Benign Prostatic Hyperplasia (BPH)

Introduction, Symptoms and Complications

The prostate gland is present only in males. Enlargement of the prostate gland causes problems in urination in elderly male. (usually over the age of 60 years). With increase in life expectancy, the incidence of benign prostatic hyperplasia (also called BPH) has also increased.

What is the prostate gland? What is its function?

The prostate gland is a small organ about the size of a walnut and is part of the male reproductive system.

The prostate gland is situated just underneath the bladder and in front of the rectum. It surrounds the initial portion of the urethra (the tube that carries urine from the bladder). In other words, the initial portion of the urethra (about 3 cm. long) runs through the prostate.

The prostate is a male reproductive organ. It secretes fluid that nourishes and carries sperm into the urethra during ejaculation.

What is benign prostatic hyperplasia (BPH)?

“Benign prostatic” means the prostatic problem is not caused by cancer and “hyperplasia” means enlargement.

Benign prostatic hyperplasia or benign prostatic hypertrophy (BPH) is a non-cancerous prostatic enlargement that occurs in almost all men as they get older. As men age, the prostate gland slowly grows bigger (or enlarges). An enlarged prostate compresses the urethra, blocks the urine stream and causes problems in urination. Because of narrowing of the urethra, flow of urine becomes slower and less forceful.

Symptoms of BPH

The symptoms of BPH usually begin after age 50. More than half of men in their 60s and up to 90% of men in their 70s and 80s have symptoms of BPH. Most symptoms of BPH start gradually and worsen over the years. The most common symptoms of BPH are:

• Frequent urination, especially at night. This is usually a very early symptom.
• Slow or weak stream of urine.
• Difficulty or straining in starting the urine flow, even when the bladder feels full.
• Urge to urinate immediately is the most bothersome symptom.
• Straining to urinate.
• Interrupted urine flow.
• Leaking or dribbling at the end of urination. Drops of urine are expelled even after urination causing wetting of underclothes.
• Incomplete emptying of bladder.

Complications of BPH

Severe BPH can cause serious problems over a time in a few patients, if left untreated. Common complications of BPH are:

• Acute urinary retention: untreated severe BPH over time can cause sudden, complete and often painful blockage of urine flow. Such patients require insertion of a tube called a catheter to drain urine from the bladder.
• Chronic urinary retention: partial blockage of urine flow for a prolonged period can cause chronic urinary retention. Chronic urinary retention is painless and is characterized by an increased residual urine volume. The amount of urine which remains in bladder after normal urination is called residual urine. Its usual presentation is incomplete bladder emptying or frequent voiding of small amount of urine (overflow of urine).

• Damage to bladder and kidney: chronic urinary retention causes stretching of the muscular wall of the bladder. In the long term the bladder becomes weak and no longer contracts properly.

  Large residual urine volume leads to increased pressure in the bladder. High bladder pressure may lead to a back pressure of urine through the ureters and into the kidneys. Resultant fullness of the ureters and the kidneys eventually may lead to kidney failure.

• Urinary tract infection and bladder stones: inability to completely empty the bladder increases the risk of urinary tract infection and formation of bladder stones.
• Remember, BPH does not increase the risk for prostate cancer.