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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 he needs 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 he’s finished a pee (‘terminal dribbling’)
- Never feeling that he’s completely emptied his bladder (‘incomplete voiding’)
What impact can BPH have?
BPH can really affect your partner's quality of life, and yours. For example, you might feel that your relationship is suffering from disturbed nights or having to sleep 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 your partner keeps having to disappear to the loo. Outings and car journeys can be a particular chore because he may have to map out every public convenience to reassure himself that he won't be caught short.
If this sounds like you and your partner, 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 symptoms5.
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 the 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 he goes to the loo. This means it becomes less stretchy, so the bladder can't hold as much pee. That's why he has to go more often, including at night, and why he really can't hold on when he needs 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. He may not be able to get or keep an erection, he may experience pain when he ejaculates and you may notice a reduced amount of semen when he ejaculates.6 It is believed that the more severe the urinary problem, the poorer the erection quality can be7. 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 the quality of the erections, such as heart problems and diabetes, also increase with age. It is therefore important that if your partner experiences problems with his peeing habits or erections, you should encourage him to seek help and advice from a healthcare professional.
How can I tell if he has BPH?
Lower urinary tract symptoms are a sign of BPH. Your partner can assess and track how severe his symptoms are using the International prostate Symptoms Score (IPSS) or assess how they affect his life by keeping a diary. If he has any concerns or thinks he might have BPH, he should speak to a healthcare professional.
Can the symptoms of BPH be caused by anything else?
If your partner is suffering from any of these symptoms he should talk to a healthcare professional, who will be able to determine if his symptoms are due to BPH and not another condition.
What will happen if he goes to see the doctor?
If your partner visits the doctor, he is likely to be given a physical examination. This may include feeling the size and consistency of the prostate by inserting a gloved finger into the rectum (back passage). This is called a digital rectal examination (DRE). Whilst it might be uncomfortable, and your partner may feel a bit embarrassed, it shouldn’t hurt. Remind him that the doctor will probably have done this test many times before. The size, shape, texture and tenderness of the prostate can be assessed by doing this.
Your partner might also have a urine test and a blood test to find out if something else is causing his symptoms. There is a blood test that looks for levels of a hormone called PSA (prostate specific antigen). The level of PSA in a man’s 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. His GP might also refer him to a specialist for further tests.8
Can BPH be treated?
Maybe your partner’s symptoms are just an inconvenience and don't trouble him too much. In this case he may feel he’s happy enough living with them. And that's fine. However, he should still keep an eye on things and have regular check-ups. This is often referred to as "watchful waiting".
But if the symptoms of BPH are spoiling his enjoyment of life, and perhaps affecting yours too, 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 muscles within the prostate gland and bladder neck so that pee can flow more freely. Up to nine out of ten 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. Your partner will be able to discuss the various treatment options with his doctor or specialist before making a decision.
What happens if my partner doesn’t treat it?
It is essential that your husband speaks to a healthcare professional if he thinks he might be suffering from BPH. Although in some men nothing will happen if they do not treat the condition, many find their symptoms get worse and affect their quality of life more and more, maybe having more of an impact on you too.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, causing them to stop functioning properly.
Some men also get a problem called urinary retention. This happens when he can't pee at all and the bladder fills up. It can be painful and needs urgent medical treatment. He would need to have a catheter (a fine tube) inserted to empty the bladder.11
BPH can also lead to urinary tract infections, such as cystitis, which need treatment with antibiotics.12