Benign prostatic hyperplasia (BPH)

What is it?

A benign (i.e. non-cancerous) enlargement of the prostate gland.

What are the main symptoms?

The most common sign of BPH — an enlarged prostate — is difficulty in passing urine. You might experience:

a weak flow
intermittency — a flow which stops and starts
hesitancy — having to wait before you start to go
frequency — having to urinate more often than previously
urgency — finding it difficult to postpone urination
nocturia — having to get up at night to urinate

What's the risk

BPH is common in men over 50. About half of all men will have BPH by the age of 60, rising to eight out of ten in their 80s.

What causes it?

Most theories involve the male hormone testosterone. It's possible that the cells in the prostate gradually become more sensitive to a related hormone, dihydrotestosterone, with ageing.
Genetic, dietary or environmental factors may also be involved.

How can I prevent it?

Increase your intake of fruit and vegetables.
Cut down on milk, red meat and sources of saturated fat.

Should I see a doctor?

Seek help before your symptoms become so troublesome that they seriously affect your quality of life.
If you are no longer able to pass urine at all, seek immediate medical attention.
Waterworks quiz — should I see a doctor?

What are the main treatments?

Watchful waiting
Drug treatments
Surgery

Watchful waiting

If your symptoms are mild or not very bothersome, your doctor may advise "watchful waiting", with regular re-examinations. Not all prostates go on getting bigger.
Life-style changes may help relieve some symptoms. You could
- avoid drinking large volumes of liquids at any one time
- avoid drinks altogether before going to bed
- limit your intake of drinks containing alcohol or caffeine

Drug treatments

Mild to moderate symptoms may be treated with alpha-blockers and 5-alpha-reductase inhibitors.

Alpha-blockers

Alpha-blockers relax the muscle in the prostate and relieve pressure on the urethra.
If they are going to work, they usually do so within two to three weeks.
Symptoms improve in up to 75% of patients but side-effects may include headaches, dizziness, faintness or tiredness.

5-Alpha-reductase inhibitors

These drugs block production of dihydrotestosterone, slowing down the rate at which the prostate is enlarging. Sometimes the prostate even shrinks.
It can take up to six months for the best results but symptoms improve in more than half of all cases.
Treatment may inhibit your sex drive and cause difficulties with erections. These side-effects usually disappear if treatment is stopped, but then the prostate tends to enlarge again.
These drugs have been shown to be very effective in men with large prostates (larger than 40 g in weight) but less useful in those with smaller prostates.
Their use should be avoided in men whose partner is pregnant or likely to become pregnant (or condoms should be used). There is evidence that these drugs can affect the unborn male babies of women exposed to them during pregnancy.

Surgery

An operation is usually recommended if your symptoms cannot be controlled by drugs or if you have urinary tract or other complications. Some men opt for surgery rather than taking medication.

TURP (transurethral resection of the prostate) is recognised as the "gold standard" treatment.
TUIP (transurethral incision of the prostate) may be used where the prostate is still relatively small. This is a much less invasive procedure than TURP.
TUMT (transurethral microwave thermotherapy) uses microwave energy to heal the prostate. This is also less invasive than TURP.
Open prostatectomy is usually only done if the prostate is very large or if there are other factors, such as a bladder stone which also requires treatment.

TURP

Carried out under an epidural or a light general anaesthetic, this usually takes less than an hour.
An instrument called a resectoscope is passed up through the the penis so that the prostate tissue obstructing the urethra can be cut away.
Afterwards a catheter is used to drain off the urine. This is removed after 36—48 hours.
You can usually go home after three or four days, but will be advised to take things quietly for a few weeks.
You may see blood in your urine for several days or even weeks after the operation, but normally your urine will gradually clear.
The most common after-effect is retrograde ejaculation.
A significant number of men report erection difficulties.
There is also a slight risk of incontinence.
The prostate can regrow, so you may need a second operation.

TUIP

The procedure is carried out under an epidural or a light general anaesthetic, and takes about 15 minutes.
An instrument is passed up the urethra and one or two small cuts are made in the bladder neck and prostate. This allows the prostate tissue around the urethra to spring apart, reducing the pressure and making it easier to pass urine.
The stay in hospital and the recovery time are shorter than after a TURP, and complications are less likely.

Open prostatectomy

This is carried out under general anaesthetic, and usually takes about an hour.
Part of the prostate is removed through a cut in the lower abdomen, which will leave a scar.
Most patients can leave hospital after a week, but pain after the operation is more likely than after TURP, because of the incision.
A longer convalescent period is needed and complications are slightly more common.

Which treatment is best for me?

Questions to ask your doctor:

What improvements in my symptoms can I reasonably expect from this treatment?
How long might these improvements reasonably be expected to last?
Would I need further treatment in future — and if so, what kind?
What are the risks of side-effects or complications?

Questions to ask yourself:

If I had to spend the rest of my life with my urinary condition the way it is now, how would I feel?
Thinking back about my symptoms over the past month, how do I feel?
How much do my symptoms stop me doing what I want?
Are my symptoms bad enough for me to want to take regular medication?
Are they bad enough for me to consider an operation?
Which would I rather do — avoid surgery if at all possible, or have an operation rather than take regular medication?

How can I help myself?

Try increasing your intake of zinc.
Some essential fatty acids, found in linseed or evening primrose oils, may help.
Natural remedies include saw palmetto berries and pollen extracts.