BPH is an enlarged prostate. The prostate goes through two main growth cycles during a man’s life. The first occurs early in puberty, when the prostate doubles in size. The second phase of growth starts around age 25 and goes on for most of the rest of a man’s life. BPH most often occurs during this second growth phase.
As the prostate enlarges, it presses against the urethra. The bladder wall becomes thicker. One day, the bladder may weaken and lose the ability to empty fully, leaving some urine in the bladder. Narrowing of the urethra and urinary retention – being unable to empty the bladder fully – cause many of the problems of BPH.
BPH is benign. This means it is not cancer. It does not cause or lead to cancer. However, BPH and cancer can happen at the same time. BPH is common. About half of all men between ages 51 and 60 have BPH. Up to 90% of men over age 80 have it.
When the prostate is enlarged, it can bother or block the bladder. Needing to urinate often is a common symptom of BPH. This might be every 1 to 2 hours, mainly at night.
Other symptoms include:
- Feeling that the bladder is full, even right after urinating
- Feeling that urinating “can’t wait”
- A weak flow of urine
- Needing to stop and start urinating several times
- Trouble starting to urinate
- Trouble starting to urinate
- Needing to push or strain to urinate
If BPH becomes severe, you might not be able to urinate at all. This is an emergency that must be treated right away.
The causes of BPH are not well-understood. Some researchers believe that factors related to aging and the testicles may cause BPH. This is because BPH does not develop in men whose testicles were removed before puberty.
Throughout their lives, men produce both testosterone, a male hormone, and small amounts of estrogen, a female hormone. As men age, the amount of active testosterone in the blood lowers, leaving a higher share of estrogen. Studies have suggested that BPH may happen because the higher share of estrogen in the prostate adds to the activity of substances that start prostate cells to grow.
Another theory points to dihydrotestosterone (DHT), a male hormone that plays a role in prostate development and growth. Some research has shown that, even when testosterone levels in the blood start to fall, high levels of DHT still build up in the prostate. This may push prostate cells to continue to grow. Scientists have noted that men who do not produce DHT do not develop BPH.
See your doctor if you have symptoms that might be BPH. See your doctor right away if you have blood in your urine, pain or burning when you urinate, or if you cannot urinate.
Your doctor can diagnose BPH based on
- Personal or family history
- A physical exam
- Medical tests
The American Urological Association (AUA) has built a BPH Symptom Score Index. It’s a series of questions about how often urinary symptoms happen. The score rates BPH from mild to severe. Take the test and talk with your doctor about your results.
Your doctor will review your Symptom Score and take a medical history. You will also have a physical exam that involves a digital rectal exam (DRE). Your doctor may also want you to have some or all of these tests:
- Cystoscopy to look at the urethra or bladder with a scope
- Post-void residual volume to measure urine left in the bladder after urinating
- PSA blood test to screen for prostate cancer
- Ultrasound of the prostate
- Urinalysis (urine test)
- Uroflowmetry to measure how fast urine flows
- Urodynamic pressure to test pressure in the bladder during urinating
- Urinary blood test to screen for bladder cancer
- PSA Blood Test
Prostate-specific antigen (PSA) is a protein that is made only by the prostate. When the prostate is healthy, very little PSA is found in the blood.
The PSA blood test measures the level of PSA in the blood. The test can be done in a lab, hospital, or doctor’s office. No special preparation is needed. The PSA test should be done before the doctor does a DRE. You should not ejaculate for 2 days before a PSA test. That’s because ejaculation can raise the PSA level for 24 to 48 hours.
A low PSA is better for prostate health. A rapid rise in PSA may be a sign that something is wrong. BPH is one possible cause of a high PSA level. Inflammation of the prostate, or prostatitis, is another common cause of a high PSA level.
Digital Rectal Exam
The DRE is done with the man bending over or lying curled on his side. The doctor puts a lubricated, gloved finger into the rectum to feel the shape and thickness of the prostate. The DRE can help your doctor find prostate problems.
Prostate problems with discomfort after urination and pains that extend to the pelvis or into the bladder (often worse when the man is lying on his back) suggest a need for this remedy. There may also be a bland, thick, yellow discharge from the penis. Pulsatilla is usually suited to emotional individuals who want a lot of affection and feel best in open air.
This remedy is often helpful when the prostate is enlarged, with urine retention and frequent urging. The person may have the feeling that a ball is lodged in the pelvic floor, or experience pressure, swelling, and soreness that are worse when sitting down.
This remedy may be helpful if urine is slow to emerge, with pressure felt in the prostate both during and after urination. The prostate is enlarged, and impotence may also be a problem. People who need this remedy often suffer from digestive problems with gas and bloating, and have an energy slump in the late afternoon.
A frequent urge to urinate at night, with difficulty passing urine, and a feeling of coldness in the sexual organs, suggest a need for this remedy. It is sometimes also used in lower potencies for urinary incontinence in older men. This remedy is made from saw palmetto which is also used as an herbal extract for similar prostate problems.
This remedy may be indicated if a man feels burning pain in his urinary passage even when urine is not flowing, and urine retention is troublesome. Men who are likely to respond to Staphysagria are often sentimental and romantic, and may also have problems with impotence (most often caused by shyness).