Benign Prostatic Hyperplasia (BPH) – Enlarged Prostate
Benign Prostatic Hyperplasia is a common condition in aged men. Prostate is an organ in the pelvis area, located right below the bladder. Prostate makes most of the fluid that forms a part of semen. This liquid along with sperm is pushed out of the penis during ejaculation. The liquid secreted by the prostate is alkaline in nature. This alkaline nature of the liquid carrying semen neutralizes the acids present inside the vagina. The sperms then swim to the egg (if present) and form a foetus.
As men age (over 80 years) , the prostate becomes larger, squeezing the urethra and does not allow the urine to pass through and results in difficulty in emptying the bladder. This not only causes the bladder to become weak, it also results in Urinary tract infections and kidney problems.
What causes prostate to enlarge?
Age is a primary cause for BHP as seen in many men. Other causes of BPH include:
- Urinary Tract Infections
- Changes in male sex hormones
- Heredity
- A condition called ‘Prostatitis’ (Prostatitis is different from BPH)
- Bladder or kidney stones
- Past surgery that scars the bladder neck
- Narrowing of the urethra (the tube that carries urine from bladder out of the penis)
- Cancer of the prostate or bladder.
Symptoms of BPH
Inability to empty the bladder is a the obvious symptom that an enlarged prostate shows. Other symptoms can be:
- As the bladder is not emptied completely, urge to empty bladder frequently at night can occur. (Nocturia).
- Dribbling at the end of urinary system / leakage.
- Painful Urination
- Blood in Urine and blockage of urine (can be caused by bladder stones that form due to enlarged prostate)
Diagnosis of BPH
Your urologist will first start with a physical examination. He/she will be inserting his/her finger through the rectum and little pressure will be put on the prostate area to estimate the size and shape of the prostate gland. Further, following tests may be required:
- Urine Analysis – To check for blood and bacteria in the urine.
- Prostatic Biopsy – A small amount of prostate tissue will be extracted and sent for examination.
- Urodynamic test – A catherer will be inserted into the bladder and the bladder will be filled with liquid. When urinating, the pressure of the bladder will be analysed.
- Prostate Specific Antigen Test (PSA) Test – To check for cancer of prostate.
- Post Void Residual Test – Post void (after emptying), residual (amount left over) test. How much of amount of urine is left inside the bladder after emptying.
- Cystoscopy – Used to examine the urethra and bladder.
- Intravenous Pyelography or Urography – A dye is injected into the body and then an X ray or a CT Scan will be done. The dye highlights the urinary system in the images produced.
Treatment for Benign Prostatic Hyperplasia
Natural Treatment for Enlarged Prostate:
- Timed frequent urination.
- Avoiding decongestants or anti-histamine medicines. They make it difficult to empty the bladder.
- Avoid alcohol, caffine, especially at nights.
- Exercise regularly especially Kegel Exercise to strengthen the pelvis area. It is advisable to start working out on the pelvis region from the middle age itself instead of waiting until the BPH problem sets in.
- Try being in warm temperatures. If you are using excess Air Conditioning, the problem of urination may get worse.
Medications for BPH
In many cases, life style changes won’t be enough to fix the problem. In such cases, medication will be administered that may include:
- Alpha-1 blockers – They are used to relax the muscles of the bladder and prostate. Relaxed prostate allows the free flow of urine.
- Medicines to reduce hormones – Medication to reduce testosterone levels may be prescribed to help reduce the size of prostate and improve urine flow. However, lowering testosterone levels will lead to impotence and decreased libido.
- Antibiotics – Prescribed when there is an infection of the prostate. The infection can cause the prostate to inflame. The reason for enlargement of prostate will be identified by your urologist. Antibiotics may not be prescribed if he/she doesn’t feel that the inflammation is caused by infection.
Surgical treatment options for BPH
Surgical treatment options are always used as the last resort for treating BPH problem. Some are minimally invasive and can be done as out-patient procedures and some may require hospitalization.
Outpatient procedures
Irrespective of the method employed, the aim of these procedures is to remove a part or portion of prostate. This can be done by using
- Radio waves where the prostate tissue is scarred and shrunk (TUNA – TransUrethral Needle Ablation)
- Microwave energy to remove prostate tissue – TUMT – TransUrethral Microwave Therapy
- Hot water is used to destroy excess prostate tissue –Water Induced Thermotherapy – WIT
- Ultrasonic energy is used to remove the prostate tissue – High Intensity Focused Ultrasonography HIFU.
In-patient procedures
In case if the problem is severe where the kidney or bladder are getting infected or damaged, in-patient surgical procedures will be employed. They can be any of the following:
- TURP – TransUrethral Resection of the Prostate. Prostate is removed in small pieces by inserting a small instrument through the urethra.
- Simple Prostatectomy – The inner part of the prostate is removed while removing the outer part. This is done by making an incision on the abdomen on in the perineum area, the place between the anus and scrotum. Removing the inner tissue relaxes the urethra and allows free flow of urine.
- TransUrethral Incision of Prostate – TUIP –This is similar to TURP but the prostate is not removed. An incision is made to enlarge the bladder outlet and the urethra to allow flow of urine freely. This may or may not require hospitalization.
What happens if you ignore BPH
Remember that urine contains mostly water matter that your body doesn’t require. It can also include many microbes that the body wants to eliminate. Improper emptying of bladder can lead to
- Urinary Tract Infections
- Urinary Stones in the bladder
- Kidney Damage – due to infection that creeps up to the kidneys or due to the obstruction of urine from bladder due to blockage by stones.
- Bleeding and swelling of urinary tract.
BPH and Prostate Cancer – Are they same?
No. BPH is benign (non cancerous). Prostate Cancer is more dangerous and must be treated immediately as per the advice of your urologist. It is important that you always see an experienced urologist in your city because, every surgery involves complications and only an experienced urogynecologist can minimise the risks.
