Benign prostatic hyperplasia (BPH) is where the prostate, a gland located near the bladder in men, gets bigger than usual, in a process known as hyperplasia or hypertrophy. The growth is not cancerous and should not cause alarm, but it can cause problems for some men in relation to passing urine. BPH is a very common condition, especially in older men. It's more likely to occur if you have obesity, diabetes or heart disease, or it runs in your family. The prostate is a small gland that wraps around the urethra, the tube that transports urine from the bladder to the penis. It produces seminal fluid that helps sustain semen and transport sperm. The prostate gland is the size and shape of a walnut in your 20s, but naturally grows in size to about apricot size in your 40s, and it may be the size of a lemon by the age of 60. This can press against the bladder and urethra, gradually causing symptoms over time.
BPH can cause you to need to urinate more often, especially at night. You may find it difficult to start urinating or that your flow is weak, and you may experience dribbling at the end of urination or a feeling that you haven’t completely emptied your bladder. Some of these symptoms can be confused with a urinary tract infection, but they will likely have gone on for weeks or months, and gradually be worsening. If untreated, BPH puts you at risk of recurring infections, urinary retention, bladder stones, bladder damage and kidney damage. It doesn’t cause erectile dysfunction or ejaculation problems in itself, although some of the medications used to treat it may.
In men, the urethra (the tube that transports urine from the bladder to the penis and out) passes through the centre of the prostate. When the prostate starts to enlarge it presses on the urethra and makes it narrow. This narrowing causes urinary symptoms. The causes are largely unknown but are thought to be linked to hormonal changes as men age.
You should book a routine appointment if you notice urinary symptoms persisting over time. Your doctor will ask about symptoms and will offer an intimate examination of the back passage, where the prostate can be felt. This tells them whether it is enlarged. The exam will also tell them if the surface of the prostate feels normal or needs further investigations for other conditions, such as prostate cancer. Your doctor may send off a urine sample to check for infection. You may have blood tests to check the health of the kidneys and test for prostate specific antigen (PSA), which can be raised in a number of conditions, including prostate cancer. Once all the results are back and it looks like BPH, your doctor may refer you to the urologist for further investigations and treatment. If results suggest a condition other than BPH, your doctor will advise on the next best steps.
The treatment for BPH varies depending on the size of the prostate, your age, your general health and how much symptoms trouble you. Medication and surgery are the two options available. Alpha-blocker tablets, such as doxazosin or tamsulosin, help relax the muscles at the neck of the bladder, which make it easier to urinate, or 5-alpha reductase inhibitors, such as finasteride, are tablets aiming to shrink the prostate. You sometimes need a combination of these to treat symptoms. In severe cases, surgery may be considered to reduce the size of the prostate.