Benign prostatic hyperplasia (BPH) is a common, non-cancerous enlargement of the prostate gland, primarily affecting men as they age. This condition can lead to lower urinary tract symptoms (LUTS). BPH symptoms are treatable, providing significant relief.
The Link Between an Enlarged Prostate and Urinary Symptoms
The prostate gland is positioned just below the bladder, encircling the urethra. As men age, the prostate often grows due to hormonal changes. This enlargement causes prostate tissue to expand inward, pressing on the urethra, like a clamp tightening around a hose.
This pressure obstructs urine flow from the bladder. The bladder muscle must work harder to push urine through the narrowed urethra. Over time, the bladder muscle can become thicker and more sensitive, contracting even with small amounts of urine. This effort and irritation contribute to difficulties with both emptying and storing urine.
Identifying Lower Urinary Tract Symptoms
Lower urinary tract symptoms (LUTS) related to an enlarged prostate are categorized into two groups: storage symptoms and voiding symptoms. These describe how the bladder functions in holding and releasing urine.
Storage Symptoms
Storage symptoms relate to the bladder’s ability to hold urine.
Increased urinary frequency: Needing to urinate more often.
Urgency: A sudden, compelling need to urinate that is difficult to postpone.
Nocturia: Waking up during the night to urinate.
Urge incontinence: Involuntary leakage of urine due to a strong urge before reaching a toilet.
Voiding Symptoms
Voiding symptoms describe difficulties during urination.
Weak or intermittent stream: Urine flow lacks force or stops and starts.
Straining to urinate: Needing to exert abdominal pressure to initiate or maintain the stream.
Hesitancy: Difficulty starting the urine stream, even when the bladder feels full.
Incomplete bladder emptying: A persistent feeling that some urine remains after urination.
The Diagnostic Process
When an individual presents with lower urinary tract symptoms, a healthcare provider undertakes a diagnostic process to confirm BPH and exclude other causes. Initial steps involve gathering a medical history, focusing on symptom nature and severity. Symptom assessment tools, such as the International Prostate Symptom Score (IPSS), are used to quantify symptom impact and track progression.
A physical examination, including a digital rectal exam (DRE), is part of the assessment. During a DRE, the doctor inserts a gloved finger into the rectum to feel the prostate gland, assessing its size, shape, and texture. This helps determine if the prostate is enlarged or identifies suspicious areas. Urine analysis (urinalysis) checks for infection, blood, or other abnormalities that could mimic BPH symptoms.
Blood tests are also ordered, notably the prostate-specific antigen (PSA) test. While an elevated PSA level can be associated with BPH, it is also a marker for prostate cancer, important for ruling out this more serious condition. Further tests like urodynamic studies, which evaluate bladder function and urine flow, or an ultrasound of the kidneys and bladder may be performed for more detailed information.
Management and Treatment Strategies
Managing benign prostatic hyperplasia and its lower urinary tract symptoms involves strategies tailored to symptom severity and patient preferences. For men with mild symptoms that do not significantly impact daily life, a “watchful waiting” approach is recommended. This involves regular symptom monitoring without immediate active treatment, along with lifestyle modifications. Adjustments like reducing fluid intake before bedtime, avoiding bladder irritants such as caffeine and alcohol, and practicing bladder training techniques can help manage mild symptoms.
When symptoms become more bothersome, medication is the first line of treatment. Alpha-blockers, such as tamsulosin or alfuzosin, relax smooth muscles in the prostate and bladder neck, reducing obstruction to urine flow. These medications provide rapid symptom relief within days to weeks. Another class of drugs, 5-alpha reductase inhibitors like finasteride or dutasteride, shrink the prostate gland itself. These medications can take several months to show their full effect but are effective for men with significantly enlarged prostates.
For individuals whose symptoms do not respond to medication or who prefer a more definitive solution, several minimally invasive procedures are available. Procedures like UroLift involve placing small implants to hold enlarged prostate lobes apart, widening the urethra. Rezūm therapy uses water vapor to destroy excess prostate tissue, reducing gland size. The iTIND device is a temporary, nitinol implant that reshapes the prostatic urethra without cutting or ablating tissue. These outpatient or office-based procedures aim to relieve obstruction with fewer risks and quicker recovery than surgery.
Surgical options are reserved for more severe BPH cases or when other treatments have not been successful. The most common surgical procedure is transurethral resection of the prostate (TURP), where a surgeon removes obstructing prostate tissue using an instrument inserted through the urethra. This procedure provides symptom relief. Newer laser-based procedures, such as holmium laser enucleation of the prostate (HoLEP), also remove prostate tissue through the urethra using laser energy. The goal of these surgical interventions is to create a wider channel for urine flow, alleviating symptoms caused by the enlarged prostate.