Benign prostatic hyperplasia (BPH) is an enlarged prostate gland that is caused by the normal ageing process and not by cancer. The prostate is a walnut-sized gland that is involved in the production of semen. It is located in front of the rectum and below the bladder. The bladder stores urine and the urethra is the tube that carries the urine out of the body. The prostate may get bigger as a man gets older.An enlarged prostate can press on the urethra. This can make it harder to pass urine. The build-up of urine in the bladder can cause infection. Back pressure and infection may progress to bladder damage and kidney failure.
What are the causes?
This condition is part of a normal ageing process. However, not all men develop problems from this condition. If the prostate enlarges away from the urethra, urine flow will not be blocked. If it enlarges toward the urethra and compresses it, there will be problems passing urine.
What increases the risk?
This condition is more likely to develop in men over the age of 50 years.
What are the signs or symptoms?
Symptoms of this condition include:
- Getting up often during the night to urinate.
- Needing to urinate frequently during the day.
- Difficulty starting urine flow.
- Decrease in size and strength of your urine stream.
- Leaking (dribbling) after urinating.
- Inability to pass urine. This needs immediate treatment.
- Inability to completely empty your bladder.
- Pain when you pass urine. This is more common if there is also an infection.
- Urinary tract infection (UTI).
How is this diagnosed?
This condition is diagnosed based on your medical history, a physical exam, and your symptoms. Tests will also be done, such as:
- A post-void bladder scan. This measures any amount of urine that may remain in your bladder after you finish urinating.
- A digital rectal exam. In a rectal exam, your healthcare provider checks your prostate by putting a lubricated, gloved finger into your rectum to feel the back of your prostate gland. This exam detects the size of your gland and any abnormal lumps or growths.
- An exam of your urine (urinalysis).
- A prostate specific antigen (PSA) screening. This is a blood test used to screen for prostate cancer.
- An ultrasound. This test uses sound waves to electronically produce a picture of your prostate gland.
Your healthcare provider may refer you to a specialist in kidney and prostate diseases (urologist).
How is this treated?
Once symptoms begin, your healthcare provider will monitor your condition (active surveillance or watchful waiting). Treatment for this condition will depend on the severity of your condition. Treatment may include:
- Observation and yearly exams. This may be the only treatment needed if your condition and symptoms are mild.
- Medicines to relieve your symptoms, including:
- Medicines to shrink the prostate.
- Medicines to relax the muscle of the prostate.
- Surgery in severe cases. Surgery may include:
- In this procedure, the prostate tissue is removed completely through an open incision or with a laparoscope or robotics.
- Transurethral resection of the prostate (TURP). In this procedure, a tool is inserted through the opening at the tip of the penis (urethra). It is used to cut away tissue of the inner core of the prostate. The pieces are removed through the same opening of the penis. This removes the blockage.
- Transurethral incision (TUIP). In this procedure, small cuts are made in the prostate. This lessens the prostate's pressure on the urethra.
- Transurethral microwave thermotherapy (TUMT). This procedure uses microwaves to create heat. The heat destroys and removes a small amount of prostate tissue.
- Transurethral needle ablation (TUNA). This procedure uses radio frequencies to destroy and remove a small amount of prostate tissue.
- Interstitial laser coagulation (ILC). This procedure uses a laser to destroy and remove a small amount of prostate tissue.
- Transurethral electrovaporization (TUVP). This procedure uses electrodes to destroy and remove a small amount of prostate tissue.
- Prostatic urethral lift. This procedure inserts an implant to push the lobes of the prostate away from the urethra.
Follow these instructions at home:
- Take over-the-counter and prescription medicines only as told by your healthcare provider.
- Monitor your symptoms for any changes. Contact your healthcare provider with any changes.
- Avoid drinking large amounts of liquid before going to bed or out in public.
- Avoid or reduce how much caffeine or alcohol you drink.
- Give yourself time when you urinate.
- Keep all follow-up visits as told by your healthcare provider. This is important.
Contact a healthcare provider if:
- You have unexplained back pain.
- Your symptoms do not get better with treatment.
- You develop side effects from the medicine you are taking.
- Your urine becomes very dark or has a bad smell.
- Your lower abdomen becomes distended and you have trouble passing your urine.
Get help right away if:
- You have a fever or chills.
- You suddenly cannot urinate.
- You feel lightheaded, or very dizzy, or you faint.
- There are large amounts of blood or clots in the urine.
- Your urinary problems become hard to manage.
- You develop moderate to severe low back or flank pain. The flank is the side of your body between the ribs and the hip.
These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services. Do not drive yourself to the hospital.
- Benign prostatic hyperplasia (BPH) is an enlarged prostate that is caused by the normal ageing process and not by cancer.
- An enlarged prostate can press on the urethra. This can make it hard to pass urine.
- This condition is part of a normal aging process and is more likely to develop in men over the age of 50 years.
- Get help right away if you suddenly cannot urinate.
This information is not intended to replace advice given to you by your healthcare provider. Make sure you discuss any questions you have with your healthcare provider.
Jung J., Kim J., MacDonald R., et. al.: Silodosin for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia. Cochrane Database Syst Rev 2017; CD012615
Roehrborn C.G., Barkin J., Gange S.N., et. al.: Five year results of the prospective randomized controlled prostatic urethral LIFT study. Can J Urol 2017; 24: pp. 8802-8813.
Simon R.M., Howard L.E., Moreira D.M., et. al.: Does prostate size predict the development of incident lower urinary tract symptoms in men with mild to no current symptoms? Results from the REDUCE trial. Eur Urol 2016; 69: pp. 885-891.
Vuichoud C., Loughlin K.: Benign prostatic hyperplasia: epidemiology, economics, and evaluation. Can J Urol 2015; 22: pp. 1-6.
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