What is benign prostatic hyperplasia?

Benign prostatic hyperplasia, benign prostatic hypertrophy or BPH, more commonly referred to as an enlarged prostate, is a common urological condition that affects millions of men over 50.

As men age, the prostate gland (a walnut-sized organ in the male reproductive system), grows larger. In some men, the enlarged prostate presses on the urethra causing trouble with urination.

An enlarged prostate is the most common health problem in men over the age of 60.

Causes of benign prostatic hyperplasia

It is unknown why the prostate starts to enlarge, but research suggests it could be due to the balance of sex hormones as men age.

The prostate gland sits beneath the bladder, and the urethra passes through the center of it. As the prostate grows larger, it can significantly block urine flow.

Risk factors for benign prostatic hyperplasia

Risk factors for an enlarged prostate include:

  • Age — as men age, they are more likely to develop an enlarged prostate, more than half of men over 80 have symptoms from benign prostatic hyperplasia.
  • Family history — if your father or brother (blood relatives) have prostate conditions including BPH, you are more likely to develop an enlarged prostate.
  • Chronic conditions — chronic conditions such as diabetes and heart disease can increase your risk of developing benign prostatic hyperplasia.
  • Obesity — being overweight makes you more likely to develop an enlarged prostate as you age.

Symptoms of benign prostatic hyperplasia

Symptoms of an enlarged prostate vary depending on the severity of your condition. Some men may not have any symptoms.

For those who do experience symptoms, common symptoms include:

  • Increased need to urinate at night
  • Difficulty starting to urinate
  • Weak urine stream
  • More frequent urination or sudden need to urinate
  • Blood in urine (hematuria)
  • Sense of not fully emptying bladder after urinating

Diagnosis of benign prostatic hyperplasia

Benign prostatic hypertrophy can be diagnosed by your primary care provider or urologist. Your physician will perform a digital rectal exam to determine if other urological problems are causing your symptoms. During a rectal exam, your doctor will insert his or her finger into the rectum to feel the prostate. The doctor will be able to determine the size and consistency of the prostate during this exam.

If your doctor suspects an infection, you may also have a urinalysis. You may also have a blood test to check for kidney problems or a PSA (prostate-specific antigen test) to test for prostate cancer.

Treatment for benign prostatic hyperplasia

Treatment for an enlarged prostate varies depending on the severity of your condition. Some men only need regular monitoring while others with more severe cases may need surgery.

Mild to moderate benign prostatic hypertrophy can be treated with medication.

Medication options include:

  • Alpha blockers — help men urinate easier.
  • 5-alpha reductase inhibitors — help shrink the prostate.
  • Combination drug therapy — taking an alpha blocker and 5-alpha reductase inhibitor together.
  • Tadalafil (Cialis) — typically used to treat erectile dysfunction, they can also treat an enlarged prostate.

If medications aren’t effective and symptoms are intensifying, surgery may be necessary.

Surgical options include:

  • Prostatectomy — commonly performed procedure that removes part of the prostate.
  • Transurethral prostatectomy (TURP) — the core of the prostate is removed to shrink the prostate, most commonly used treatment for enlarged prostate.
  • Transurethral incision of the prostate (TUIP) — relieves pressure on the urethra by making small incisions on the prostate gland.
  • Open prostatectomy — if the prostate is very large, your doctor may recommend an open prostatectomy during which large prostatic nodules are removed through the bladder.

Recovery from benign prostatic hyperplasia

Unfortunately, there is not a cure for an enlarged prostate. As men age, the prostate will continue to get larger. Most men will find relief with medications. If surgery is necessary, recovery will depend upon the surgical option that your doctor recommends.

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