It is common for the prostate gland to become enlarged as a man ages. Doctors call the condition benign prostatic hyperplasia (BPH) or benign prostatic hypertrophy.
As a man matures, the prostate goes through two main periods of growth. The first occurs early in puberty, when the prostate doubles in size. At around age 25, the gland begins to grow again. This second growth phase often results, years later, in BPH.
Though the prostate continues to grow during most of a man's life, the enlargement doesn't usually cause problems until late in life. BPH rarely causes symptoms before age 40, but more than half of men in their 60s and as many as 90 percent in their 70s and 80s have some symptoms of BPH.
As the prostate enlarges, the layer of tissue surrounding it stops it from expanding, causing the gland to press against the urethra like a clamp on a garden hose. The bladder wall becomes thicker and irritable. The bladder begins to contract even when it contains small amounts of urine, causing more frequent urination. Eventually, the bladder weakens and loses the ability to empty itself, and urine remains in the bladder. The narrowing of the urethra and partial emptying of the bladder cause many of the problems associated with BPH.
Many people feel uncomfortable talking about the prostate, since the gland plays a role in both sex and urination. Still, prostate enlargement is as common a part of aging as gray hair. As life expectancy rises, so does the occurrence of BPH. In the United States in 2000, there were 4.5 million visits to a physician for this condition.
Understanding the Prostate
The prostate is a walnut-sized gland that forms part of the male reproductive system. The gland is made of two lobes, or regions, enclosed by an outer layer of tissue. The prostate is located in front of the rectum and just below the bladder, where urine is stored. The prostate also surrounds the urethra, the canal through which urine passes out of the body.
Scientists do not know all of the prostate's functions. One of its main roles, though, is to squeeze fluid into the urethra as sperm move through during sexual climax. This fluid, which helps make up semen, energizes the sperm and makes the vaginal canal less acidic.
The cause of BPH is not well understood. No definite information on risk factors for the condition exists. For centuries, it has been known that BPH occurs mainly in older men and that it doesn't develop in men whose testes were removed before puberty. For this reason, some researchers believe that factors related to aging and the testes may spur the development of BPH.
Many BPH symptoms stem from obstruction of the urethra and gradual loss of bladder function, which results in incomplete emptying of the bladder. These symptoms vary, but the most common ones involve changes or problems with urination, such as:
- A hesitant, interrupted, or weak stream
- Urgency and leaking or dribbling
- More frequent urination, especially at night.
The size of the prostate does not always determine how severe the obstruction or the symptoms will be. Some men with greatly enlarged glands have little obstruction and few symptoms, while others, whose glands are less enlarged, have more blockage and greater problems.
Sometimes a man may not know he has any obstruction until he suddenly finds himself unable to urinate at all. This condition, called acute urinary retention, may be triggered by taking over-the-counter cold or
allergy medicines. Such medicines contain a decongestant drug known as a sympathomimetic. A potential side effect of this drug may be to prevent the bladder opening from relaxing and allowing urine to empty. When partial obstruction is present, urinary retention also can be brought on by alcohol, cold temperatures, or a long period of immobility.
It is important to tell your doctor about urinary problems such as these. In eight out of ten cases, these symptoms suggest BPH, but they can also signal other, more serious conditions that require prompt treatment. These conditions, including
prostate cancer, can only be ruled out by a doctor's exam.
Severe BPH can cause serious problems over time. Urine retention and strain on the bladder can lead to:
If the bladder is permanently damaged, treatment for BPH may be ineffective. When the condition is found in its earlier stages, there is a lower risk of developing such complications.
You may first notice the symptoms of BPH yourself, or your doctor may find that your prostate is enlarged during a routine checkup. When BPH is suspected, you may be referred to a urologist -- a doctor who specializes in problems of the urinary tract and the male reproductive system. Several tests help the doctor identify the problem and decide whether surgery is needed. The tests vary from person to person, but the following are the most common:
- Digital rectal exam
- Prostate specific antigen test (PSA test)
- Rectal ultrasound
- Urine flow study
- Cystoscopy.
Men who have BPH and
enlarged prostate symptoms will usually require some form of treatment at some point. However, a number of recent studies have questioned the need for early treatment when the gland is only mildly enlarged. These studies report that early treatment may not be needed because the symptoms clear up without it in as many as one-third of all mild cases. Instead of immediate treatment, these studies recommend regular checkups to watch for early problems. If the condition begins to pose a danger to the person's health or causes a major inconvenience to him, treatment is usually recommended.
Since BPH may contribute to
urinary tract infections, a doctor will usually clear up any infection with antibiotics before treating the BPH itself. Although the need for treatment is not usually urgent, doctors generally advise going ahead with treatment once the problems become bothersome or present a health risk.
About half of the men with BPH eventually have symptoms that are bothersome enough to need treatment. This condition cannot be cured, but drugs or surgery can often relieve symptoms. In addition, symptoms do not always grow worse.
There are three ways to manage BPH:
- Watchful waiting (having regular follow-up appointments with your doctor)
- Drug therapy
- Surgery.
If you have BPH, talk with your doctor about which type of treatment is the best choice for you. Your symptoms may change over time, so be sure to tell your doctor about any new symptoms you experience.
About 9 percent of men 30 years of age and older (6.3 million men) report having been told by a physician they had BPH.
It is estimated that BPH occurs in different age groups at the following rates:
- Ages 30-54: 2.2 percent
- Ages 55-74: 19.6 percent
- Ages 75 and up: 36.3 percent.
The estimated number of hospital discharges among men who are 20 years or older with a discharge diagnosis of BPH includes:
- 402,000 discharges (2001)
- 398,000 discharges (2000).
The estimated number of doctor visits by men age 20 or older with BPH as a listed diagnosis includes:
- 6.4 million visits (2000)
- 6.0 million visits (1999).
