As men age, the prostate gland enlarges. This is also known as benign prostatic hyperplasia (BPH). BPH is a noncancerous growth of the cells within the prostate gland. By age 60, more than half of men have BPH. By age 85, about 90 percent of men have BPH, but only about 30 percent will have symptoms. An enlarged prostate can put pressure on the urethra which makes it difficult to urinate.
It is unclear what causes benign prostatic hyperplasia. However, what we do know is that age and testosterone play an important role. Other risk factors include poor diet, physical inactivity, abdominal obesity, smoking, and excessive alcohol use.
The signs and symptoms of benign prostatic hyperplasia are related to urination because the enlarging of the prostate puts pressure on the urethra which decreases the flow of urine. Signs and symptoms include a weak or slow urinary stream, incomplete emptying of the bladder, frequent urination, urinary urgency, a urinary stream that starts and stops, waking up often at night to urinate, straining to urinate, dripping and leaking after urination.
Your doctor will use the AUA index to evaluate your symptoms. The American Urologic Association (AUA) has developed a symptom score for BPH. AUA scores: 0-7 are mild; 8-19 are moderate; 20-35 are severe symptoms. AUA scores are calculated by circling the answer to each question and adding up the numbers. Talk to your doctor about your score to determine what treatment you may need.
Your doctor will also check for other conditions like diabetes and neurological disorders. A digital rectal exam may be needed to evaluate the size of the prostate and to check for any abnormalities that could indicate prostate cancer or infection. A urinalysis and a PSA blood test may also be performed.
Because BPH progresses slowly, most men can make the decision on their own about if and when they should be treated. In few cases, BPH symptoms are severe enough to require immediate treatment. The treatment options available for BPH depend on the severity of your symptoms. The most common treatment options include watchful waiting, prescription medications, or surgery.
· Watchful waiting: Watchful waiting is the only option for men with low AUA scores. This method includes reducing fluid intake, especially at night, limiting alcohol and caffeine intake, avoiding medications that may affect bladder and prostate function, and scheduling regular timed bathroom visits.
· Medications: Prescription medications to treat BPH include alpha-blockers, hormone blockers, and combination therapy.
· Surgery: The type of surgery used to treat BPH is called a transurethral resection of the prostate (TURP). It is the most common treatment for BPH as it reduces symptoms in 80 to 90 percent of patients. Complications may include dry ejaculation, infection or bleeding, erectile dysfunction, and incontinence. Because the prostate can grow back, up to 20 percent of patients require another TURP procedure within ten years.