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What is BPH?
BPH stands for benign prostatic hyperplasia. It's a non-malignant overgrowth of the cells in the prostate gland, which causes it to become enlarged. The prostate gland (or, simply, prostate) is a chestnut-shaped organ found just underneath the bladder in men. It's normally about 4cm wide and 3cm thick.2 It produces a milky fluid which, together with sperm and other secretions, makes up semen. Women don't have a prostate.
The urethra is the tube that carries urine from the bladder out through the penis, and runs through the middle of the prostate. As the prostate gets bigger, it starts to obstruct the urethra. This is what causes the symptoms of BPH.
How common is it?
BPH is very common. Young men aren’t often affected but, overall, one in four (25%) men over the age of 40 can expect to suffer from it as they get older.3
What are the symptoms of BPH?
The symptoms of BPH are called lower urinary tract symptoms (LUTS) because they affect the lower urinary tract (the bladder and urethra). The following are typical:4
- Needing to pee often ('frequency')
- Needing to pee urgently ('urgency')
- Needing to pee at night, sometimes many times ('nocturia')
- Not being able to hold on when you need a pee ('urge incontinence')
- Finding it difficult to start peeing (known as 'hesitancy')
- Stopping and starting during a pee ('intermittent stream')
- Having to push to get the pee out ('straining')
- Having a weak, dribbly flow of pee ('weak stream')
- Dribbling once you've finished a pee ('terminal dribbling')
- Never feeling that you've completely emptied your bladder ('incomplete voiding')
What impact can BPH have?
Many sufferers find that BPH can really affect their quality of life. For example, it can affect your relationship with your partner, ranging from having disturbed nights to sleeping in separate bedrooms. You might feel tired all the time because you can't get a decent night's sleep, and embarrassed at social gatherings because you keep having to disappear to the loo. Outings and car journeys can be a chore because you may feel the need to map out every public convenience to reassure yourself you won't be caught short.
If this sounds like you, you're certainly not alone. Research among BPH sufferers has shown that 57% of men avoid drinking before bedtime, 40% of men plan their day around toilet stops and 30% of men avoid travelling long distances because of their urinary symptoms.5
What causes the symptoms?
The symptoms of BPH occur because the prostate squeezes the urethra (the tube that carries urine), causing it to narrow. This means that urine can't pass down it easily.
The muscle of the bladder wall starts to thicken because it has to work to push the pee out each time you go to the loo. This means it becomes less stretchy, so the bladder can't hold as much pee. That's why you have to go more often, including at night, and why you can't hold on when you need to go.
Although not inevitable, it is true that the likelihood of male sexual dysfunction and BPH both increase with age. Some men with BPH may also have problems with sex. You may be unable to get or keep an erection, experience pain when you ejaculate, or notice a reduced amount of semen when you ejaculate.6 It is believed that the more severe the urinary problem, the poorer the erection quality can be.7 This could simply be caused by sleep disturbance due to having to get up several times at night to pee, resulting in tiredness. It also seems that both BPH and erection problems worsen with age. However, other health problems that can affect quality of erections, such as heart problems and diabetes, also increase with age. It is therefore important that if you experience problems with your peeing habits or erections, you seek help and advice from a healthcare professional.
How do I know if I have BPH?
Lower urinary tract symptoms are a sign of BPH. You can assess and track how severe your symptoms are using the International prostate Symptom Score (IPSS) or assess how they affect your life by keeping a diary. If you have any concerns or think you might have BPH, speak to a healthcare professional.
Can the symptoms of BPH be caused by anything else?
If you are suffering from any of these symptoms, you should talk to your healthcare professional who will be able to determine if they are due to BPH and not to another condition.
What will happen if I tell my doctor I think I have BPH?
If you visit your GP, he or she is likely to carry out a physical examination. This may include feeling the size and consistency of the prostate by inserting a gloved finger into your rectum (back passage). This is called a digital rectal examination (DRE). Whilst it might be uncomfortable, and you might feel a bit embarrassed, it won't hurt. Remember your doctor has probably done this many times before. The size, shape, texture and tenderness of the prostate can be assessed by doing this.
You might also have a urine test and a blood test with your GP or a nurse to find out if something else is causing your symptoms.
There is a blood test that looks for the levels of a hormone called PSA (prostate specific antigen). The level of PSA in your blood increases with age normally, but it can also be raised if the prostate gland is big or if there is infection within the prostate or urine.
Your GP might also refer you to a specialist for further tests.8
Can BPH be treated?
Maybe your symptoms are just an inconvenience and don't trouble you too much. In this case, you may feel you're happy enough living with them. And that's fine. You should still keep an eye on things though, and have regular check-ups. This is often referred to as "watchful waiting". But if, like many men, you find the symptoms of BPH are spoiling your enjoyment of life, there's no need to put up with them. Symptoms can usually be relieved with a type of medicine called 'alpha-blockers'. They work by relaxing the muscle in the bladder and around the prostate so that pee can flow more freely. Up to nine out of 10 men find that these medicines improve their symptoms.9
Another option is a type of medicine called '5-alpha reductase inhibitors', which can slow the enlargement or even shrink the prostate over time.
Surgery is an option if medicines don't help you. You will be able to discuss the various treatment options with your doctor or specialist before making a decision.
What happens if I don't treat it?
It is essential that you speak to a healthcare professional if you think you might be suffering from BPH. Although in some men nothing will happen if they do not treat the condition, many find that their symptoms get worse and affect quality of life more and more.10
In some men where BPH has been a long-standing condition, the bladder can become very distended and cause pressure to be placed on the kidneys. This can cause the kidneys to stop functioning properly. There is also the possibility that you could suffer from 'urinary retention'. This happens when you can't pee at all and the bladder fills up. It can be painful and needs urgent medical treatment. You'll need to have a catheter (a fine tube) put in to empty the bladder.11
BPH can also lead to urinary tract infections, such as cystitis, which need treatment with antibiotics.12