Prostate Disorders Overview
You can do a lot to take care of yourself and give your body what it needs. Still, as you get older, your body changes in ways you can’t always control. For most men, one of those changes is that the prostate gets bigger.
It’s a natural part of aging, but at some point, it can lead to a condition called BPH, or benign prostatic hyperplasia.
Your prostate surrounds part of your urethra, the tube that carries urine and semen out of your penis. When you have BPH, your prostate is larger than usual, which squeezes the urethra. This can cause a weak stream when you pee and cause you to wake up a lot at night to go to the bathroom along with other bothersome urinary symptoms.
BPH isn’t prostate cancer and doesn’t make you more likely to get it.
It’s a common condition, especially in older men, and there are a lot of treatments for it, from lifestyle changes to medication to surgery. Your doctor can help you choose the best care based on your age, health, and how the condition affects you.
What Causes BPH?
Doctors aren’t sure exactly what makes this happen. Some think it may have to do with normal hormonal changes as you age, but it’s not clear.
Early in puberty, your prostate actually doubles in size. Later in life, around age 25, it starts to grow again. For most men, this growth happens for the rest of their lives. For some, it causes BPH.
Symptoms
As the prostate gets larger, it starts to pinch the urethra. This causes symptoms that affect your urine flow, such as:
- Dribbling when you finish
- A hard time getting started
- A weak stream, or you pee in stops and starts
When your urethra is squeezed, it also means your bladder has to work harder to push urine out. Over time, the bladder muscles get weak, which makes it harder for it to empty. This can lead to:
- Feeling like you still have to pee even after you just went
- Having to go too often — eight or more times a day
- Incontinence (when you don’t have control over when you pee)
- An urgent need to pee, all of a sudden
- You wake up several times a night to pee
A larger prostate doesn’t mean you’ll have more or worse symptoms. It’s different for each person. In fact, some men with very large prostates have few, if any, issues.
Diagnosis and Tests
Your doctor will first talk to you about your personal and family medical history. You might also fill out a survey, answering questions about your symptoms and how they affect you daily.
Next, your doctor will do a physical exam. This may include a digital rectal exam. During this, he puts on a glove and gently inserts one finger into your rectum to check the size and shape of your prostate.
Basic tests: Your doctor may start with one or more of these:
- Blood tests to check for kidney problems
- Urine tests to look for infection or other problems that could be causing your symptoms
- PSA (prostate-specific antigen) blood test. High PSA levels may be a sign of a larger-than-usual prostate. A doctor can also order it as screening for prostate cancer.
Advanced tests: Based on the results of those tests, your doctor may order additional tests to rule out other problems or to see more clearly what’s happening. These might include:
- Different types of ultrasound to measure your prostate and see if it looks healthy
- A bladder ultrasound to see how well you empty your bladder
- Biopsy to rule out cancer
- Urine flow test to measure how strong your stream is and how much pee you make
- Urodynamics testing to evaluate your bladder function
Treatments
How your doctor handles your case varies based on your age, health, the size of your prostate, and how BPH affects you. If your symptoms don’t bother you too much, you can put off treatment and see how it goes.
Lifestyle changes: You may want to start with things you can control. For example, you can:
- Do exercises to strengthen your pelvic floor muscles
- Lower the amount of fluids you drink, especially before you go out or go to bed
- Drink less caffeine and alcohol
Medicine: For mild to moderate BPH, your doctor might suggest medicine. Some medications work by relaxing the muscles in your prostate and bladder. Others help shrink your prostate. For some men, it takes a mix of medicines to get the best results.
Procedures: If lifestyle changes and medications don’t work, your doctor has a number of ways to remove part or all of your prostate. Many of these are called “minimally invasive,” meaning they’re easier on you than regular surgery. They use probes or scopes and don’t require large cuts in your body.
Examples of a minimally invasive procedures are TUMT, TUNA, or Rezūm which use a varied form of energy to destroy part of the prostate.
Other surgical procedures include:
- Laser therapy to remove part of your prostate
- Transurethral resection of the prostate, or TURP, in which the doctor uses a scope and cuts out pieces of the gland with a wire loop
In some cases, your doctor may also suggest a traditional, open surgery or a robotic procedure to remove your prostate.
Any Complications?
BPH doesn’t lead to prostate cancer or make you more likely to get it.
It rarely leads to other conditions, but it can, and a couple of them are serious. For example, BPH can lead to kidney damage or, worst-case, cause a problem where you can’t pee at all.
It may also cause:
- Bladder damage
- Bladder stones
- Urinary tract infections
- Blood in your urine
As they age, some men may notice that they have trouble peeing. You might find it hard to start going, or perhaps the stream starts and stops several times.
These are just two possible signs of benign prostatic hyperplasia, called BPH, which is an enlarged prostate.
This gland, which grows during early puberty and then again around age 25, becomes enlarged in many men. It can pinch your urethra, the tube that carries urine from your bladder through your penis. Your bladder walls may also grow thicker.
This is the most common prostate problem in men 50 and older. It’s good to know the symptoms of BPH because you might want to talk with your doctor.
What Should I Watch Out For?
Symptoms of BPH fall into 2 categories. Those caused by pressure on your urethra are called obstructive. The others start in your bladder.
Some of the obstructive symptoms include:
- Trouble starting to urinate
- You have to strain or push when you pee
- The stream is weak
- You have to stop and restart several times
- Pee dribbles out at the end
If BPH causes changes in your bladder, it may include these signs:
- You suddenly feel a strong need to urinate. Doctors call this “urgency.”
- You have to pee more than 8 times a day. This is called “frequency.”
- Even after you go, you feel as though your bladder is not empty.
- You wake up often in the night to relieve yourself. This is called “nocturia.”
Complications
If you don’t get treatment for prostate problems, your bladder can become irritated because urine is backing up rather than being released.
Your symptoms may start to cause more issues in your day-to-day life. For instance, it may be tough for you to control your bladder. You might wet the bed at night or not be able to get to the bathroom quickly enough when the urgent need to go strikes.
You also could develop an infection in your urinary tract or get bladder stones.
Some symptoms of BPH are not as common, and they could signal that your condition is more complicated or advanced. Those signs include:
- Burning or pain when you pee
- Blood in your urine
- You can’t go at all because your urethra is blocked. Get emergency treatment right away if this happens
When Should I Call a Doctor?
Your symptoms may not bother you too much. But it’s important to talk over any urinary problems with your doctor.
It’s hard to predict how BPH will play out, and you can’t 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 can’t urinate at all
You have to pee frequently, it’s 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
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