Benign Prostatic Hyperplasia
Benign prostatic hyperplasia (BPH), is a condition in which the prostate is enlarged, but not cancerous. The enlargement of the prostate can restrict the flow of urine from the bladder, causing uncomfortable and inconvenient urinary symptoms.
The prostate gland is about the same size as a walnut and lies just below the bladder. The tube through which urine passes from the bladder (the urethra) passes through it. The prostate gland’s job is to make a fluid, which forms part of the semen.
Whilst it’s normal for the prostate gland to grow as you get older, it can also increase in size due to medical conditions.
The prostate gland becomes enlarged in most men as they get older. In the vast majority of cases, this is not prostate cancer. More than half of all men over the age of 60 and 80% of all men over 80 have enlarged prostate glands which are not cancerous.
When the prostate becomes enlarged, this is called benign prostatic hyperplasia. Whether treatment is needed depends on how enlarged the gland becomes and what symptoms occur.
There are different kinds of prostate problems, however, all conditions have similar symptoms, including:
- The urge to frequently urinate
- Difficulty in urination, which can include pain or a burning sensation
- The presence of blood in urine or semen
- Difficulties in having and/or maintaining an erection
- Painful ejaculation
- Pain or stiffness in the lower back, hips, and/or upper thighs
- Incontinence and leaking or dribbling urine
When the prostate becomes enlarged it begins to squeeze the urethra and when this happens you might find that you have difficulty passing water. You may also have to go to the toilet more often during the day (called frequency) or night, (called nocturia). Because your bladder has difficulty squeezing the urine out, it seldom empties completely, and because it is never completely empty it takes a shorter time for it to fill up again.
Over time, other symptoms can start to occur. Due to the extra work which the bladder muscles have to do, the bladder’s muscular wall can become thicker and less flexible and it can also become overactive and irritable. This can cause the need to pass water urgently and on occasion you may not make it to the toilet in time (urge incontinence). If this takes place at night time it can lead to bedwetting (nocturnal enuresis).
The enlarged prostate itself also contains more muscle tissue than previously. Any muscles can sometimes contract involuntarily as a result of the cold or of nervousness and such involuntary contractions can cause further difficulties in passing water.
Diagnosis and Tests
If you have symptoms of prostate problems, there are several tests that your doctor can take to make a diagnosis.
Urine and semen samples – you will be asked to supply a sample of urine to test for infections. You may also be required to supply a sample of semen to test for any further infections. Blood tests may also be needed to help identify the problem.
Digital rectal examination – the doctor puts gloves and inserts a finger into the rectum to feel the prostate and check for swelling, enlargement, masses or tenderness.
Prostate Specific Antigen – this test measures the levels of PSA in a blood sample. The prostate specific antigen is a substance produced in the prostate and circulating in the bloodstream. Higher than normal levels of PSA may indicate a prostate problem.
In addition you may be tested for bladder function and lower urinary tract efficiency in order to establish how much trouble the enlarged gland is actually responsible for.
If you are concerned about a problem and it is starting to affect your day to day life make an appointment to see your doctor, continence nurse or specialist physiotherapist. A continence nurse and specialist physiotherapist are healthcare professionals who specialise in bladder and bowel problems.