What is BPH benign prostatic hyperplasia?
What is BPH?
BPH stands for benign prostatic hyperplasia. It's an overgrowth of the cells in the prostate gland, which then becomes enlarged. Benign means that it's not malignant (i.e. it's not cancer) and it won't spread to other parts of your body.
The prostate gland (or, simply, prostate) is a walnut-shaped organ found just underneath the bladder in men. It is normally about 4cm wide and 3cm thick (approximately 1.5” by 1”).
The prostate produces a milky fluid which, together with sperm and other secretions, makes up semen. Women don't have a prostate.
The urethra is the tube that carries urine from the bladder out through the penis and runs through the middle of the prostate. As the prostte gets bigger, it starts to obstruct the urethra. This is what causes the symptoms of BPH.
How common is it?
BPH is very common. Young men aren't often affected but, overall, one in four (25%) men over the age of 40 can expect to suffer from it as they get older
What are the symptoms of BPH and what causes them?
The symptoms of BPH are called 'lower urinary tract symptoms' (LUTS) because they affect the lower urinary tract (the bladder and urethra).
Symptoms of BPH happen because the prostate presses on the urethra (the tube that carries urine), causing it to narrow. This means that urine can't pass down it as easily as before - it's obstructed. This is why some symptoms are called 'obstructive symptoms'. The following are typical obstructive symptoms:
- Poor stream - The flow of urine is weaker, and it takes longer to empty your bladder
- Hesitancy - You may have to wait at the toilet for a while before urine starts to flow
- Dribbling - Towards the end of passing urine, the flow becomes a slow dribble
- Poor emptying - You may have a feeling of not quite emptying your bladder
When you have obstructive symptoms, the blader has to work to push the pee out. After a while, the muscle of the bladder wall starts to thicken because of the extra work it's been doing. This means it becomes less stretchy, so the bladder can't hold as much pee. That's why you have to go more often, including at night, and why you often can't hold on when you need to go. These are called 'irritative symptoms'.
The following are typical irritative symptom:
- Frequency (passing urine more often than normal). This can be most irritating if it happens at night. Getting up several times a night is a common symptom and is called 'nocturia'.
- Urgency. This means you have to get to the toilet quickly when you 'need to go'.
It's often these symptoms that are most bothersome and cause the most disruption to daily life.
What impact can BPH have?
Like you, many men find that BPH affects their enjoyment of life. For example, you might feel tired all the time because you can't get a decent night's sleep. You might feel anxious and embarrassed at social gatherings because you keep having to disappear to the loo. Maybe you always have to think about what you're drinking and when - one more drink before the journey home might mean you can't make it back without stopping for a pee.
Outings and car journeys can be frustrating, especially if you have to map out every public toilet to reassure yourself you won't be caught short. BPH can affect your relationship with your partner too. Do they get annoyed with your toilet habits? Maybe you're disturbing their sleep, which might even lead to you sleeping in separate bedrooms.
If this sounds like you, you're certainly not alone. In a website survey with BPH sufferers, nine out of ten men say their condition has forced them to make significant adjustments to their lifestyle. In addition, 59% avoid drinking before bedtime, 41% plan their day around the availability of a toilet and 31% avoid travelling long distances.
Sex and BPH
It's not inevitable, but some men with BPH also have problems with sex (called sexual dysfunction or erectile dysfunction). Because the prostate plays a role in sexual function, prostate problems and LUTS may cause you to experience difficulties. The worse your urinary symptoms are, the poorer the erection quality can be.
Doctors don't know why these problems occur. It may just be that the likelihood of having both sexual dysfunction and BP increases with age. Or it could simply be because you're tired from having to get up several times at night to pee. All sorts of reasons can cause erectile problems, some of which (e.g. heart disease and diabetes) increase with age. Other possible causes include:
- Alcohol, smoking and illegal drugs
- Some medicines, including anti-depressants and drugs for high blood pressure (such as ACE inhibitors and beta-blockers)
- Conditions affecting nerves or blood supply, including multiple sclerosis or a stroke
- Hormonal conditions
- Conditions affecting the erectile tissue in the penis, such as major surgery in the abdomen, particularly prostate operations
- Long-term conditions, such as diabetes
It's really important that you seek advice from a healthcare professional if you experience any serious or ongoing symptoms, such as problems with your peeing habits, to ensure that you can get treatment, as well as identifying any underlying cause.
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