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Enlarged Prostate: A Complex Problem

There are many treatments for enlarged prostates (BPH), but all have side effects and possible complications. Learn what to expect -- and how to decide.
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All his life, he slept like a stone. But now, there's an annoying trip to the bathroom every night, sometimes once or twice a night.

For most men, these nightly bathroom runs may be the first sign of an enlarged prostate. Other symptoms may include trouble starting a stream of urine, leaking, or dribbling. And, like gray hair, an enlarged prostate is a natural by-product of getting older, doctors say. Trouble is, the nightly bathroom runs become more frequent -- eventually edging their way into the daytime routine.

"They can't sit through a meeting or a plane flight without getting up," says Kevin Slawin, MD, a professor of urology at Baylor School of Medicine in Houston. "It's very annoying … and when they have to go, they really have to go."

It's a problem that has several names -- enlarged prostate, benign prostate hyperplasia, or simply BPH. According to the National Kidney and Urological Disease Information Clearinghouse, the most common prostate problem for men over 50 is prostate enlargement. By age 60, over one-half of men have BPH; by age 85, the number climbs to 90%, according to the American Urological Association (AUA).

Enlarged Prostate Symptoms and Causes

In men, urine flows from the bladder through the urethra. BPH is a benign (noncancerous) enlargement of the prostate that blocks the flow of urine through the urethra. The prostate cells gradually multiply, creating an enlargement that puts pressure on the urethra -- the "chute" through which urine and semen exit the body.

As the urethra narrows, the bladder has to contract more forcefully to push urine through the body.

Over time, the bladder muscle may gradually become stronger, thicker, and overly sensitive; it begins to contract even when it contains small amounts of urine, causing a need to urinate frequently. Eventually, the bladder muscle cannot overcome the effect of the narrowed urethra so urine remains in the bladder and it is not completely emptied.

Symptoms of enlarged prostate can include:

  • A weak or slow urinary stream
  • A feeling of incomplete bladder emptying
  • Difficulty starting urination
  • Frequent urination
  • Urgency to urinate
  • Getting up frequently at night to urinate
  • A urinary stream that starts and stops
  • Straining to urinate
  • Continued dribbling of urine
  • Returning to urinate again minutes after finishing

When the bladder does not empty completely, you become at risk for developing urinary tract infections. Other serious problems can also develop over time, including bladder stones, blood in the urine, incontinence, and acute urinary retention (an inability to urinate). A sudden and complete inability to urinate is a medical emergency; you should see your doctor immediately. In rare cases, bladder and/or kidney damage can develop from BPH.

Time to Do Something About Your Enlarged Prostate?

Most men put up with an enlarged prostate for months, even years, before seeing a doctor, says Slawin. "When they're getting up several times a night, and have trouble falling asleep again, that's when they come in," he tells WebMD.

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