Benign prostatic hyperplasia (BPH)

Benign prostatic hyperplasia (BPH) is a very common, non-cancerous enlargement of the prostate gland in men. As the prostate grows larger, it can squeeze the urethra—the tube that carries urine out of the body—and interfere with urination. BPH affects most men as they age, with symptoms typically appearing after age 40. 

Common causes

The exact cause of BPH is not fully understood, but it is believed to be linked to the aging process and hormonal changes. The prostate gland has two main growth phases: 

  • The first occurs during puberty.

  • The second starts around age 25 and continues throughout life, often leading to BPH later on. 

Risk factors for developing BPH include:

  • Aging: The risk increases significantly with age.

  • Family history: Having a father or brother with BPH increases your risk.

  • Other health conditions: Obesity, heart disease, circulatory problems, and type 2 diabetes are all linked to a higher risk. 

Signs and symptoms

The symptoms of BPH can range from mild to severe and may worsen over time. These symptoms are caused by the pressure the enlarged prostate puts on the bladder and urethra. 

  • Urinary frequency and urgency: A need to urinate more often, especially at night.

  • Weak or slow urine stream: The stream of urine may start and stop, and is often not as strong as it used to be.

  • Trouble starting urination: It can be difficult to begin urinating.

  • Feeling of incomplete emptying: The sensation that you haven't fully emptied your bladder, even after you have finished urinating.

  • Dribbling: Urine may continue to dribble out after you have finished urinating.

  • Straining: Having to push or strain to urinate. 

Less common symptoms can include painful urination or blood in the urine, but these may also point to other, more serious conditions. In some cases, a sudden inability to urinate (acute urinary retention) is a medical emergency requiring immediate attention. 

Diagnosis

To diagnose BPH, a doctor will typically use a combination of methods: 

  • Medical history and symptom assessment: The doctor will ask about your symptoms and medical history. You may be asked to complete a questionnaire to score the severity of your symptoms.

  • Physical exam: A digital rectal exam (DRE) is used to feel the size, shape, and texture of the prostate.

  • Blood and urine tests: These tests can help rule out other conditions. A prostate-specific antigen (PSA) blood test can check for an enlarged prostate, though it's not specific to BPH and can also be high in prostate cancer.

  • Post-void residual volume test: This measures how much urine is left in the bladder after urination, often using an ultrasound.

  • Urinary flow test: A patient urinates into a special device that measures the strength and speed of the urine stream. 

Treatment

Treatment options for BPH depend on the severity of symptoms and your overall health.

  • "Watchful Waiting": If symptoms are mild and not bothersome, lifestyle changes may be all that is needed. This includes limiting fluids before bed, avoiding caffeine and alcohol, and exercising regularly.

  • Medications: For moderate symptoms, medication is often the first step.

    • Alpha-blockers: These drugs relax the bladder neck and prostate muscles to improve urine flow. E.g. Flomax 

    • 5-alpha reductase inhibitors: These medications shrink the prostate by preventing hormone changes. E.g. Finasteride 

    • Combination therapy: In some cases, a doctor may prescribe a combination of both types of drugs.

  • Minimally Invasive Procedures: If medication isn't enough, several procedures are available to remove or reshape prostate tissue without major surgery.

    • UroLift: Implants are used to lift and hold the prostate away from the urethra.

    • Rezūm water vapor therapy: Steam is used to destroy excess prostate tissue.

  • Surgery: For severe symptoms or when other treatments fail, surgery may be necessary to remove the blocking prostate tissue.

    • Transurethral resection of the prostate (TURP): A surgical instrument is inserted into the urethra to remove the excess tissue.

    • Prostatectomy: For very large prostates, surgery may involve removing the obstructing tissue through an incision.


 

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