What Is BPH?

Benign prostatic hyperplasia, or BPH, is a common condition caused by an enlarged prostate — and it can result in urinary symptoms that affect one’s quality of life and overall health.

Benign prostatic hyperplasia (BPH) is a condition caused by an enlarged prostate gland. It is not cancerous, nor does it increase the risk of prostate cancer. However, it does affect millions of men as they age, and it can result in bothersome lower urinary tract symptoms (LUTS).

Jullet Han, MD, a urologic oncologist at Keck Medicine of USC, explains what causes BPH and how to treat BPH.

How common is BPH?

BPH becomes increasingly common as men age:

• It can occur in men as early as their 30s, but it is more prevalent as men get older.
• By age 50, there’s a 50% chance of having BPH.
• By age 60, it’s about 70%.
• By age 70, it reaches 80%.

Dr. Han notes that while nearly 80% of men will develop BPH, only about 30% experience symptoms significant enough to need medical intervention.

What causes BPH?

What is the main cause of BPH? Age is the most significant risk factor for BPH. While the exact mechanism behind BPH is not fully understood, it has been linked to hormonal changes that occur as men age, Dr. Han explains.

Other contributing factors may include:

• Genetics: Family history may play a role, suggesting a genetic predisposition to developing BPH.
• Lifestyle influences: There are no definitive studies linking lifestyle factors to BPH. Dr. Han affirms that certain activities like cycling (sitting on a narrow bicycle seat) might cause prostate irritation or pelvic floor dysfunction. However, that is not a proven cause of BPH.
• Health conditions: Conditions such as diabetes can affect bladder function and may cause symptoms that mimic symptoms of BPH.

What are the symptoms of BPH?

Dr. Han explains that the prostate sits under the bladder and surrounds the urethra. The prostate’s primary function is to produce the fluid that sperm travels through, also known as semen. The prostate can get bigger as men age, and it can obstruct the flow of urine, resulting in lower urinary tract symptoms.

Dr. Han uses this analogy to describe the impact an enlarged prostate can have on the urethra: “It’s like stepping on a hose. When you step on the hose, it restricts the flow of water, similar to how an enlarged prostate can restrict urine flow through the urethra.”

It’s important to note that not all prostates are created equal, and a patient’s prostate size doesn’t always correlate with symptom severity. “Some men with large prostates have no issues urinating, while some with smaller prostates do,” Dr. Han says.

This variability means that symptoms can range from mild to severe, regardless of prostate size. So, she says, it’s important to discuss any urinary changes with a doctor, even if you don’t think your prostate is enlarged.

BPH can cause various urinary symptoms, including:

• Difficulty initiating urination (hesitancy)
• Feeling of incomplete bladder emptying
• Weak urine stream
• Dribbling after urination
• Having to push in order to get urine out

These symptoms often develop gradually. “Most men don’t notice day-to-day changes,” Dr. Han notes, “but many do recognize differences when asked to compare their current urinary symptoms to their voiding habits in their 20s.”

When to see a doctor for BPH

It is important to communicate openly with your doctor about any urinary symptoms you are experiencing.

Dr. Han says that when she asks patients if they have any urinary symptoms, men often say no. “But when I really break it down and ask specific questions, they say, ‘Oh yeah, I do have that sometimes,’” she says.

Consider these questions about your urinary health, and compare your answers to your experience when you were in your 20s:

• Have there been any changes in your urinary habits?
• Do you have difficulty starting your urine stream?
• Do you have a weak stream when urinating?
• Do you experience any dribbling after urination?
• Do you feel like you’re fully emptying your bladder?

Dr. Han suggests initiating the conversation with your doctor this way: “Hey, I feel like there has been a change in my urinary stream.”

How is BPH diagnosed?

Tools for diagnosing BPH typically include:

• Patient history
• Digital rectal exam
• Bladder ultrasound (if available)

A bladder ultrasound checks the post-void residual (PVR), which is the amount of urine remaining in the bladder after urination.

Dr. Han emphasizes the importance of differentiating BPH from other conditions with similar symptoms. “One great mimicker of BPH — and one that I often see misdiagnosed — is an overactive bladder. If the patient can empty their bladder completely as confirmed by a PVR but still complains of urgency and frequency, then it is more likely that they have an overactive bladder.”

“Proper diagnosis is crucial because these conditions are treated differently,” she adds.

Doctors might also test a patient’s prostate-specific antigen (PSA) level to rule out prostate cancer.

How to treat BPH

Dr. Han outlines several treatments for BPH, emphasizing the significant advancements that have been made in recent years. “There are so many different ways of treating BPH,” she notes.

Medications for BPH

• Alpha blockers: These are typically the first line of treatment, taken for 4-6 weeks to assess effectiveness.
• 5-alpha reductase inhibitors: Added if alpha blockers don’t provide full relief, taking 4-6 months to reach maximum effect.

Surgery for BPH

If medications fail, various surgical options are available. Modern surgical techniques have significantly improved patient outcomes, Dr. Han explains, compared to early treatment options for BPH. Following surgery, most patients are able to go home the same day, with lower risks of complications like incontinence or erectile dysfunction.

“Most patients who undergo prostate surgery for noncancerous purposes do not experience those effects,” Dr. Han reassures.

She also emphasizes that no specific diets or supplements are proven to prevent or treat BPH, advising overall health maintenance instead.

Key takeaways about BPH

If you’re experiencing urinary changes, discuss them with your doctor. BPH is manageable, and early intervention can improve your quality of life. BPH is common as men age, but remember:

• Not all enlarged prostates cause symptoms, and not all urinary symptoms are due to BPH.
• Proper diagnosis is crucial for proper treatment.
• Various treatment options are available, from medications to minimally invasive surgical procedures.
• Modern surgical techniques have significantly reduced risks associated with BPH treatment.

Remember, your doctor is there to help you. Don’t be embarrassed to discuss these topics — they’re important for your health. By providing detailed information to your primary care physician or urologist, you help them make a more accurate diagnosis and recommend the most appropriate treatment or referral.

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