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Enlarged prostate

BPH; Benign prostatic hyperplasia (hypertrophy); Prostate - enlarged

 

The prostate is a gland that produces the fluid that carries sperm during ejaculation. The prostate gland surrounds the urethra, the tube through which urine passes out of the body.

An enlarged prostate means the gland has grown bigger. Prostate enlargement happens to almost all men as they get older.

An enlarged prostate is often called benign prostatic hyperplasia (BPH). It is not cancer, and it does not raise your risk for prostate cancer.

Causes

 

The actual cause of prostate enlargement is unknown. Factors linked to aging and changes in the cells of the testicles may have a role in the growth of the gland. Men who have had their testicles removed at a young age (for example, as a result of testicular cancer) do not develop BPH.

Also, if the testicles are removed after a man develops BPH, the prostate begins to shrink in size.

Some facts about prostate enlargement:

  • The likelihood of developing an enlarged prostate increases with age.
  • BPH is so common that it has been said all men will have an enlarged prostate if they live long enough.
  • A small amount of prostate enlargement is present in many men over age 40. More than 90% of men over age 80 have the condition.
  • No risk factors have been identified other than having normally functioning testicles.

 

Symptoms

 

Less than half of all men with BPH have symptoms of the disease. Symptoms may include:

  • Dribbling at the end of urinating
  • Inability to urinate (urinary retention)
  • Incomplete emptying of your bladder
  • Incontinence
  • Needing to urinate 2 or more times per night
  • Pain with urination or bloody urine (these may indicate infection)
  • Slowed or delayed start of the urinary stream
  • Straining to urinate
  • Strong and sudden urge to urinate
  • Weak urine stream

 

Exams and Tests

 

Your health care provider will ask you questions about your medical history and do a digital rectal exam to feel the prostate gland. Other tests you may have include:

  • Urine flow rate
  • Post-void residual urine test to see how much urine is left in your bladder after you urinate
  • Pressure-flow studies to measure the pressure in the bladder as you urinate
  • Urinalysis to check for blood or infection
  • Urine culture to check for infection
  • Prostate-specific antigen (PSA) blood test to screen for prostate cancer
  • Cystoscopy

You may be asked to fill out a form to rate how bad your symptoms are and how much they affect your daily life. Your doctor can use this score to judge if your condition is getting worse over time.

 

Treatment

 

The treatment you choose will be based on how bad your symptoms are and how much they bother you. Your provider will also take into account other medical problems you may have.

Treatment options include "watchful waiting," lifestyle changes, medicines, or surgery.

If you are over 60, you are more likely to have symptoms. But many men with an enlarged prostate have only minor symptoms. Self-care steps are often enough to make you feel better.

If you have BPH, you should have a yearly exam to monitor your symptoms and see if you need changes in treatment.

SELF-CARE

For mild symptoms:

  • Urinate when you first get the urge. Also, go to the bathroom on a timed schedule even if you don't feel a need to urinate.
  • Avoid alcohol and caffeine, especially after dinner.
  • DO NOT drink a lot of fluid all at once. Spread out fluids during the day. Avoid drinking fluids within 2 hours of bedtime.
  • Try NOT to take over-the-counter cold and sinus medicines that contain decongestants or antihistamines. These drugs can increase BPH symptoms.
  • Keep warm and exercise regularly. Cold weather and lack of physical activity may worsen symptoms.
  • Learn and perform Kegel exercises (pelvic strengthening exercises).
  • Reduce stress. Nervousness and tension can lead to more frequent urination.

MEDICINES

Alpha-1 blockers are a class of drugs that are also used to treat high blood pressure. These medicines relax the muscles of the bladder neck and prostate. This allows easier urination. Most people who take alpha-1 blockers notice improvement in their symptoms.

Finasteride and dutasteride lower levels of hormones produced by the prostate. These drugs also reduce the size of the gland, increase urine flow rate, and decrease symptoms of BPH. You may need to take these medicines for 3 to 6 months before you notice symptoms getting better. Possible side effects include decreased sex drive and impotence.

Antibiotics may be prescribed to treat chronic prostatitis (inflammation of the prostate), which may occur with BPH. BPH symptoms improve in some men after a course of antibiotics.

Watch out for drugs that may make your symptoms worse:

SAW PALMETTO

Many herbs have been tried for treating an enlarged prostate. Many men use saw palmetto to ease symptoms. Some studies have shown that it may help with symptoms, but results are mixed and more research is needed. If you use saw palmetto and think it works, ask your doctor if you should still take it.

SURGERY

Prostate surgery may be recommended if you have:

  • Incontinence
  • Recurrent blood in the urine
  • Inability to fully empty the bladder (urinary retention)
  • Recurrent urinary tract infections
  • Decreasing kidney function
  • Bladder stones
  • Bothersome symptoms not responding to medicines

The choice of which surgical procedure is recommended is most often based on the severity of your symptoms and the size and shape of your prostate gland. Most men who have prostate surgery have improvement in urine flow rates and symptoms.

Transurethral resection of the prostate (TURP): This is the most common and most proven surgical treatment for BPH. TURP is performed by inserting a scope through the penis and removing the prostate piece by piece.

Simple prostatectomy: It is a procedure to remove the inside part of the prostate gland. It is done through a surgical cut in your lower belly. This treatment is most often done on men who have very large prostate glands.

Other, less-invasive procedures use heat to destroy prostate tissue. None have been proven to be better than TURP. People who receive these procedures are more likely to need surgery again after 5 or 10 years. However, these procedures may be a choice for:

  • Younger men (many of the less-invasive procedures carry a lower risk for impotence and incontinence than TURP, although the risk with TURP is not very high)
  • Older people
  • People with severe medical conditions, including uncontrolled diabetes, cirrhosis, alcoholism, psychosis, and serious lung, kidney, or heart disease
  • Men who are taking blood-thinning drugs

 

Support Groups

 

Some men may find it helpful to take part in a BPH support groups.

 

Possible Complications

 

Men who have had BPH for long time with slowly worsening symptom may develop:

  • Sudden inability to urinate
  • Urinary tract infections
  • Urinary stones
  • Damage to the kidneys
  • Blood in the urine

BPH may come back over time even after having surgery.

 

When to Contact a Medical Professional

 

Call your provider right away if you have:

  • Less urine than usual
  • Fever or chills
  • Back, side, or abdominal pain
  • Blood or pus in your urine

Also call if:

  • Your bladder does not feel completely empty after you urinate.
  • You take medicines that may cause urinary problems such as diuretics, antihistamines, antidepressants, or sedatives. DO NOT stop or change your medicines without talking to your doctor.
  • You have tried self-care steps for 2 months and symptoms have not improved.

 

 

References

McNicholas TA, Kirby RS, Lepor H. Evaluation and nonsurgical management of benign prostatic hyperplasia. In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 91.

McVary KT, Roehrborn CG, Avins AL, et al. Update on AUA guideline on the management of benign prostatic hyperplasia. J Urol. 2011;185(5):1793-1803. PMID: 21420124 www.ncbi.nlm.nih.gov/pubmed/21420124.

Oelke M, Bachmann A, Descazeaud A, et al. EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol. 2013;64(1):118-40. PMID: 23541338 www.ncbi.nlm.nih.gov/pubmed/23541338.

Roehrborn CG. Male lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH). Med Clin North Am. 2011;95(1):87-100. PMID: 21095413 www.ncbi.nlm.nih.gov/pubmed/21095413.

 
  • Enlarged prostate gland

    Enlarged prostate gland

    Animation

  •  

    Enlarged prostate gland - Animation

    This animation illustrates the prostate gland and its surrounding structures and shows the effects of benign prostatic hypertrophy (BPH).

  • Enlarged prostate

    Enlarged prostate

    Animation

  •  

    Enlarged prostate - Animation

    Not every man will have to deal with age-related issues like balding or weight gain. Whether you have these problems really depends on your health, and luck. But one problem just about every man will have to face, if he lives long enough, is an enlarged prostate. Let's talk about an enlarged prostate, also known as benign prostatic hyperplasia, or BPH. The prostate gland is part of your reproductive system, and its job is to add fluid to the sperm before ejaculation. The prostate is pretty small when you're young, but as you get older it grows and grows. Keep in mind, this growth isn't cancerous. But by design, the prostate is wrapped around the urethra, the tube that carries urine from your bladder out of your body. So as the prostate grows, it can begin to squeeze or pinch the urethra which often can make it harder for men with an enlarged prostate to urinate. If you have an enlarged prostate, the first notice that you're having trouble urinating. Instead of having a strong even flow, the urine only dribbles out like a leaky faucet; drip, drip, dribble, drip. Because you're not emptying your bladder fully each time, you keep feeling the urge to use the bathroom, even in the middle of the night. To check your prostate, your doctor or urologist will check your prostate gland by inserting a lubricated, gloved finger and feeling for any growth. Other tests may check your urine flow, and how much urine is left in your bladder after you go, as well as look for signs of an infection or prostate cancer. How is an enlarged prostate treated? Treatment often depends on how you feel. If you're not having any symptoms, your doctor may suggest just watching it, that's called watchful waiting. If you've got bothersome symptoms, medications can reduce the size of the prostate gland, and relax your bladder and prostate so you don't constantly feel the urge to go. For more serious symptoms, surgery can remove the extra prostate tissue. To help relieve the symptoms of an enlarged prostate, watch how much fluid you drink, especially before bedtime, or before going out. Minimize alcohol and caffeine, as well as over-the-counter decongestants and antihistamines. They can make your symptoms worse. Double voiding can help. After you've emptied your bladder, wait a moment and try to go again without straining or pushing. Some people take herbs like saw palmetto for an enlarged prostate. Although there's some evidence that these herbs can relieve BPH symptoms, many studies haven't found a benefit. Talk to your doctor before taking any herbal remedy, because they can cause side effects. Prostate enlargement isn't usually serious, but it can have a serious impact on your way of life, especially when you're always going to the bathroom. Remember that BPH is treatable. Work with your doctor to find the treatment that works best for you. If you've been caring for your symptoms for 2 months and not finding any relief, or you're having more serious symptoms like you're not urinating at all, or you have a fever or pain in your back or abdomen, call your doctor as soon as possible.

  • Benign prostate hyperplasia (BPH) -causes and symptoms

    Benign prostate hyperplasia (BPH) -causes and symptoms

    Animation

  •  

    Benign prostate hyperplasia (BPH) -causes and symptoms - Animation

    Learn about the cause, symptoms and treatment of benign prostatic hyperplasia (BPH).

  • Male reproductive anatomy

    Male reproductive anatomy - illustration

    The male reproductive structures include the penis, the scrotum, the seminal vesicles and the prostate.

    Male reproductive anatomy

    illustration

  • BPH

    BPH - illustration

    Benign prostatic hypertrophy (BPH) is a non-cancerous enlargement of the prostate gland, commonly found in men over the age of 50.

    BPH

    illustration

  • Prostatectomy - Series

    Prostatectomy - Series

    Presentation

  • Transurethral Resection of the Prostate (TURP) - Series

    Transurethral Resection of the Prostate (TURP) - Series

    Presentation

  • Enlarged prostate gland

    Animation

  •  

    Enlarged prostate gland - Animation

    This animation illustrates the prostate gland and its surrounding structures and shows the effects of benign prostatic hypertrophy (BPH).

  • Enlarged prostate

    Animation

  •  

    Enlarged prostate - Animation

    Not every man will have to deal with age-related issues like balding or weight gain. Whether you have these problems really depends on your health, and luck. But one problem just about every man will have to face, if he lives long enough, is an enlarged prostate. Let's talk about an enlarged prostate, also known as benign prostatic hyperplasia, or BPH. The prostate gland is part of your reproductive system, and its job is to add fluid to the sperm before ejaculation. The prostate is pretty small when you're young, but as you get older it grows and grows. Keep in mind, this growth isn't cancerous. But by design, the prostate is wrapped around the urethra, the tube that carries urine from your bladder out of your body. So as the prostate grows, it can begin to squeeze or pinch the urethra which often can make it harder for men with an enlarged prostate to urinate. If you have an enlarged prostate, the first notice that you're having trouble urinating. Instead of having a strong even flow, the urine only dribbles out like a leaky faucet; drip, drip, dribble, drip. Because you're not emptying your bladder fully each time, you keep feeling the urge to use the bathroom, even in the middle of the night. To check your prostate, your doctor or urologist will check your prostate gland by inserting a lubricated, gloved finger and feeling for any growth. Other tests may check your urine flow, and how much urine is left in your bladder after you go, as well as look for signs of an infection or prostate cancer. How is an enlarged prostate treated? Treatment often depends on how you feel. If you're not having any symptoms, your doctor may suggest just watching it, that's called watchful waiting. If you've got bothersome symptoms, medications can reduce the size of the prostate gland, and relax your bladder and prostate so you don't constantly feel the urge to go. For more serious symptoms, surgery can remove the extra prostate tissue. To help relieve the symptoms of an enlarged prostate, watch how much fluid you drink, especially before bedtime, or before going out. Minimize alcohol and caffeine, as well as over-the-counter decongestants and antihistamines. They can make your symptoms worse. Double voiding can help. After you've emptied your bladder, wait a moment and try to go again without straining or pushing. Some people take herbs like saw palmetto for an enlarged prostate. Although there's some evidence that these herbs can relieve BPH symptoms, many studies haven't found a benefit. Talk to your doctor before taking any herbal remedy, because they can cause side effects. Prostate enlargement isn't usually serious, but it can have a serious impact on your way of life, especially when you're always going to the bathroom. Remember that BPH is treatable. Work with your doctor to find the treatment that works best for you. If you've been caring for your symptoms for 2 months and not finding any relief, or you're having more serious symptoms like you're not urinating at all, or you have a fever or pain in your back or abdomen, call your doctor as soon as possible.

  • Benign prostate hyperplasia (BPH) -causes and symptoms

    Animation

  •  

    Benign prostate hyperplasia (BPH) -causes and symptoms - Animation

    Learn about the cause, symptoms and treatment of benign prostatic hyperplasia (BPH).

  • Male reproductive anatomy

    Male reproductive anatomy - illustration

    The male reproductive structures include the penis, the scrotum, the seminal vesicles and the prostate.

    Male reproductive anatomy

    illustration

  • BPH

    BPH - illustration

    Benign prostatic hypertrophy (BPH) is a non-cancerous enlargement of the prostate gland, commonly found in men over the age of 50.

    BPH

    illustration

  • Prostatectomy - Series

    Presentation

  • Transurethral Resection of the Prostate (TURP) - Series

    Presentation

A Closer Look

 

Talking to your MD

 

Self Care

 

Tests for Enlarged prostate

 

 

Review Date: 8/31/2015

Reviewed By: Jennifer Sobol, DO, Urologist at the Michigan Institute of Urology, West Bloomfield, MI. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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