Benign Prostatic Hyperplasia (BPH)

Benign prostatic hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland, a common condition which affects men as they age. Although it’s not cancerous and doesn’t increase the risk of prostate cancer, because the prostate is enlarged, BPH can cause urinary problems by pressing on the urethra, the tube which carries urine out of the body. Examples of restrictions include:

• Trouble urinating such as slow/weak flow
• Frequent urination, especially waking up at night to urinate
• Dribbling/leakage and the feeling that the bladder is not completely empty

If untreated, in addition to impacting one’s quality of life, more serious problems can occur such as bladder stones, damage to the bladder or kidneys, infection and urinary retention. While an enlarged prostate can be uncomfortable, it is not life threatening.

The main risk factors for benign prostatic hyperplasia (BPH) are:

• Age: The risk of BPH significantly increases in men after age 50, with most men over 60 having some degree of an enlarged prostate. It’s very rare for men under the age of 40 to have BPH, whereas it’s very common in men over the age of 80 to have it.
• Family history: Men with a close relative with BPH increases the risk of them also suffering from it.
• Other health issues: Men suffering from Type 2 diabetes, obesity or heart disease have increased changes of being diagnosed with BPH.
  
   

Benign prostatic hyperplasia (BPH) is diagnosed through a combination of a physical exam, prostate specific antigen (PSA) blood test, symptom assessment and various tests. First, a physical exam is typically done involving a urine analysis and digital rectal exam (DRE) where the physician asses the prostate’s size and shape. The DRE helps the physician determine if there are any nodules, often suggesting that prostate cancer is present, and evaluate the prostate’s tenderness, which can happen if there is inflammation.

Other tests that may be run include:

• Prostate specific antigen (PSA) blood test, which measures the level of PSA, a protein produced by the prostate. Elevated PSA levels can indicate BPH as well as other conditions, including prostate cancer.
• Urodynamic tests to determine bladder performance.
• Cystoscopy, where a scope is inserted into the urethra to visualize the bladder and prostate.
• Transrectal ultrasound, where sound waves are sent through the rectum walls to get images of the prostate gland and surrounding tissues.

Many tests to gauge urine flow strength and checking for lingering urine in the bladder can conveniently be done in the office.

There are several ways to treat benign prostatic hyperplasia (BPH) depending on the severity of the symptoms, the prostate’s size and overall health of the patient. Treatment options include:

Lifestyle changes

Several changes to a patient’s diet and exercise can impact symptoms associated with BPH, including:

• Exercising regularly
• Limiting alcohol and coffee intake
• Maintaining a healthy weight
• Monitoring over-the-counter medications
• Pelvic floor muscle exercises
• Urinating on schedule

Medication

Physicians may recommend treating benign prostatic hyperplasia (BPH) with medications like Alpha Blockers and Alpha Reductase Inhibitors to relax muscle fibers found in the bladder and prostate to increase urine flow and decrease urination frequency. Alpha Reductase Inhibitors reduce the prostate’s size over time by blocking hormones that cause prostate swelling. Your physician may recommend a combination of both medication types.

Minimally-invasive procedures

If lifestyle changes and medications are not effective, surgery may be necessary. Yale New Haven Health offers several outpatient procedures, including:

Surgery

For patients who don’t get relief from medication or a less invasive procedure. Physicians will discuss if aggressive treatment is needed with the patient based on their prostate’s size and symptom severity. Surgical options include: