What is BPH?

Benign prostatic hyperplasia^[1] (BPH), also called prostate gland enlargement, is a condition common in older men that causes enlargement of the prostate gland. BPH may also be referred to as benign prostatic hypertrophy or benign prostatic obstruction.While BPH shares some signs and symptoms with prostate cancer, it is, as its name states, a benign (non-cancerous) condition. It causes urinary symptoms that can be uncomfortable, such as blocking the flow of urine from the bladder. BPH can also cause problems in the bladder, urinary tract, and kidneys. In most men, the signs and symptoms of BPH worsen with age. However, there are many effective options available for treating the disease, from medications to minimally invasive therapies and surgery. Your healthcare provider will likely recommend a particular course of treatment based on your signs and symptoms, the size of your prostate, any pre-existing health conditions, and your treatment goals and preferences.

What is the prostate?

The prostate#Symptoms)^[2] is a gland in the male reproductive system. It is about the size of a walnut and is located below the bladder in front of the rectum. The urethra, the tube connecting the bladder to the urethra (the opening through which urine exits the body), runs through the prostate. For this reason, an enlarged prostate can cause constriction and blockages that make urination difficult. The main job of the prostate is to produce the fluid for semen. During ejaculation, sperm (which is produced in the testes) travels to the urethra. Simultaneously, fluid from the prostate and seminal vesicles moves through the urethra. This fluid carries the sperm through the urethra and out through the penis.

How common is BPH?

BPH is the most common prostate problem^[3] for men over the age of 50. While BPH rarely causes symptoms in men younger than 40, the incidence and symptoms of the condition increase with age. About half)^[4] of men between the ages of 51 and 60 have some signs of BPH. By age 80, up to 90% of men will have signs of the condition.

BPH causes

The prostate has two main growth periods^[5] throughout a man’s life. The first phase of growth occurs in early puberty. During this time, the prostate doubles in size. The second growth period begins around the age of 25 and continues throughout most of a man’s life. BPH generally occurs during this second phase of growth. When the prostate enlarges, it presses against and constricts the urethra. The wall of the bladder also becomes thicker. Eventually, the bladder can weaken to the point of being unable to empty completely. It’s not entirely clear what causes benign prostatic hyperplasia. It is supposed^[6] that changes in the balance of men’s sex hormones as they age may play a role in developing the condition. Over the course of their lives, men produce the (male) hormone testosterone and small amounts of the (female) hormone estrogen. As a man ages, the concentration of active testosterone in his blood decreases, leaving a higher proportion of estrogen in the body. Studies have indicated that BPH may occur when a higher proportion of estrogen in the prostate increases the activity of certain substances that promote prostate cell growth. It has also been suggested that BPH can be attributed to the accumulation of dihydrotestosterone (DHT), a male hormone that plays a role in the prostate’s growth and development. Research has shown that older men continue to produce and accumulate high levels of DHT in the prostate even after blood testosterone levels have dropped. The accumulation of DHT in the prostate may cause the gland’s cells to continue to grow. Scientists have also observed that men who don’t produce DHT do not develop BPH. Some conditions^[7] may cause signs and symptoms similar to those of BPH. Other possible causes of urinary symptoms include:

• Urinary tract infection (UTI): A bacterial infection that can occur in any part of the urinary tract
• Prostatitis: Inflammation of the prostate
• Urethral stricture: Narrowing of the urethra, the tube through which urine exits the body
• Scarring in the neck of the bladder caused by a previous surgery
• Bladder or kidney stones: Hard deposits made up of excess wastes from the bloodstream
• Damage to the nerves that control the bladder
• Cancer in the prostate or bladder

Risk factors for BPH

Some factors^[8] may increase your risk of developing BPH, including:

• Aging: BPH rarely causes signs and symptoms in men under age 40. The condition is common in older men, and the risk for BPH continues to increase with age.
• Family history: If you have a blood relative, such as a brother or father, with BPH, you’re more likely to develop the condition too.
• Medical conditions: Obesity, cardiovascular disease, and type 2 diabetes increase the risk^[9] of BPH. The use of beta blockers may also increase the risk of BPH.
• Lifestyle and overall health: Obesity and a lack of exercise increase the risk of BPH. Conversely, exercise can lower your risk of the condition.

Enlarged prostate symptoms

The signs and symptoms of BPH are most often caused by a blocked urethra or a bladder that is overworked from attempting to pass urine through a blockage. When symptomatic, benign prostatic hyperplasia causes issues in the urinary tract. Men with BPH commonly feel frequent urges to urinate, mostly during the night (nocturia). The severity of the signs and symptoms of BPH can vary. Generally, however, symptoms gradually worsen over time. In severe cases, men with BPH may not be able to urinate at all. This is a medical emergency that must be treated immediately. Common signs and symptoms)^[10] of benign prostatic hyperplasia include:

• Feeling that the bladder is full, even just after urinating
• Sudden, intense urges to urinate
• Weak urine flow
• Stopping and starting several times during urination
• Difficulty starting to urinate
• Needing to push or strain to urinate
• Pain after ejaculation or while urinating
• Inability to empty the bladder completely (urinary retention)
• Frequent urination during the night (nocturia)

Some less common signs and symptoms^[11] of BPH include:

• Urinary tract infections (UTIs)
• Blood in the urine
• Inability to urinate

The size of your prostate isn’t necessarily related to the severity of your symptoms. Fewer than half^[12] of all men with BPH experience lower urinary tract symptoms. In some men, the signs and symptoms of BPH may stabilize—or even improve—over time. If you experience any of the signs and symptoms of BPH, talk to your healthcare provider. While most men go through routine prostate screenings, it is important to bring up any changes or new symptoms you’ve noticed.

BPH complications

Benign prostatic hyperplasia can lead to a number of health complications^[13], including:

• Urinary retention: Some men with BPH are unable to empty their bladders completely. The condition in which a small amount of urine is left over after urination is called urinary retention.

Some men may find success by having a thin tube called a catheter inserted into the bladder to drain remaining urine, while others may require surgery.

• Urinary tract infections (UTIs): Incompletely emptying the bladder can increase the risk of developing a bacterial infection in the urinary tract. Men with frequent UTIs may require surgery to remove part of the prostate gland.
• Bladder stones: Bladder stones are usually caused by urinary retention. Stones can cause infection, bladder irritation, obstructed urine flow, and blood in the urine.
• Bladder damage: Over time, urinary retention can cause the bladder to stretch and weaken. When this occurs, the muscles of the bladder wall are unable to properly contract, making it difficult to empty your bladder fully.
• Kidney damage: Urinary retention causes pressure to build in the bladder. This can make it easier for bladder infections to reach the kidneys or even damage the kidneys directly.

Some men with BPH may experience erectile dysfunction^[14] (ED) and problems with ejaculation. BPH itself does not cause ED; rather, some of the medications used to treat the condition may cause erectile dysfunction. Most men with BPH do not develop these health complications. However, acute (severe) urinary retention and kidney damage can pose serious threats to your health. Benign prostatic hyperplasia is not believed to increase the risk of prostate cancer.