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Benign prostatic hyperplasia (BPH) is a condition faced by men, where a gland called prostate merely gets enlarged in size without developing cancer in it. This condition is considered to be age-related which usually affects men over 40 years of age. The chances of developing BPH keeps on increasing as a man gets older.
The prostate gland sits in the lowest part of your abdomen just beneath the urinary bladder. The gland surrounds a tube-like structure called urethra which flows the urine out of the body.
When the prostate enlarges in size it compresses the hollow tube-like urethra pinching its lumen and causing problems in the outflow of urine. This, in turn, puts back pressure on the urinary bladder which eventually becomes weakened losing its ability to get completely empty.
Know more about the prostate gland and its function
The exact cause of benign BPH is not known, however, it is known to develop and get worse with age.
Role of hormones:
Mainly two hormones have been suggested to be associated with the development of BPH in following ways.
• Change in testosterone/estrogen balance: Throughout a man’s life, the body producesboth testosterone, a male hormone, and small proportion of estrogen, a female hormone. As they age, the level of active testosterone in the blood decreases, leaving a higher proportion of estrogen. Studies have suggested thathigher proportion of estrogen within the prostate increases the activity of substances that promote prostate cell growth leading to BPH.
• Dihydrotestosterone (DHT): type of testosterone which plays an important role in prostate growth. According to some studies even with a drop in blood testosterone levels with age, older males continue to accumulate significant levels of DHT in the prostate. This may continue to promote growth of prostate cells. Researchers have found that men who do not produce DHT do not develop BPH.
BPH is the commonest urinary system problem faced by the old men. The BPH and specially the symptoms caused by the BPH is rare in males below the age of 40 years. The occurrence of BPH and the symptoms caused by it increases significantly with age affecting different age groups as follows:
• 8% male between 31 to 40 years of age
BPH has been also found to be commonest pathology of prostate in men in India with an incidence of about 93%.
If you are a man and have following factors in you, then your are at a higher risk of developing BPH:
• Age of 40 years and above
• Family history: have someone with BPH in your family
• Medical conditions such as heart and blood vessels disease, and type 2 diabetes
• Obesity and lack of physical activity
• Suffer from erectile dysfunction
The symptoms of BPH occurs because of two main reasons one, the enlarged prostate narrows the urethra and the other is that bladder becomes irritable due to constant back pressure on it. This leads to symptoms called as lower urinary tract symptoms which are as follows:
• Frequency: frequent need to pass urine throughout the day, typically being more than 7 to 8 times during the day.
• Nocturia: need to wake up from the sleep typically, multiple times to pass urine.
• Urgency: strong urge to pass urine as soon as possible with reduced or no ability to hold it.
• Hesitancy: difficulty or sense of hesitation with starting of a urine stream
• Poor flow: a weak or an interrupted stream of urine
• Dribbling: dribbling of drops of urine at the end of urination
• Urine retention: feeling of presence of urine after voiding the bladder completely
• Urine incontinence: involuntary passage of urine
The size of the prostate doesn’t always decide the severity of the symptoms. Some men may have significantly enlarged prostate but may have no or mild symptoms, whereas some men may have mildly enlarged prostate but with significant symptoms.
It is also found that less than half of the men wit BPH develops symptoms.
Sometimes BPH may lead to more concerning issues and complications given below:
• Complete blockage of urine flow: called as acute urinary retention, where the person present with inability to pass urine at all. The person may not be aware of the underlying BPH until it complicates to this condition. It can be triggered due to intake of over the counter cough and cold medicines containing pseudoephedrine, diphenhydramine or oxymetazoline.
• Blood in the urine
• Urinary tract infections (UTI): usually due to persistence of urine with the bladder even after voiding.
• Bladder damage
• Kidney damage
• Urinary bladder stones
Most of the men with BPH do not complicate, however, several of the conditions such as kidney damage if develops can have serious consequences.
The above discussed symptoms in a men may also suggest another condition which may need urgent attention such as UTI, inflammation of the prostate, bladder or kidney stone, or prostate cancer. Thus all men with symptoms described above should consult a doctor and get properly evaluated to conform the underlying cause and get it treated.
Men with the following symptoms should seek immediate medical care:
• Inability to pass urine at all
• Blood in the urine
• Pain or burning in urine
• Lower urinary tract symptoms with fever and chills
Your doctor diagnose BPH on the basis of following:
• Physical examination
• Lab tests
The benign prostatic hyperplasia can be treated by the following options, depending upon the severity of the symptoms, its effects on the quality of life and one’s personal preference.
• Watch full waiting with or without lifestyle changes
• Minimally invasive procedures and surgeries
Some men may have enlarged prostate however with no symptoms. These men and one with mild symptoms may not need treatment at all. Whereas, in some men, more than one treatment may be required to relieve the symptoms.
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