BPH (Benign prostatic hyperplasia)

BPH (Benign prostatic hyperplasia or hypertrophy) is the medical term for the condition commonly known as an enlarged prostate. The problem is commonly encountered and symptoms are classified as:

• Irritative symptoms - a need to urinate frequently, nocturia (having to get up at night to urinate), a feeling of incomplete emptying
• Obstructive symptoms – poor stream, hesitancy (stopping and starting), dribbling at the end of urination.

Doctors have known for a long time that the degree of prostate enlargement does not always correlate to the level of symptoms experienced. BPH-like symptoms can be present even if there is no evidence of prostate enlargement. Such symptoms should always be checked by your doctor to rule out other causes of your symptoms, including prostate cancer.

The word hyperplasia indicates an increase in the number of cells. Hypertrophy refers to an enlargement or increase in size of an organ or tissue.

Hence, benign prostatic hyperplasia is the term used when cell numbers in the prostate increase. This may then lead to an increase in the size of the prostate and so, the term benign prostatic hypertrophy is also appropriate.

You will find both terms used, although experts would suggest that benign prostatic hyperplasia is the more correct one.

We don’t really understand the cause of BPH, but what we do know is that as a man becomes older, prostate cells become more sensitive to the testosterone known as DHT (dihydro-testosterone) circulating in the body.

Prostatic cells react and respond by dividing and multiplying (the hyperplasia mentioned above) and this causes the prostate to enlarge. However, the enlargement in itself does not always explain why BPH symptoms occur:

• Mildly enlarged prostate glands can lead to severe symptoms, including obstructive symptoms making it difficult or nearly impossible for a man to urinate comfortably
• Very large prostate glands on the other hand, have been found in men who complain of no or few symptoms.

It is suggested that apart from responding to DHT by growing more cells, inflammation is present in prostatic tissue. This leads to an irritation or disturbance of nerve function in the bladder as well as at the junction of the bladder and the prostate (known as bladder neck) which controls the flow of urine.

As we don’t fully understand why BPH occurs, risk factors described by prostate experts and doctors are based on empirical observations. These include:

• Increasing age
• Being of African or Afro-Caribbean descent
• Being overweight
• Lack of physical activity
• Having erectile dysfunction – although it is not clear if it is BPH which is the cause
• Family history of BPH

In general, BPH is a relatively benign condition even if severe symptoms are present. However, complications can occur and these bring about secondary problems which may sometimes be serious:

• Cystitis / Bladder infections / UTIs. If incomplete emptying of the bladder is present, a residue of urine forms in the bladder and this ‘sump’ will have a tendency to become infected. Hence, although it is rare for a younger man to suffer from a urinary tract infection or cystitis, it is not so uncommon in one older and when this occurs, it would normally suggest BPH.
• Acute retention of urine. This may be seen in both previously diagnosed or undiagnosed BPH. Decreasing ability or inability to urinate, increasing discomfort, abdominal swelling, tenderness and pain are the key signs. The introduction of a catheter into the bladder brings about quick relief
• Chronic retention of urine. Sometimes, a man does not know that he has a problem with his prostate despite the fact that he has difficulty urinating. Over time, urine builds up and the bladder becomes desensitised. This allows even more urine to build up in the bladder and over months or years, a backflow of urine into the kidneys can damage these important organs in the body
• Hernia. Prolonged and repeated straining when urinating can lead to breaks in various parts of the abdominal wall.

This page summarises the options available for treating an enlarged prostate, also known as Benign Prostatic Hyperplasia or Benign Prostatic Hypertrophy. These treatments are only suitable once a diagnosis of an enlarged prostate has been confirmed by your doctor.

There are a variety of ways of treating prostate enlargement (BPH). Decision on the best treatment for each individual depends on how long your prostate has been enlarged and the level of prostate symptoms you are experiencing.

In general, the following treatment options are used:

• Watch and wait. This is the option for mild cases with few symptoms
• Prescribed medication. Used for moderate or troublesome symptoms and before surgery is considered
• Surgery. Used for moderate or severe symptoms, ranging from minimally invasive to open surgery
• Herbal remedies. Whilst not always accepted by the medical profession, Saw Palmetto herb is increasingly being considered as an option by doctors, including urologists.

Your doctor should be in a position to discuss the range of options and offer advice on which option is best suited to you.