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What Are The Manifestations Of Benign Prostatic Hyperplasia

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How Is Benign Prostatic Hyperplasia Diagnosed

Your doctor will look at your medical history and give you a complete physical examination.

Your doctor will perform a digital rectal examination by inserting a gloved, lubricated finger into your rectum to feel the prostate, estimate its size and detect any hard areas that could be cancer.

Several studies may be performed to help diagnose your condition:

  • A survey to evaluate how severe your symptoms are.
  • A flow study may be conducted to measure how slow the urinary stream is compared with normal urine flow.
  • A study to detect how much urine is left in the bladder after you finish urinating.
  • A cystoscopy to look into the bladder.

What Happens When The Prostate Enlarges

As the prostate enlarges, it presses against the urethra and interferes with urination. At the same time, the bladder wall becomes thicker and irritated, and begins to contract–even when it contains only small amounts of urine–which causes more frequent urination. And, as the bladder continues to weaken, it may not empty completely and leave some urine behind, leading to a frequent sensation of having to void, having a slow urinary flow, and waking up at night to urinate.

Blocking or narrowing of the urethra by the prostate and partial emptying of the bladder cause many of the problems associated with BPH.

What Are Symptoms Of Bph

The following are the most common symptoms of benign prostatic hyperplasia. However, each individual may experience symptoms differently. Symptoms may include:

  • Leaking or dribbling of urine

  • More frequent urination, especially at night

  • Urgency to urinate

  • Urine retention

  • A hesitant, interrupted, weak stream of urine

These problems may lead to one or more of the following:

  • Incontinence

  • Bladder stones

  • Inability to pass urine at all

The symptoms of benign prostatic hyperplasia may resemble other conditions or medical problems. Always consult your doctor for a diagnosis.

How Can I Tell The Difference Between Prostatitis And Bph

    If you do not have any symptoms of BPH or any of the types of prostatitis, which can be the situation for some men, you may not be able to tell if you have either problem. However, a doctor or other health care professional can detect enlargement of the prostate with a digital rectal exam , even if you dont have any symptoms.

    If you do have symptoms, they are related to the increase in size of your prostate gland. When the gland enlarges, it can constrict the urethra and produce one or more of these symptoms.

    • The need to urinate frequently during the day or night
    • The sudden urgent need to urinate
    • Difficulty initiating urinary stream
    • Feeling like you still need to urinate even though you recently urinated
    • Feeling like you need to push or strain to empty your bladder
    • A decrease in the force of the urine stream
    • Loss of small amounts of urine

    The symptoms of prostatitis depend upon the type of prostatitis.

    Acute bacterial prostatitis symptoms

    Asymptomatic inflammatory prostatitis

      Some men may have some of these symptoms with both BPH and prostatitis. If you are over age 50, it is more likely BPH than prostatitis, and if you are under age 35, acute bacterial prostatitis is more likely than BPH. In some patients, prostatitis may be recurrent .

      How Does The Urolift System Work

      Benign Prostatic Hyperplasia (BPH) SymptomsMEC

      The UroLift® System uses a revolutionary approach to treating BPH that lifts and holds the enlarged prostate tissue so it no longer blocks the urethra. It is the only available BPH treatment performed by a urologist that does not require heating, cutting, or removal of the prostate tissue. The procedure is typically performed using local anesthesia in a physicians office or ambulatory surgery center. Patients typically return home the same day without a catheter.1

      What Is The Treatment For Bph

      Specific treatment for BPH will be determined by your doctor based on:

      • Your age, overall health, and medical history

      • Extent of the disease

      • Your tolerance for specific medications, procedures, or therapies

      • Expectations for the course of the disease

      • Your opinion or preference

      Eventually, BPH symptoms usually require some kind of treatment. When the gland is just mildly enlarged, treatment may not be needed. In fact, research has shown that, in some mild cases, some of the symptoms of BPH clear up without treatment. This determination can only be made by your doctor after careful evaluation of your individual condition. Regular checkups are important, however, to watch for developing problems.

      Treatment for BPH may include:

    • Laser surgery. Using laser instruments to cut away obstructing prostate tissue.

    • Open surgery. Surgery that requires an external incision; often performed when the gland is very enlarged, when there are complicating factors, or when the bladder has been damaged and needs to be repaired.

    • Nonsurgical treatments may include:

    • Balloon urethroplasty. A thin tube with a balloon is inserted into the opening of the penis and guided to the narrowed portion of the urethra. The balloon is inflated to widen the urethra and ease the flow of urine.

    • Transurethral microwave thermotherapy. A device called a Prostatron uses microwaves to heat and destroy excess prostate tissue to reduce urinary frequency and urgency.

    • Lifestyle management for BPH may include:

    • What Increases Your Risk

      Men who are older than 50 have a higher risk for benign prostatic hyperplasia .

      The hormone testosterone, which is produced mainly by the testicles, is needed in order for BPH to develop. Men who have their testicles removed before puberty never develop BPH. Men who have their testicles removed after puberty rarely develop BPH.

      A vasectomy does not increase your risk of BPH.

      Diagnosing Benign Prostate Enlargement

      You might have several different tests to find out if you have an enlarged prostate.

      A GP may do some of these tests, such as a urine test, but others might need to be done at a hospital.

      Some tests may be needed to rule out other conditions that cause similar symptoms to BPE, such as prostate cancer.

      How Common Is Benign Prostatic Hyperplasia

      BPH is the most common prostate problem in men. Almost all men will develop some enlargement of the prostate as they grow older. By age 60, 50% of men will have some signs of BPH; by age 85, 90% of men will have signs of the condition. About half of these men will develop symptoms that need to be treated.

      What Is The Prostate Gland

      The prostate is a small organ about the size of a walnut. It lies below the bladder and surrounds the urethra . The prostate makes a fluid that helps to nourish sperm as part of the semen .

      Prostate problems are common in men 50 and older. Most can be treated successfully without harming sexual function.

      What Happens When The Prostate Gland Enlarges

      In benign prostatic hyperplasia, the prostate gland enlarges. Normally the size of a walnut, the prostate gland may become as large as a tennis ball. The enlarging prostate gland squeezes the urethra, which carries urine out of the body. As a result, urine may flow through more slowly, or less urine may flow through.

      How Is Benign Prostatic Hyperplasia Treated

      Patients who have mild symptoms may not require treatment other than continued observation to make sure their condition doesn’t get worse. This approach is sometimes called “watchful waiting” or surveillance. There are a number of treatment options available if your symptoms are severe.

      Medications

      Finasteride and dutasteride work by decreasing the production of the hormone dihydrotestosterone , which affects the growth of the prostate gland. These appear to be most beneficial for men with larger prostates.

      Drugs that relax the muscle in the prostate are more commonly used. These include terazosin , doxazosin , tamsulosin , alfuzosin , and silodosin . The most common side effects are lightheadedness, weakness and retrograde ejaculation.

      Medications are sometimes combined to help treat symptoms and improve the flow of urine. One such medication is dutasteride and tamsulosin .

      Surgery

      Several different types of surgery can be used to remove the prostate tissue that blocks the flow of urine, including:

      Minimally invasive treatments

      Minimally invasive treatments include:

      Last reviewed by a Cleveland Clinic medical professional on 03/10/2020.

      References

      Symptoms Of Benign Prostate Enlargement

      Benign Prostatic Hyperplasia (BPH)

      The prostate is a small gland, located in the pelvis, between the penis and bladder.

      If the prostate becomes enlarged, it can place pressure on the bladder and the urethra, which is the tube that urine passes through.

      This can affect how you pee and may cause:  

      • difficulty starting to pee
      • a frequent need to pee
      • difficulty fully emptying your bladder

      In some men, the symptoms are mild and do not need treatment. In others, they can be very troublesome.

      Psa Tests For Bph And Prostate Cancer

      A PSA test measures the level of prostate-specific antigen in the patient’s blood. It is the standard screening test for prostate cancer. A PSA is recommended annually for all men over 50 years old and for men over 40 who are at high risk for prostate cancer.

      BPH itself can also raise PSA levels, but the test has generally been optional for men with suspected BPH. One 2000 study indicated that PSA levels may be good predictors of future prostate growth in men with BPH.

      In the study, men in the lowest PSA level groups had prostate growth rates of only 0.7mL per year while those in the high PSA groups had growth rates of 3.3 mL per year. Other research has detected a specific molecular form of P SA, which has been termed BPSA because it may be a specific marker for BPH. Such findings could eventually lead to a shift from focusing on symptoms and flow rates for diagnosis to a more specific and possible preventive approach.

      Certain treatments for BPH, including the drug finasteride and the surgical procedure transurethral resection of the prostate , can reduce PSA levels and possibly mask the existence of prostate cancer.

      A more recent test identifies so-called free PSA, which is found in lower levels when prostate cancer is present and in higher levels with BPH. This may be more accurate than total PSA, regardless of whether a man is taking finasteride or not.

      When Should I Call A Doctor

      Your symptoms may not bother you too much. But itâs important to talk over any urinary problems with your doctor.

      Itâs hard to predict how BPH will play out, and you canât assume that the problem will get better on its own. Your doctor also will want to rule out things that cause similar problems.

      Some symptoms need quick medical attention. If you have any of these, call your doctor right away or head to an emergency room:

      • You canât urinate at all.
      • You have to pee frequently, itâs painful, and you have fever and chills.
      • You have blood in your urine.
      • You feel a great deal of pain in your lower belly and urinary tract.

      National Institutes of Health: National Institute of Diabetes, Digestive and Kidney Diseases — Prostate Enlargement: Benign Prostatic Hyperplasia.

      Cleveland Clinic: Diseases and Conditions — Benign Prostatic Enlargement .

      Johns Hopkins Medicine Health Library: Benign Prostatic Hyperplasia.

      Mayo Clinic: Diseases and Conditions — Benign Prostatic Hyperplasia .

      How Common Is Bph

      BPH is more common when you get older, usually starting after 40 years of age and affecting nearly all men at some time in their lives. Some people dont have any symptoms, even though their prostate has grown larger. BPH usually becomes more of a problem over time, with symptoms getting worse if left untreated.

      Treatment If The Condition Gets Worse

      If any of the following occur, you will probably need surgery for benign prostatic hyperplasia :

      • You cannot urinate.
      • Your BPH is causing repeated urinary tract infections, bladder stones, or bladder damage.
      • You have blood in your urine that is not getting better and is causing other problems such as clots that make it hard to urinate.
      • You have kidney damage.

      Diagnosis And Management Of Benign Prostatic Hyperplasia

      JONATHAN L. EDWARDS, MD, Barberton Citizens’ Hospital, Barberton, Ohio

      Am Fam Physician. 2008 May 15;77:1403-1410.

       Patient information: See related handout on benign prostatic hyperplasia, written by the author of this article.

      Benign prostatic hyperplasia is a common condition in older men. Histologically, it is characterized by the presence of discrete nodules in the periurethral zone of the prostate gland. Clinical manifestations of BPH are caused by extrinsic compression of the prostatic urethra leading to impaired voiding. Chronic inability to completely empty the bladder may cause bladder distension with hypertrophy and instability of the detrusor muscle. Some patients with BPH present with hematuria. Because the severity of symptoms does not correlate with the degree of hyperplasia, and other conditions can cause similar symptoms, the clinical syndrome that often accompanies BPH has been described as lower urinary tract symptoms.

      SORT: KEY RECOMMENDATIONS FOR PRACTICE

      Men with suspected BPH can be evaluated with a validated questionnaire to quantify symptom severity.

      BPH = benign prostatic hyperplasia.

      A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, see page 1360 or https://www.aafp.org/afpsort.xml.

      SORT: KEY RECOMMENDATIONS FOR PRACTICE

      What Are The Symptoms

      BPH causes urinary problems such as:

      • Trouble getting a urine stream started and completely stopped .
      • Often feeling like you need to urinate. This feeling may even wake you up at night.
      • A weak urine stream.
      • A sense that your bladder is not completely empty after you urinate.

      In a small number of cases, BPH may cause the bladder to be blocked, making it impossible or extremely hard to urinate. This problem may cause backed-up urine , leading to bladder infections or stones or kidney damage.

      BPH does not cause prostate cancer and does not affect a man’s ability to father children. It does not cause erection problems.

      Tests That May Be Done

      The following tests may be done if you have complications of BPH or if there is a need to look for other causes of the symptoms.

      • Ultrasound uses sound waves to check the size and structure of the kidneys, bladder, and prostate. A small device called a transducer is inserted into the rectum to evaluate the prostate.
      • Cystoscopy allows the doctor to look inside the urethra and bladder. This may allow the doctor to find out how much an enlarged prostate is blocking the urethra.
      • Intravenous pyelogram uses X-rays to show the function of the kidneys and the flow of urine from the kidneys to the bladder.
      • Spiral computed tomography scan uses X-rays to make detailed pictures of structures inside the body. These scanners can check for an enlarged prostate gland, blockage, and urine flow from the kidneys.

      What Makes My Prostate Grow

      Benign Prostatic Hyperplasia (BPH) Treatment in Kuala ...

      The male sex hormone testosterone makes the prostate grow in size. As you get older, the prostate grows larger. At puberty, your testosterone levels start to increase, and the prostate grows to about eight times its size. It continues to grow, doubling in size between the ages of 21 and 50, and almost doubles again between the ages of 50 and 80. We still dont fully understand the reasons for this ongoing growth.

      Tests That Are Used As Needed

      If your symptoms are moderate to severe, additional tests, called urodynamic studies, may be done.

      • A blood creatinine test checks how well your kidneys are working.
      • Post-void residual urine test measures the amount of urine left in the bladder after urination. This test is done using ultrasound or a small tube put into the bladder through the urethra.
      • Pressure flow studies measure pressure in the bladder while urinating. They may help distinguish between urinary symptoms caused by obstruction, such as BPH, and those caused by a problem affecting the bladder muscles or nerves.
      • Cystometrogram measures the bladder’s pressure, compliance, and capacity during urinary storage. This may include a uroflowmetry test, which measures how fast the urine flows out of the bladder.

      How Is It Treated

      As a rule, you don’t need treatment for BPH unless the symptoms bother you or you have other problems such as backed-up urine, bladder infections, or bladder stones.

      Although home treatment cannot stop your prostate from getting larger, it can help reduce or control your symptoms. Here are some things you can do that may help reduce your symptoms:

      • Practice “double voiding.” Urinate as much as you can, relax for a few moments, and then urinate again.
      • Avoid caffeine and alcohol. They make your body try to get rid of water and can make you urinate more often.
      • If possible, avoid medicines that can make urination difficult, such as over-the-counter antihistamines, decongestants , and allergy pills. Check with your doctor or pharmacist about the medicines you take.

      If home treatment does not help, BPH can be treated with medicine. Medicine can reduce the symptoms, but it rarely gets rid of them. If you stop taking medicine, symptoms return.

      If your symptoms are severe, your doctor may suggest surgery to remove part of your prostate. But few men have symptoms or other problems severe enough to need surgery.

      What Should I Do If I Think I May Have Prostate Problems

      Regardless of which problem you may think you have, you should see your primary care doctor. To make the diagnosis your doctor will take a complete history, physical exam that includes a digital rectal exam, and other appropriate diagnostic tests, for example, a urinalysis, urine culture, blood tests such as the PSA test, electrolytes, creatinine, and occasionally blood urea nitrogen levels. Your doctor may order other tests, for example, an ultrasound, endoscopy, urine flow rate studies, and biopsy of the prostate gland. Your doctor also may refer you to a specialist called a urologist, especially if you require surgery as part of your treatment.

      What Is The Prostate

      The prostate is a walnut-shaped gland that is part of the male reproductive system. The main function of the prostate is to make a fluid that goes into semen. Prostate fluid is essential for a mans fertility. The gland surrounds the urethra at the neck of the bladder. The bladder neck is the area where the urethra joins the bladder. The bladder and urethra are parts of the lower urinary tract. The prostate has two or more lobes, or sections, enclosed by an outer layer of tissue, and it is in front of the rectum, just below the bladder. The urethra is the tube that carries urine from the bladder to the outside of the body. In men, the urethra also carries semen out through the penis.

      What Procedures Or Tests Diagnose This Prostate Problem

      A doctor or other health care professional usually can detect an enlarged prostate by rectal examination. A medical professionals may perform a rectal examination to ensure that there are no “nodules,” which are hard, irregular areas in the prostate suspicious for prostate cancer, as well as to assess the size of the prostate. Assessment of prostate size and shape is better assessed with an abdominal or transrectal ultrasound or cystoscopy. A cystoscope is a long, thin telescope-like instrument that has a light source and lens allowing one to look at the urethra, the prostate, and the bladder when inserted through the opening at the tip of the penis. Cystoscopy and/or ultrasound is recommended prior to surgical treatment of BPH. Other tests that medical professionals may perform include: bladder scanner postvoid residual determination and uroflowmetry . Lastly, a PSA is often obtained and if abnormal may require further evaluation to rule out prostate cancer.

      The American Urological Association recommends that men with BPH complete the AUA-symptom index , which assesses the degree to which symptoms bother. It is a useful way to assess changes in bothersome symptoms with treatment.

        Are There Other Non

        Yes, aside from BPH, there are a number of prostate problems that also have nothing at all to do with prostate cancer. Among these benign disorders of the prostate are acute prostatitis and chronic prostatitis and, rarely, prostatic infarct .

        Acute prostatitis is a bacterial infection of the prostate. It can occur in men at any age. Symptoms include fever, chills, and pain in the lower back and between the legs. This problem also can make it hard or painful to urinate. Doctors prescribe antibiotic medicines for acute prostatitis and recommend that the patient drink more liquids. Treatment is usually successful.

        Chronic prostatitis is a prostate inflammation that tends to recur over time. It is usually not associated with true bacterial infection but causes similar symptoms of pain and discomfort, without fevers or chills. Chronic prostatitis is difficult to treat, and the exact cause is not well understood. Antibiotics may be used in some cases as well as anti-inflammatory medicines such as ibuprofen. In many cases, symptoms will resolve on their own.

        Prostate infarct is a localized area of dead prostate tissue as a result of inadequate blood supply. Prostate infarct is uncommon and may cause sudden increases in the PSA test.

        How Is Bph Diagnosed

        Your doctor can diagnose BPH by asking questions about your symptoms and past health and by doing a physical examination. Tests may include a urine test and a digital rectal examination, which lets your doctor feel the size of your prostate. In some cases, a prostate-specific antigen test is done to help rule out prostate cancer.

        Your doctor may ask you how often you have symptoms of BPH, how severe they are, and how much they affect your life. If your symptoms are mild to moderate and do not bother you much, home treatment may be all that you need to help keep them under control. Your doctor may want to see you regularly to check on your symptoms and make sure other problems haven’t come up.

        You can use this tool to help you think about how bothersome your symptoms are:

        How Is Each Condition Diagnosed

        Benign Prostatic Hyperplasia

        Youll see a specialist called a urologist to diagnose BPH or prostate cancer. Doctors use many of the same tests to diagnose both of these conditions.

        • Prostate-specific antigen test:This blood test detects PSA, a protein your prostate gland makes. When your prostate grows, it produces more of this protein. A high PSA level can only tell your doctor that your prostate has grown. It cant tell for sure that you have BPH or prostate cancer. Youll need more tests to confirm the diagnosis.
        • Digital rectal exam : Your doctor will insert a gloved, lubricated finger into your rectum. This test can show if your prostate is enlarged or abnormally shaped. Youll need more tests to find out if you have BPH or prostate cancer.

        Are Prostatitis And Bph The Same Prostate Gland Problem

        The answer to this question is yes and no, because both may have some similar health symptoms , but each prostate problem have different causes. Yes, BPH is by definition an enlarged prostate, and no, because the cause is not an infection/inflammation like prostatitis. However, not all enlarged prostates are due to BPH. An enlarged prostate may be caused by BPH, prostatitis, and prostate cancer.

        What Causes Bph At What Age Do Men Develop The Condition

        Medical professionals do not have a good understanding of what causes an enlarged prostate.

        BPH generally begins in a man’s 30s, evolves slowly, and most commonly only causes symptoms after 50.

          In benign prostatic hyperplasia, the prostate gland grows in size. It may compress the urethra, which courses through the center of the prostate. This can impede the flow of urine from the bladder through the urethra to the outside. Lower urinary tract symptoms from BPH can be due to one of the factors: dynamic, static, and compensatory. Dynamic factors are related to the tone of the muscle surrounding the prostate and the outlet of the bladder whereas static factors are related to the enlargement of the prostate tissue. Dynamic and static symptoms are prostate-related symptoms. Compensatory factors are the result of changes that occur in the bladder as a result of the bladder working harder to push urine past the bladder neck and prostate.

          Signs and symptoms of BPH include lower urinary tract symptoms of weak urine stream, difficulty starting the urine stream , straining to urinate, inability to completely empty the bladder, inability to urinate , blood in the urine , leakage of urine , decreased urine flow , and post-void dribbling of urine.

          BPH may also be related to the development of bladder stones, recurrent urinary tract infections, and backup of urine in the kidneys .

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