You can do a lot to take care of yourself and give your body what it needs. Still, as you get older, your body changes in ways you can’t always control. For most men, one of those changes is that the prostate gets bigger.
It’s a natural part of aging, but at some point, it can lead to a condition called BPH, or benign prostatic hyperplasia.
Your prostate surrounds part of your urethra, the tube that carries urine and semen out of your penis. When you have BPH, your prostate is larger than usual, which squeezes the urethra. This can cause your pee stream to be weak, waking you up a lot at night to go to the bathroom along. it also could lead to other bothersome urinary symptoms.
BPH isn’t prostate cancer and doesn’t make you more likely to get it.
It’s a common condition, especially in older men, and there are a lot of treatments for it, from lifestyle changes to medication to surgery. Your doctor can help you choose the best care based on your age, health, and how the condition affects you.
What Causes BPH?
Doctors aren’t sure exactly what makes this happen. Some think it may have to do with normal hormonal changes as you age, but it’s not clear.
Early in puberty, your prostate actually doubles in size. Later in life, around age 25, it starts to grow again. For most men, this growth happens for the rest of their lives. For some, it causes BPH.
As the prostate gets larger, it starts to pinch the urethra. This causes symptoms that affect your urine flow, such as:
- Dribbling when you finish
- A hard time getting started
- A weak stream, or you pee in stops and starts
When your urethra is squeezed, it also means your bladder has to work harder to push urine out. Over time, the bladder muscles get weak, which makes it harder for it to empty. This can lead to:
- Feeling like you still have to pee even after you just went
- Having to go too often -- eight or more times a day
- Incontinence (when you don’t have control over when you pee)
- An urgent need to pee, all of a sudden
- You wake up several times a night to pee
Urinary tract infections, bleeding, bladder damage, and bladder stones
It rarely leads to other conditions, but it can, and a couple of them are serious. For example, BPH can lead to kidney damage or, worst-case, cause a problem where you can’t pee at all.
A larger prostate doesn’t mean you’ll have more or worse symptoms. It’s different for each person. In fact, some men with very large prostates have few, if any, issues.
Diagnosis and Tests
Your doctor will first talk to you about your personal and family medical history. You might also fill out a survey, answering questions about your symptoms and how they affect you daily.
Next, your doctor will do a physical exam. This may include a digital rectal exam. During this, they put on a glove and gently insert one finger into your rectum to check the size and shape of your prostate.
Basic tests: Your doctor may start with one or more of these:
- Blood tests to check for kidney problems
- Urine tests to look for infection or other problems that could be causing your symptoms
- PSA (prostate-specific antigen) blood test. High PSA levels may be a sign of a larger-than-usual prostate. A doctor can also order it as screening for prostate cancer.
Advanced tests: Based on the results of those tests, your doctor may order additional tests to rule out other problems or to see more clearly what’s happening. These might include:
- Different types of ultrasound to measure your prostate and see if it looks healthy.
- A bladder ultrasound to see how well you empty your bladder.
- Biopsy to rule out cancer.
- Urine flow test to measure how strong your stream is and how much pee you make.
- Urodynamics testing to evaluate your bladder function.
- Cystourethroscopy is a procedure using a camera to examine the inside of the prostate, urethra and bladder.
How your doctor handles your case varies based on your age, health, the size of your prostate, and how BPH affects you. If your symptoms don’t bother you too much, you can put off treatment and see how it goes.
Lifestyle changes: You may want to start with things you can control. For example, you can:
- Do exercises to strengthen your pelvic floor muscles
- Lower the amount of fluids you drink, especially before you go out or go to bed
- Drink less caffeine and alcohol
Medicine: For mild to moderate BPH, your doctor might suggest medicine. Some medications work by relaxing the muscles in your prostate and bladder. Others help shrink your prostate. For some men, it takes a mix of medicines to get the best results.
Procedures: If lifestyle changes and medications don’t work, your doctor has a number of ways to remove part or all of your prostate. Many of these are called “minimally invasive,” meaning they’re easier on you than regular surgery. They use probes or scopes and don’t require large cuts in your body.
Examples are TUMT, Rezūm, and laser therapy to remove part of your prostate gland. Other surgeries include:
Transurethral resection of the prostate, or TURP, in which the doctor uses a scope and cuts out pieces of the gland with a wire loop
Transurethral incision of the prostate or TUIP, in which a few small cuts are made in the prostate to reduce the gland’s pressure on the urethra.
UroLift system is a permanently placed device used to lift and hold the enlarged prostate tissue out of the way, so it no longer blocks the urethra.
In some cases, your doctor may also suggest a traditional, open surgery or a robotic procedure to remove your prostate.
With any BPH surgery, there may be side effects or complications such as bleeding, narrowing of the urine tube also known as urethral stricture, urinary incontinence or leakage, erectile dysfunction, and retrograde ejaculation.
BPH doesn’t lead to prostate cancer or make you more likely to get it.