plant extracts.
There are several types of surgery performed.
Transurethral resection of the prostate (TURP): is the most commonly undertaken type of prostate surgery. TURP involves removing the prostate in small pieces. The surgeon passes a small tube with a camera on the end into the urethra (the tube that carries urine from the bladder down to the opening of the penis). Via this tube, the surgeon can cut away part of the prostate using a metal loop carrying an electric current. Removing part of the prostate gland stops it from pressing on the urethra. TURP is sometimes done under a general anaesthetic and sometimes a spinal anaesthetic.
After having TURP, some men will suffer from retrograde ejaculation. This is when semen flows backward into the bladder during ejaculation. Erectile dysfunction is also an unfortunate result of TURP surgery in some cases.
Transurethral incision of the prostate (TUIP): this also relieves the pressure on the urethra. This may be used in cases where the enlargement is not as pronounced.
Balloon dilation: this is done by inserting a balloon-tipped catheter into the penis through the urethra and into the bladder. The balloon is then inflated to stretch the urethra to allow urine to flow more freely.
Minimally invasive surgical treatments: these usually use some form of heat, such as laser therapy, microwave therapy, or trans-urethral needle ablation (TUNA), to reduce the size of the prostate and so relieve pressure on the urethra. They may carry a smaller risk of side effects than a TURP and may require milder forms of anaesthesia. These treatments are not suitable for all men with prostate problems.
Open prostatectomy: if the prostate is very large, most of it may have to be removed by open surgery, where the abdomen is opened up. There is a risk of erectile dysfunction and a small chance of urinary incontinence after open surgery.
What happens if BPH is not treated?
In most people the symptoms stay the same or fluctuate, while in some, they get worse. You can get infected urine which will make you unwell and give you a fever. In a small percentage of people the blockage gets really bad, and they are unable to pass much urine at all and the kidneys can get damaged, making the person generally weak and sick. You may get a total blockage, and a tube will have to be put in to drain your urine.
2. Andrology Australia. BPH [updated 2005, Oct 11; accessed 2009, May 21]. Available at: http://www.andrologyaustralia.org/pageContent.asp?pageCode=BPH#AZBPHTREAT
3. MayoClinic.com. Prostate gland enlargement [updated 2007, Dec 14; accessed 2009, May 21]. Available at: http://www.mayoclinic.com/health/prostate-gland-enlargement/DS00027/