Benign Prostatic Hyperplasia (BPH)
Hello, hi, and welcome, Bestie! It’s another Sunday, which means another pelvic health chat. I’m so happy to have you along for this ride. Today we’re talking Benign Prostatic Hyperplasia (BPH).
BPH is a condition in which the prostate gland is enlarged but not cancerous. It is common with aging, but many men do not seek treatment. It has not been shown to cause erectile dysfunction (ED), prostate cancer, or infertility, but it is associated with urinary dysfunction. Interestingly, according to a study by the Mayo Clinic, the severity of symptoms in BPH does not always correlate with the size of the prostate (1).
As the prostate grows in size in cases of BPH, it causes increased pressure on the urethra. The urethra is the tube connecting the bladder with the outside world and it allows urine to exit the body. When there is too much pressure on the urethra, it is difficult for urine to flow out so that the bladder can empty. Men with BPH may notice any of the following symptoms:
- Weak stream of urine: The urethra doesn’t have as much space to expel urine as it did before BPH and therefore a smaller amount of urine can exit in the same amount of time. This may cause an increase in the time it takes to finish emptying the bladder.
- Urinary hesitancy: It may feel difficult to initiate the flow of urine or keep your stream going.
- Dribbling: This often occurs at the end of a stream of urine when the flow has slowed to a trickle. This can prolong the final part of urination and make aiming more difficult.
- Incomplete emptying: Due to a weakened stream and urinary hesitation, it is common for the bladder to remain partially full in folks with BPH. Since the ureters are constantly depositing more urine into the bladder, it is not expected that the bladder is ever entirely empty, but there are normal and abnormal values for how much urine should remain in the bladder after urination. The urine that remains in the bladder after peeing is called the post void residual (PVR). A PVR of less than 50mL is considered to be good emptying. There is no evidence-based maximum volume that is considered to be normal, but a PVR between 50 and 100mL is typically still considered normal, though some will classify this is abnormal (2). A PVR greater than 200mL is generally considered abnormal and indicates poor emptying of the bladder.
- Nocturia: The need to get up at night and urinate is common in folks with BPH due to the lack of complete bladder emptying, leaving more urine present in the bladder and causing increased frequency of urination at all hours.
- Dysuria: Painful urination may result from increased pressure on the urethra due to enlarged prostate.
- Straining: Often, folks with BPH feel the need to strain in order to expel urine due to the blockage of the urethra.
- Incontinence: BPH interferes with the outflow of urine from the bladder and this can increase bladder dysfunction. When the bladder muscle (detrusor) malfunctions, urinary incontinence can occur.
If any of these symptoms are present, especially in combination with each other, you should talk with your medical provider. The sooner treatment occurs, the better. Avoiding treatment can result in BPH causing long-term effects such as bladder thickening and dysfunction, pelvic floor muscle (PFM) dysfunction, blood in the urine, and more.
So, how is BPH treated? As with most things, you’ve got a lot of treatment options to consider. First, let’s discuss non-surgical treatments. These can include lifestyle changes such as utilizing a timed voiding schedule, restricting fluid in the evening to reduce nocturia, reducing intake of foods that irritate the bladder/urethra, and incorporating pelvic floor exercises into your routine (1). Learning how to appropriately lengthen the PFMs can help improve urinary frequency, straining during urination, urinary stream strength, incomplete emptying, and dribbling. You can also work on positions for urination. It is common for males to stand during urination, but this may be working against you if you are struggling with urinary retention. Consider sitting down to pee or placing one hand on the wall in front of you and leaning into it if standing while peeing. These will help relax the PFMs and may improve the urination experience.
Another non-surgical treatment option is medication. Alpha blockers, such as Flomax work to relax smooth muscles and can help improve symptoms of BPH in a short period of time.
Surgical treatments may be indicated when non-surgical treatments fail or as BPH progresses with time. Your surgeon will likely perform a partial resection of the prostate in which they remove the excess tissue from the prostate, but leave much of the prostate intact. This procedure is called a transurethral resection of the prostate (TURP). Complications include urinary incontinence and pelvic pain, both of which can be addressed post-operatively in pelvic health physical therapy. There are many surgical techniques for BPH, but the TURP is the most common and most studied (1).
If you have noticed symptoms of urinary retention or hesitancy, it might be time to chat with your medical doctor about whether you’re suffering from BPH. Remember, BPH becomes more common as you age and, while not as serious as prostate cancer, does require medical intervention. Also, you’re not alone! Chances are you already know at least one other person with BPH.
Let’s talk soon!
XOXO,
Your Pelvic Bestie
References:
1. Mayo Clinic. Benign Prostate Hyperplasia (BPH).. URL: http://www.mayoclinic.com/bph. Posted Dec 6, 2011.
2. Doreen E. Chung, Alexis E. Te, Renuka Tyagi, Chapter 39 - Lower Urogenital Tract Dysfunction in Men and Women, Principles of Gender-Specific Medicine (Second Edition), Academic Press, 2010, Pages 421-431
*The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a qualified health provider regarding any questions you may have about a medical condition or health objectives.
