What Is BPH?
You can do a lot to take care of yourself and give your body what it needs. Still, as you get older, your body changes in ways you can't always control. For most men, one of those changes is that the prostate gets bigger.
It's a natural part of aging, but at some point, it can lead to a condition called benign prostatic hyperplasia (BPH).
Why Would an Enlarged Prostate Cause Frequent Urination?
Your prostate surrounds part of your urethra, the tube that carries urine and semen out of your penis. When you have BPH, your prostate grows larger than usual and squeezes the urethra. This can cause your pee stream to be weak, which can make you have to go to the bathroom more often than usual. Benign prostatic hyperplasia also could lead to other bothersome urinary symptoms, like pain when you pee.
BPH isn’t prostate cancer and doesn’t make you more likely to get it.
Benign prostatic hyperplasia is a common condition, especially in older men. There are a lot of treatments for it, from lifestyle changes to medication and surgery. Your doctor can help you choose the best care based on your age, health, and how BPH affects you.
BPH Causes
Doctors aren't sure exactly what makes BPH happen. It may have to do with normal hormonal changes as you age, but it's not clear.
Early in puberty, your prostate doubles in size. Later in life, at around age 25, it starts to grow again. For most men, this growth continues for the rest of their lives. In some men it causes BPH.
BPH and testosterone. Testosterone is the main sex hormone in men and people assigned male at birth. This hormone acts on cells of the prostate and leads to the production of growth factors that make the prostate get bigger. As evidence of this effect, when men with prostate cancer take medicine to stop testosterone production, their prostate shrinks.
BPH Symptoms
As the prostate gets larger, it starts to pinch the urethra. This causes symptoms that affect your urine flow, such as:
- Dribbling when you pee
- A hard time getting your pee stream started
- A weak stream or peeing in stops and starts
When your urethra is squeezed, it also means your bladder has to work harder to push urine out. Over time, the bladder muscles get weak, which makes it harder for it to empty. This can lead to:
- Feeling like you still have to pee even after you just went
- Having to go too often — eight or more times a day
- Incontinence (when you don't have control over when you pee)
- An urgent need to pee, all of a sudden
- Waking up several times a night to pee
- Urinary tract infections (UTIs), bleeding, bladder damage, and bladder stones
BPH rarely leads to other conditions, but it can, and a couple of them are serious. For example, BPH can lead to kidney damage or cause a problem where you can't pee at all.
A larger prostate doesn't mean you'll have more or worse symptoms. It's different for each person. In fact, some men with very large prostates have few, if any, issues.
BPH lower urinary tract symptoms (LUTS)
LUTS are a common problem with BPH. These symptoms affect how you pee and include:
- Needing to pee at night
- Going to the bathroom more often than usual
- Feeling an urgent need to pee
- Having a pee stream that's weaker than usual or slow to start
- Not fully emptying your bladder when you pee
BPH complications
Having an enlarged prostate, especially if it's untreated, can lead to problems like these:
Bladder damage. BPH prevents your bladder from emptying all the way. As your bladder works harder to push the pee out, its muscles get weaker. Eventually, they may be too weak to squeeze hard enough to empty your bladder.
UTIs. When pee sits in your bladder too long, bacteria can grow in it and cause an infection.
Bladder stones. When your bladder doesn't fully empty, your urine gets more concentrated. In time, crystals can form in your pee and form into hard stones.
Urinary retention. This is when your prostate gland squeezes your urethra so much that you can't pee at all. You may need a tube called a catheter or surgery to open up your urethra.
Kidney damage. When pee backs up from your bladder, it puts pressure on your kidneys that can damage them.
BPH Diagnosis
Your doctor will first talk to you about your personal and family medical history. You might also fill out a survey, answering questions about your symptoms and how they affect you daily.
Next, your doctor will do a physical exam. This may include a digital rectal exam where they put on a glove and gently insert one finger into your rectum to check the size and shape of your prostate.
Basic tests
Your doctor may start with one or more of these tests:
- Blood tests to check for kidney problems
- Urine tests to look for infection or other problems that could be causing your symptoms
- Prostate-specific antigen (PSA) blood test. High PSA levels may be a sign of a larger-than-usual prostate. A doctor can also order it as a screening test for prostate cancer.
Advanced tests
Based on the results of those tests, your doctor may order more tests to rule out other problems or to see more clearly what's happening. These might include:
- Types of ultrasound to measure your prostate and see if it looks healthy
- A bladder ultrasound to see how well you empty your bladder
- Biopsy to rule out cancer
- Urine flow test to measure how strong your stream is and how much pee you make
- Urodynamic testing to evaluate your bladder function
- Cystourethroscopy using a camera to examine the inside of the prostate, urethra, and bladder
BPH Treatments
BPH isn't curable, but treatments can improve your symptoms. How your doctor treats you depends on your age, health, the size of your prostate, and how BPH affects you. If your symptoms don't bother you too much, you can put off treatment and see how you feel.
Lifestyle changes
You may want to start with some changes to your daily routine. For example, you can:
- Do exercises to strengthen your pelvic floor muscles
- Reduce the amount of fluids you drink, especially before you go out or go to bed
- Drink less caffeine and alcohol
For mild to moderate BPH, your doctor might suggest medicines like alpha-blockers. Some medications work by relaxing the muscles in your prostate and bladder. Others help shrink your prostate. For some men, it takes a mix of medicines to get the best results.
Medicines for BPH
For mild to moderate BPH, your doctor might suggest medicines. Some medications work by relaxing the muscles in your prostate and bladder. Others help shrink your prostate. Examples of BPH medicines include:
- Alfuzosin (Uroxatral)
- Doxazosin (Cardura)
- Dutasteride (Avodart)
- Finasteride (Proscar)
- Silodosin (Rapaflo)
- Tamsulosin (Flomax)
- Terazosin (Hytrin)
For some men, it takes a mix of medicines to get the best results.
Procedures for BPH
If lifestyle changes and medications don't work or you have repeated UTIs, bladder stones, or other complications, your doctor has ways to remove part or all of your prostate. Many of these procedures are called "minimally invasive," meaning they use smaller cuts than open surgery. Your doctor will use probes or scopes to see and remove your prostate.
Examples of BPH procedures are:
- Transurethral resection of the prostate, in which the doctor uses a scope and cuts out pieces of the gland with a wire loop.
- Transurethral incision of the prostate, in which the doctor makes a few small cuts in the prostate to reduce the gland's pressure on the urethra.
- Transurethral vaporization of the prostate, which uses a special tool to deliver heat energy to burn off prostate tissue. Another form of treatment called photoselective vaporization uses a high-powered laser to burn off the tissue.
- Simple prostatectomy, where the surgeon removes the part of your prostate gland that's blocking your urethra through a small cut in your belly.
- Prostatic urethral lift (UroLift) uses tiny implants to lift the prostate tissue out of the way so that it doesn't block the urethra.
- Water vapor thermal therapy uses steam to destroy prostate tissue.
- Holmium laser enucleation of the prostate or thulium laser enucleation of the prostate use types of lasers to remove prostate tissue.
- Robotic waterjet treatment, or Aquablation, destroys prostate tissue with powerful jets of water.
- Prostate artery embolization places tiny beads into an artery that delivers blood to the prostate. These beads cut off blood flow to the prostate, which causes its tissues to die.
In some cases, your doctor may suggest open surgery or a robotic procedure to remove your prostate.
Care plan for BPH
You'll work with your urologist to create a treatment plan that's tailored to you. Which treatments you get depend on your prostate size, health, and personal choices. Your care plan may include lifestyle changes, medication, or surgery.
BPH Complications
With any BPH surgery, there may be side effects or complications such as:
- Bleeding
- Narrowing of the urine tube, called urethral stricture
- Urinary incontinence or leakage
- Erectile dysfunction
- Retrograde ejaculation, where semen backs up into your bladder instead of going out of your body
BPH doesn't lead to prostate cancer or make you more likely to get it.
Takeaways
BPH is when your prostate grows larger and puts pressure on your urethra. That pressure can cause symptoms like having to pee more often than usual, a weak urine stream, and an urgent need to pee. Treatments for BPH include lifestyle changes, medications, and surgery.
BPH FAQs
What is the best treatment for BPH?
BPH treatments include lifestyle changes, medications, and surgery. The best treatment for you depends on the size of your prostate, your overall health, and your personal preferences.
What are three symptoms of BPH?
BPH symptoms include a frequent or urgent need to pee, a weak pee stream, and not being able to fully empty your bladder when you pee.
Is BPH a serious condition?
BPH isn't serious itself. But if you don't treat BPH, it can lead to complications like UTIs, bladder stones, and kidney damage.
