Benign prostatic hyperplasia, also called BPH, is a condition where the prostate becomes enlarged. It is known to cause urinary issues such as changes in bladder control and affects most men as they age. Understanding how BPH affects urination can help guide conversations with your healthcare provider and help you make informed care decisions.
As a nurse, helping people understand why something is happening is often helpful. Understanding BPH includes looking at the prostate and how enlargement from BPH impacts urination, as well as discussing treatment options.
What is the Prostate?
The prostate is a small muscular gland located under the bladder and in front of the rectum. It is considered part of the male reproductive system and produces fluid. This extra fluid is what makes up semen and is pushed through the urethra. The prostate gland is normally small in size, but gets larger as men age.
What is BPH?
BPH occurs when the prostate becomes enlarged beyond its normal size. Due to its location near the urethra, as it grows, it can place pressure and affect how urine and semen leave the body. The term benign used in BPH signals that this growth of the prostate is not cancerous; however, some symptoms of BPH may overlap with or be warning signs of prostate cancer, so it is important to be evaluated and diagnosed by a healthcare professional.
While most males will develop BPH in their lifetime, only about half of them will have symptoms that are disruptive and need treatment. Many people ask what they can do to prevent or avoid BPH, but currently there is no exact known cause, making prevention difficult.
Symptoms of BPH
Because the prostate is so close to the urethra, the majority of symptoms impact urination. These are some of the signs or symptoms you can experience with BPH:
- Hesitancy or difficulty starting the flow of urine
- Urine leaving the body slowly or dripping or dribbling
- Incontinence (involuntary leaking of urine)
- Experiencing urgency, which is a strong sudden need to urinate with little warning
- Needing to urinate at night
- Feeling like you need to pee right after peeing, which can indicate the bladder is not emptying all of the way
- Pain with urination or ejaculation
- Changes in the color or smell of your urine
If you experience any of these symptoms, schedule an appointment with your provider to avoid more serious issues that can occur with untreated BPH, such as urinary tract infections, bladder or kidney stones, and kidney damage.
How is BPH Diagnosed?
BPH is diagnosed through a physical exam. The provider will perform a digital rectal exam, which means they will place a finger into the rectum, allowing them to feel the prostate gland. This also helps rule out any hardened or abnormal areas that could indicate cancer. Additional tests may be needed to diagnose the condition and also determine the severity of your symptoms.
These tests can include a urine flow test (to see how quickly or slowly urine leaves the body), a test to see if your bladder is emptying (often called a post-void residual measurement), a urinalysis ( a sample of urine is analyzed for signs of blood or infection) or a cystoscopy, which is a scope that goes inside your body to get a look at the urethra and bladder.
Managing Incontinence from BPH
Incontinence can be the hardest part of BPH to manage. Unexpected leaks, urinary urgency, hesitancy, and difficulty with voiding can cause some people to avoid activities they enjoy. While there are treatment options available to manage BPH and reduce symptoms, most men will experience some amount of bladder control changes at some point.
Using incontinence products is a common way to manage bladder control changes before, during, and after treatment. Incontinence products are discreet, disposable items worn underneath clothing. Incontinence products come in different sizes, styles, and absorbency levels. There are products designed specifically for men that provide more targeted leak protection by placing absorbent materials at the front rather than the back.
Incontinence products work best when used correctly, which includes measuring your body for size, selecting a product that feels comfortable to you, and ensuring it is worn properly. Incontinence products need to be changed throughout the day to avoid leaks and reduce moisture against the skin, which can cause damage. There are also products designed for overnight that provide more absorbency.
Treatment Options
Treatment for BPH will depend on the severity of symptoms. For people with mild symptoms, this can include lifestyle modifications and monitoring for changing or worsening symptoms over time. Lifestyle modifications are things that can be done without medical intervention, such as limiting caffeine and alcohol intake, monitoring fluid intake, and timed voiding (scheduling bathroom trips to avoid overfilling the bladder). These strategies can help manage mild urinary symptoms associated with BPH.
For those with moderate to more severe symptoms that become disruptive and decrease quality of life, other treatment options are available. These can include:
- Medication management: Many types of medications can be used to manage BPH. The specific medication used will differ for each person based on their other conditions and the medications they are taking. The most common medications are called alpha-adrenergic receptor antagonists, such as Tamsulosin, also branded as FloMax.
- Surgery: For some men, lifestyle modifications and medication may not relieve their symptoms. In these cases, surgery may be recommended to manage BPH. The goal of surgery is to remove excess prostate tissue to relieve pressure on the urethra.
- Minimally Invasive Treatments: Minimally invasive treatments can offer faster recovery times than surgery and can be performed in outpatient settings rather than in a hospital operating room. Two common minimally invasive treatments include a prostatic urethral lift ( a procedure where implants are used to separate the two sides of the prostate, allowing more room for the urethra) and Rezūm™ therapy ( a steam vapor treatment that damages prostate cells, which the body then reabsorbs, and allows the prostate to shrink).
Better Bladder Control Starts With Understanding BPH
Once men reach 70 years of age, nearly 90% of them will have experienced BPH. While not every person who develops BPH will have bothersome symptoms or require treatment, understanding what it is can help you be prepared. Knowing what to do if incontinence or other bladder control issues arise with BPH can help ensure you receive treatment and continue enjoying daily life.
