If you are a man over age 50, chances are you know — or will soon — someone taking a medication for an enlarged prostate gland. In fact, by age 60, half of all men will have an enlarged prostate, a condition also known as benign prostatic hyperplasia, or BPH. By age 85, the number reaches 90%.
Urinary problems caused by BPH
BPH can cause bothersome problems like frequent urination at night, slow urine flow, difficulty urinating or completely emptying the bladder, and the urgent need to urinate at inconvenient times.
Do you have BPH?
(Problems with bladder function)
(Problems with the flow of urine)
- Difficulty starting urination
- Straining to urinate
- Incomplete bladder emptying
- Weak, slow, or intermittent urine stream
Dribbling after urinating
What is BPH?
Unfortunately, most men will experience some kind of prostate problem during their lifetime. Prostate problems are generally associated with three conditions: prostatitis, cancer, and BPH.
BPH, or "enlarged prostate," refers to the excessive growth of the prostate gland. It usually occurs after age 50, likely due in part to a change in the balance of hormones as men get older. It's also believed certain male hormones such as dihydrotestosterone tend to act more strongly on the prostate gland later in life.
The urethra — the tube that conveys urine from the bladder to outside the body — passes right through the prostate, so it doesn't take much prostate growth to make urination difficult. As the bladder works against the blockage, its muscular walls thicken. This can cause problems like the need for more frequent visits to the bathroom and difficulty fully emptying the bladder.
Treatment options for BPH
Drug therapy relieves symptoms, and for severe problems surgery may be considered. But for men with milder symptoms that don't interfere much with their daily lives, simple changes in behavior can help to take the edge off urinary symptoms.
This approach is broadly available to men who have lower urinary tract symptoms that have been attributed to BPH, but who are not bothered enough to take on the small but finite risks of treatment, such as drugs or surgery.
The question that should drive treatment decisions is this: how much do your symptoms bother you? Whether it is getting in the way of doing the things you want to do should be the primary driver of treatment.
How bothersome is it?
Doctors use the International Prostate Symptom Score (IPSS) or the American Urological Association symptom score to measure how frequent a man's symptoms are. It's a seven-item questionnaire about typical BPH symptoms that provides a score from 0 to 35.
Typically, men who score 8 and above are more likely to think their condition needs treatment, but it varies from man to man. Above a score of 8 there is actually a spectrum of bother. Two men can have the same symptom score, and one can tolerate it just fine but the other can't.
Both tests cut through the subjectivity with this additional question: "If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that?" If the answer is, "I could live with it," then holding off on drug therapy or surgery might be best for you.
But not taking medication or having surgery doesn't mean "do nothing." It should include strategies to lessen symptoms or make them easier to cope with.
Living with BPH: A toolbox for managing urinary symptoms
BPH progresses slowly, so most men can decide for themselves if and when they would like to consider medication or surgery. Men with mild to moderate symptoms often find that the changes in fluid intake, medication use, and bladder habits listed below can noticeably relieve BPH's bothersome effects.
Medication use: Alter use of medications that could worsen urinary symptoms.
- Talk to your doctor or pharmacist about prescription or over-the-counter medications that may be contributing to your BPH symptoms. Antihistamines and decongestants can cause problems for some.
- If you use medications that could make you urinate more, don't take them right before driving, traveling, attending an event, or going to bed.
- Don't rely on ineffective dietary supplements. Saw palmetto and other herbal supplements have failed rigorous scientific testing so far.
Fluid restriction: Change how much fluid you drink — and when — to prevent bothersome bathroom visits.
- Don't drink liquids before driving, traveling, or attending events where finding a bathroom quickly could be difficult.
- Avoid drinking caffeinated or alcoholic beverages after dinner or within two hours of your bedtime.
Bladder habits: Change the timing and manner in which you empty your bladder to reduce symptoms or make them less disruptive.
- Don't hold it in; empty your bladder when you first get the urge.
- When you are out in public, go to the bathroom and try to urinate when you get the chance, even if you don't feel a need right then.
- Take your time when urinating so you empty your bladder as much as possible.
- Double void: After each time you urinate, try again right away.
- On long airplane flights, avoid drinking alcohol, and try to urinate every 60 to 90 minutes.
- If you experience urinary urgency, progressively delay the time to when you urinate.
- Ask your doctor for detailed instructions on bladder training.
A serious complication of BPH
Infrequently, BPH can cause acute urinary retention, or the inability to pass urine. This may be accompanied by pain in the lower abdomen. Acute urinary retention is a medical emergency. If you are unable to empty your bladder, you will need to visit an emergency room where a medical professional will relieve the obstruction. Your physician or nurse may also instruct you on how to safely relieve the blockage yourself by inserting a small tube (catheter) through the opening at the tip of the penis and passing it into the bladder to enable urine to flow properly. This is called intermittent catheterization.s