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Enlarged Prostate (BPH) 

Introduction

An enlarged prostate gland is a very common condition.  The prostate is a golf ball sized gland in men.  It is located underneath the bladder and in front of the rectum.  It is very common for a prostate gland to enlarge with age. 

As the prostate gland grows larger, it presses against the urethra, the tube that transports urine.  This leads to difficulties with urination.  The exact cause of an enlarged prostate is unknown and unpreventable.  It is treatable with lifestyle changes, medications, or surgery. 

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Anatomy
The prostate is a golf ball sized gland in men.  It is actually one organ composed of thirty to fifty tiny glands.  The outside layer of the gland is composed of fibrous tissue.
 
The prostate gland is located underneath the bladder and in front of the rectum.  The prostate gland surrounds the urethra.  The urethra is the tube that carries urine from the bladder to the penis.
 
Doctors do not know all of the functions of the prostate gland.  One function of the prostate gland is to add fluid and nutrients to sperm to make semen.  The fluids and nutrients energize the sperm and make them move more effectively. 
 
The prostate gland has two growth spurts.  During puberty, the prostate gland doubles in size.  The second growth period is at about age 25.  The prostate gland grows again and continues to grow throughout a man’s life.

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Causes
The cause of prostate enlargement is unknown.
 
It is very common for the prostate gland to grow larger as men age.  This condition is called Benign Prostatic Hyperplasia (BPH) or Benign Prostatic Hypertrophy.  The enlargement usually does not cause symptoms before the age of 40, but many men experience BPH in their sixties, seventies, and eighties.
 
As the prostate gland enlarges, it presses against the urethra.  The pressure causes the urethra to narrow and the bladder to work harder to eliminate urine through it.  The bladder wall becomes thicker and irritable.  The bladder may contract even when it contains only a small amount of urine.  Eventually, the bladder wall weakens and is unable to completely empty the urine.  This leads to the symptoms associated with BPH.

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Symptoms
Many men with BPH do not have symptoms.  The most common symptoms involve problems with urination that result from bladder dysfunction and the narrowing of the urethra.  It may be difficult to start urinating.  You may have a weak stream of urine or be unable to urinate.  You may lose control of your bladder and urinate at times when you did not intend.  You may leak urine or dribble urine, especially after urinating.  You may experience a strong or sudden urge to urinate and frequent urination, especially at night.  Your bladder may not empty all of the way.  If you experience pain when you urinate and have blood in your urine you should contact your doctor.  This can be a sign of an infection.

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Diagnosis
Your doctor can diagnose BPH after reviewing your medical history and by conducting a physical examination and some tests.  You should tell your doctor about your symptoms.  Your doctor will perform a digital rectal examination to check the size and condition of your prostate gland.  Your doctor will also test a sample of your urine for blood and signs of infection or kidney problems. 
 
A Prostate-Specific Antigen (PSA) blood test is ordered to rule out cancer.  BPH does not cause cancer.  BPH is not cancer, although a person may certainly have prostate cancer and BPH at the same time. Doctors commonly screen for cancer during an examination for BPH because some of the symptoms of cancer and BPH are similar.
 
Your doctor may refer you to an urologist.  An urologist is a doctor who specializes in diseases of the urinary and genital tract.  The urologist may conduct tests to identify how fast your urine flows and the pressure at which it flows.  You may also be tested to determine how much urine is left in your bladder after you urinate.  The urologist may use a cytoscope to view your prostate gland and determine the extent of your condition.  A cytoscope is a thin tube with a lens and a lighting system.  The cytoscope is inserted through your penis, after your penis is completed numbed with a solution.

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Treatment
The treatment that you receive will depend on the extent of your condition, your symptoms, and your other medical conditions.  Treatments range from monitoring your condition, making lifestyle changes, medications, or surgery.  Doctors may choose to simply monitor mild cases of BPH.
 
Men with mild symptoms can make lifestyle changes to help improve their symptoms.  You should go to the bathroom as soon as you feel the urge to urinate and whenever you have a chance to use the bathroom, even if you do not feel the need to urinate. 
 
You should drink fluids throughout the day instead of all at once.  It can be helpful not to drink fluids two hours before bedtime.  Additionally, avoid drinking alcohol and caffeine, especially after dinner.  Some over-the-counter medications can make the symptoms of BPH worse.  You should talk to your doctor before using cold or sinus medicines that contain decongestants or antihistamines. 
 
Cold temperatures and a lack of physical activity can make symptoms worse.  You should stay warm and exercise regularly.  You should strive to relax.  Nervousness can cause more frequent urination.
 
Your doctor may prescribe medication to treat your BPH.  Some medications can prevent the prostate gland from growing larger or cause it to shrink.  Another type of medication relaxes the muscles in the bladder to improve urine flow.  Additionally, antibiotics can reduce prostate gland inflammation.
 
Surgery may be recommended if you have loss of bladder control, repeated blood in your urine, repeated urinary tract infections, or if your bladder does not empty completely.  There are several different types of surgical procedures.  The goal of surgery is to remove part of the prostate gland to relieve the pressure on the urethra.  Most men experience a relief of symptoms after surgery; however, BPH can redevelop over time in some people.

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Prevention
The exact cause of BPH (enlarged prostate) is unknown.  At this time, there is no way to prevent BPH.  You should attend all of your scheduled doctor appointments and have regular prostate examinations.

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Am I at Risk

There are no definite risk factors for BPH.  BPH develops in men that have testes.  Men that have had their testes removed do not develop BPH.  BPH tends to develop as men age.  It is more common in men over the age of 40 and very common in older men. 

 

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Complications
Some men with BPH may experience an increase in symptoms over time.  These may include a sudden inability to urinate, urinary tract infections, urinary stones, kidney damage, and blood in the urine.  You should call your doctor immediately if you experience fever or chills; back, side, or abdominal pain; and blood or pus in your urine.  You should also call your doctor if you produce less urine than usual and if you feel like your bladder is not emptying fully.

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Advancements
In recent years, advancements have been made in BPH surgery methods.  Surgical methods have changed over time with some surgeries performed as outpatient procedures.  Laser or microwave surgeries are less invasive.  They are associated with less blood loss and fewer side effects after surgery. 

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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.