Understanding Enlarged Prostate: Why Early Treatment Matters

Many men in my practice over the age of 50 sometimes experience difficulties urinating. The cause is usually benign prostatic hyperplasia (BPH), and it’s a common problem affecting millions of men worldwide. In fact, about 50 percent of men between the ages of 51 and 60, and 90 percent of men over age 80 have BPH.  

Unfortunately, BPH often doesn’t get treated when it should, raising the risk of serious complications. Many men overlook early symptoms, thinking it’s just a part of aging, while others realize something is wrong, but choose to suffer in silence. They’re embarrassed by the problem, so they don’t even discuss it with a physician.    

My goal is for you and/or your partner to understand BPH and how it progresses so that you can make informed decisions about your health and lower your risk of serious complications.  
 

What is Benign Prostatic Hyperplasia?  

BPH occurs when the prostate gland enlarges. Since the gland surrounds the urethra (the tube through which urine flows from the bladder out of the body), it compresses it as it increases in size, creating a bottleneck that makes urination increasingly difficult.  

What Causes BPH?  

Researchers haven’t identified a specific cause of BPH, but have linked several risk factors to it, including:  

• Middle age – being older than 40 increases your risk.  
• Hormonal balance shifts – shifting levels of testosterone and estrogen, as well as higher levels of dihydrotestosterone (DHT), can cause prostate growth.  
• Family history – having a father or brother with BPH raises your risk of developing it.  
• Heart disease – can cause vascular damage, which restricts blood flow to the prostate, aggravates the prostate gland, stimulates growth and leads to BPH.  
• Diabetes – can cause atherosclerosis, which restricts blood flow to the prostate gland.  
• Regularly sitting for long durations – sitting for long durations, whether it be for a desk job or just sedentary behavior, can place pressure on the prostate, exacerbating BPH pain and discomfort.  
• Obesity – being obese can cause increased intra-abdominal pressure, raising bladder pressure, which also can exacerbate BPH symptoms.  
• Erectile dysfunction (ED)– is not fully understood, but 70 percent of men with BPH also have ED.  

Early Warning Signs  

BPH symptoms typically develop gradually, which is why many men initially ignore them. However, some symptoms may seem minor but can affect the quality of your life and overall health. For example, frequent urination at night causes you to lose sleep. Disordered sleep has ties to high blood pressure, diabetes, obesity and heart disease - all contributing causes of BPH. As symptoms worsen, daily activities may become increasingly challenging. The most common early symptoms are:  

• Difficulty starting urination  
• Weak or interrupted urine stream  
• Frequent urination, especially at night  
• Sudden urges to urinate  
• Feeling like your bladder isn't empty after urinating  
• Dribbling after you finish  
• Some men also experience constipation due to prostate pressure on the rectum

Potential Complications if Not Treated  

Here’s where my real concern lies – in the potential complications. Many men (and their partners) mistake BPH for an inconvenience. But the reality is that untreated BPH can be quite problematic and cause serious complications, such as:  

• Infections. Urinary tract infections (UTIs) can develop when the bladder doesn’t empty. Bacteria in the retained urine multiply, resulting in painful infections that include fever, chills, nausea and a burning sensation during urination. UTIs are notorious for becoming recurrent and creating a cycle of discomfort and potential health risks.  
• Kidney infections also arise for the same reasons. Kidney infections are among the more serious complications of BPH because they can become systemic and life-threatening. Both bladder and kidney infections can require immediate, urgent or emergent care to alleviate bladder distension, persistent fever and inability to urinate.  
• Bladder dysfunction. This develops when the bladder works harder to push urine through the blocked urethra. This thickens the muscle wall, which decreases the bladder's capacity. As a result, the bladder works harder, causing involuntary contractions that increase the urgency and frequency of urination, leading to the bladder becoming fatigued and weakened.  
• Acute Urinary Retention (AUR). This occurs when the bladder loses the ability to urinate, despite feeling the urge. It is severely painful and considered a medical emergency that requires catheter insertion.  
• Bladder Stones. Stones form when retained urine remains in the bladder for extended periods. Generally, stones are painful, cause blood in urine, make urinating difficult and require surgical removal. Kidney stones develop in the same manner as bladder stones, but cause severe pain in the back or side, nausea, vomiting and blood in the urine. More importantly, kidney stones can permanently damage the kidneys and, in extreme cases, cause kidney failure.  
• Permanent bladder damage. Over time, irreversible damage can happen. This can include the loss of bladder elasticity and normal function, resulting in chronic incontinence that requires permanent catheterization.  

Treatment Options  

The good news is that there are treatment options for BPH. And the earlier you seek treatment for BPH, the better chance you have of controlling it, reducing complications, preserving sexual function and preventing irreversible damage.  

Of course, the earlier BPH is diagnosed, the easier the treatment is. For instance, if your case is mild, your doctor may recommend lifestyle changes such as a healthier diet, more exercise and fluid management. If your case has progressed to moderate, you may need a combination of medications to shrink the prostate and relax its muscles. If you have severe BPH, you may need laser treatment or a surgical procedure such as a transurethral resection of the prostate (TURP), a UroLift procedure or prostatic artery embolization (PAE).  

Bottom Line  

My advice to men and their partners is to pay very close attention to signs and symptoms. If you’re getting up to use the restroom even a little more often than usual, don’t shrug it off – talk to your primary care doctor. Having a strong relationship with your primary care physician also is important. This is one reason why MDVIP-affiliated practices are much smaller than traditional primary care practices. Unhurried visits enable doctors to get to know you and your health history.    

The MDVIP Wellness Program also includes a urinalysis that can help detect BPH, as well as screenings that can identify risks for BPH, such as blood pressure, sexual health, diet/nutrition, fitness, diabetes, sleep and weight management/body composition. Your MDVIP-affiliated physician can use the results from these screenings to develop a personalized wellness program for you and refer you.