As a man gets older, an organ inside his body called the prostate gland enlarges. This condition is a common part of aging and is called benign prostatic hyperplasia (BPH).
The prostate gland is located right below your urinary bladder. A tube called the urethra runs through your prostate. Urine flows from your bladder through your urethra in order to exit the body. The symptoms of BPH occur because of where the prostate gland is situated.
A thin layer of tissue covers your entire prostate gland. As the cells inside your prostate gland increase in number, this tissue layer prevents your prostate gland from growing outward. Instead, your prostate becomes thicker and bulkier within. This increased growth causes your prostate to press on the part of the urethra running through it.
Difficulty in urinating
Since the urethra is now partially blocked by your enlarged prostate gland, it is more difficult for urine to exit the bladder. In order to push urine out, your bladder now has to overcome this partial block in your urethra. The muscles in your bladder wall have to work harder in order to exert a stronger force. At first, the only symptom you may experience with BPH is difficulty beginning urination. Over time, you may notice that urine may exit your body in a less forceful stream. Eventually, you may need to strain in order to start urinating.
As your prostate continues to enlarge, your urethra becomes even more and more narrowed. Your bladder has to exert more and more effort. This causes the muscles in your bladder wall to become thicker and more irritable. Normally, your bladder only contracts when it is full. This contraction signals to you that you need to urinate. However, with an irritable bladder, even small amounts of urine cause it to contract. This gives you the feeling of needing to urinate more often than usual. You may find yourself going to the restroom more frequently than before. The urge to urinate may come even during the night, forcing you to wake up in order to go to the bathroom.
Urinary retention
As time goes on, the additional effort that the bladder needs to exert may cause the bladder muscles to weaken and tire. The block in the urethra may become more severe. These two problems together may cause your bladder to be unable to completely empty itself. There may be urine remaining inside your bladder even after urination. This may cause an uncomfortable sensation doctors call urinary retention.
Blood in urine
The narrowing of your urethra and the weakening of your bladder muscles may also cause other problems with urination. You may dribble urine, even after you feel that you have already finished urinating. Urine may also leak from your penis in between visits to the restroom. You may notice that instead of having a steady flow of urine during urination, your urine may exit in spurts. Eventual damage to your urethra or bladder can cause bleeding, leading to blood being found in your urine.
The symptoms of BPH may lead to further complications. The problems with urination can lead to urinary tract infections. These infections can occur again and again, even with treatment. You may also suddenly be completely unable to urinate. This condition is called acute urinary retention. If this happens, seek medical help immediately.
Other symptoms that require prompt medical attention are:
- Blood in the urine. This indicates damage to your urinary tract. There may also be a more serious problem other than BPH causing your symptoms.
- Severe lower back pain.
- Fever and chills. A serious urinary tract infection may be present.
- Nausea and vomiting. These symptoms may also indicate a severe urinary tract infection.
Relieving the symptoms of BPH
If you have any of the above symptoms, your doctor will examine your prostate. Depending on the findings, your doctor may request additional tests. There may be other conditions aside from BPH that are causing your symptoms.
Once other diseases have been ruled out, you and your doctor can work on a treatment plan for BPH. Many men with BPH have very mild symptoms, or even none at all. For these men, doctors recommend watchful waiting. Symptoms may lessen or spontaneously resolve. With watchful waiting, your doctor will check on your prostate annually and see if your condition has improved.
However, if you have more severe symptoms, or if your symptoms worsen over time, your doctor may recommend the following:
- Medications. Your doctor may prescribe a drug that can reduce the size of your prostate, such as finasteride (brand name: Proscar) or dutasteride (Avodart). These drugs can relieve the pressure on your urethra and lessen the severity of your symptoms. Other medications do not directly shrink your prostate. Rather, they relax the muscles in your prostate and bladder. Relaxation of your muscles helps improve the flow of your urine. These drugs are called alpha blockers. Examples of alpha blockers are terazosin (Hytrin), tamsulosin (Flomax), alfuzosin (Uroxatral), prazosin (Minipress), and doxazosin (Cardura).
- Surgery. If your symptoms are very severe, your doctor may recommend surgery to debulk your prostate, thus reducing pressure on your urethra. There are several procedures that can accomplish this. Each procedure has its own benefits and side effects. Talk to your doctor so that you can decide together which procedure is best for you.