Benign Prostatic Hyperplasia (BPH) Diagnosis and Treatment

Symptoms of BPH

Symptoms related to prostate enlargement are collectively known as LUTS (lower urinary tract symptoms). Other conditions can also lead to lower urinary tract symptoms, so a proper evaluation is essential.

As the prostate swells, it may compress the urethra, partially obstructing urine flow. This can result in obstructing symptoms, including:

• Hesitation: There may be a delay before there is a flow of urine.
• Incomplete emptying: A sensation that the bladder hasn't been completely emptied.
• Dribbling: Towards the end of urination, the flow slows to a trickle.
• Weak urinary stream: The flow is reduced, and it takes longer to empty urine from the bladder.

Additionally, prostate enlargement may irritate the bladder, causing:

• Urgency: A sudden, strong urge to urinate, often requiring immediate action.
• Frequent urination: An increased need to pass urine, especially at night (nocturia).

Symptoms are often mild initially, with slight changes such as brief hesitation before urination begins or reduced flow of urine. Over time, symptoms may gradually worsen and become more disruptive. It's important to note that not all urinary issues in men are caused by enlargement of the prostate. Symptoms like blood in the urine, incontinence, or pain during urination might indicate other conditions affecting the prostate, bladder, or kidneys. Seek medical advice if any of these symptoms arise.

Enlarged prostate vs prostate cancer

Recent news about King Charles undergoing treatment for BPH (benign prostatic hyperplasia) has brought attention to prostate health. While it's been clarified that his condition isn't related to cancer, it's common for men to worry about the potential overlap in symptoms. Prostate cancer and benign prostate enlargement can share similar signs, but they are distinct conditions.

Causes of prostate enlargement

The main cause of prostate enlargement remains unclear, though it's considered a normal part of ageing. Hormonal changes, particularly in male sex hormones, are thought to play a role.

In some cases, BPH (benign prostatic hyperplasia) may result from diseases such as:

• Chronic prostatitis
• Prostate cancer
• Acute prostatitis

Diagnosing enlargement of the prostate

The diagnosis of prostate enlargement is typically based on symptoms. However, tests may be performed to check for complications or cross out other causes. These may include:

• Blood and urine tests to check for infections, blood in the urine, or kidney function.
• A physical examination to assess the size of the prostate through a rectal exam.

The patient should be referred to a urologist for further evaluation in severe cases, including:

• Ultrasound scans: Checking for residual urine in the bladder post-urination.
• A PSA (prostate-specific antigen) test may also be offered to help assess prostate size. However, elevated PSA levels can occur in both benign and cancerous conditions, so further evaluation may be needed.
• Cystoscopy: Examining the bladder using a telescope-like device.
• Urine flow tests: Assessing the degree of obstruction.

Possible complications of BPH

Most men with prostate enlargement won't experience any severe complications. However, in some cases, the following issues can arise:

• Chronic retention: Persistent incomplete emptying of the bladder can lead to repeated urinary infections or incontinence.
• Urinary retention: A complete inability to pass urine, requiring the insertion of a catheter to empty the bladder

It's important to note that having BPH doesn't increase the risk of developing prostate cancer.

Treatment options for BPH

While no treatment can eliminate symptoms completely, most men experience significant relief through available options. Treatment depends on the severity and impact of the symptoms.

Surgical Interventions

Surgery may be considered for severe symptoms or when medications fail. Options include:

• Rezum®: A treatment using water vapour to shrink the prostate.
• Laser surgery: Using lasers to remove or vaporise prostate tissue with fewer side effects.
• Transurethral resection of the prostate (TURP): The most common procedure involving the removal of prostate tissue to improve urine flow.
• UroLift®: A minimally invasive procedure that lifts and holds excess prostate tissue to widen the urethra.

Watchful waiting

For mild symptoms, a "wait-and-see" approach may be sufficient. Regular monitoring can help determine if symptoms worsen over time.

Medications

Medications can often ease symptoms without curing the underlying issue. Common options include:

• Alpha-blockers: They relax the muscles in the bladder, neck and prostate, improving the passage of urine.
• A 5-alpha reductase inhibitor: They lower the size of the prostate by obstructing hormone activity.

When to Seek Help

It's not always necessary to treat benign prostatic hyperplasia, particularly if symptoms are mild. However, if you're experiencing significant disruption to your quality of life or complications such as frequent infections or urinary retention, it's important to seek medical advice.

For more information or to book an appointment, contact us today. Your prostate health matters!

FAQs

What Causes Prostate Enlargement?

The exact cause of prostate enlargement isn't fully understood, but it's believed to result from hormonal changes as men age. Risk factors that may increase the likelihood of prostate enlargement include:

• Being middle-aged or older.
• Being overweight.
• Having diabetes.
• A family history of prostate enlargement.

In some cases, an enlarged prostate may also be caused by conditions such as acute prostatitis, chronic prostatitis, or prostate cancer.

What Is the Best Treatment for an Enlarged Prostate?

The ideal treatment depends on the severity of your symptoms and how much they affect your quality of life. If your symptoms are mild, you may not need any treatment. While treatment may not eliminate all symptoms, it can significantly improve them. Common treatment options include:

• Catheters: A soft tube inserted through the penis or via a small incision to help drain the bladder.
• Urinary habit changes: Techniques such as double voiding, urethral massage, and bladder training programs.
• Lifestyle changes: Drinking less in the evening, increasing fiber intake, losing weight, reducing alcohol, caffeine, and fizzy drinks, and strengthening pelvic floor muscles.
• Medications: Options include alpha-blockers, 5-alpha-reductase inhibitors, anticholinergics, desmopressins, or diuretics.
• Medical procedures: Treatments like botulinum toxin injections, sacral nerve stimulation, or prostate artery embolization.
• Surgery: Options such as laser prostate surgery, transurethral resection of the prostate (TURP), open prostatectomy, or water ablation.

Can You Feel an Enlarged Prostate?

You cannot feel your own prostate, but certain symptoms may indicate it is enlarged, such as:

• Blood in urine.
• Difficulty starting urination or a weak, intermittent urine stream.
• Feeling that your bladder isn't fully emptied.
• Frequent urination, especially at night.
• Painful urination.
• Sudden, strong urges to urinate.
• Urinary incontinence.

If you experience these symptoms, consult your GP. They may perform a physical exam, including a rectal examination, to determine if your prostate is enlarged.

What Happens When You Have an Enlarged Prostate?

An enlarged prostate can press on your bladder and urethra, affecting your urine flow. While symptoms are often mild and may improve without treatment, prostate enlargement can increase the risk of:

• Urinary tract infections (UTIs).
• Acute urinary retention: A condition where you cannot empty your bladder, which is a medical emergency.

Is Drinking a Lot of Water Good for Your Prostate?

Staying hydrated helps prevent concentrated urine, which can irritate your bladder and worsen prostate symptoms. However, to avoid nighttime urination, it's best to limit water intake in the evenings and drink more during the day. Reducing alcohol, caffeine, artificial sweeteners, and fizzy drinks can also help manage symptoms.

What Foods Should You Avoid if You Have an Enlarged Prostate?

If you have an enlarged prostate, avoid foods and drinks that irritate the bladder, including:

• Alcohol
• Caffeine
• Artificial sweeteners
• Fizzy drinks

Maintaining a healthy weight and managing diabetes can also help. Focus on a balanced diet that is low in sugar and fat.