Benign Prostatic Hyperplasia (BPH)

As the prostate gradually enlarges, it may press against the urethra and interfere with urine flow. This can cause difficulty urinating, incomplete bladder emptying, urinary tract infections, bladder problems, and, in severe untreated cases, kidney complications.

Why Does the Prostate Cause Urinary Problems?

The prostate gland is located beneath the bladder and surrounds the upper part of the urethra, the tube that carries urine out of the body.

When the prostate enlarges, it may compress the urethra and obstruct urine flow. The bladder must then work harder to push urine through the narrowed passage. Over time, this may weaken the bladder and cause urine to remain inside after urination.

BPH is not prostate cancer and does not automatically increase the risk of cancer. However, both conditions can occur at the same time and may cause similar urinary symptoms.

Common Symptoms of BPH

Symptoms may include:

๐ Frequent urination, particularly during the night

๐ A sudden or urgent need to urinate

๐ Difficulty starting urination

๐ The need to strain before urine begins to flow

๐ A weak or slow urine stream

๐ Urine flow that stops and starts

๐ Dribbling after urination

๐ A feeling that the bladder has not emptied completely

๐ Pain or burning during urination

๐ Blood in the urine

The severity of symptoms does not always correspond directly to the size of the prostate. A mildly enlarged prostate may cause significant symptoms in some men, while a larger prostate may cause little difficulty in others.

When Should You See a Doctor?

Consult a doctor whenever urinary symptoms develop, even when they appear mild.

Immediate medical attention is required if you:

๐ Cannot urinate at all

๐ Have blood in the urine

๐ Develop fever and chills with urinary symptoms

๐ Experience severe lower abdominal pain

๐ Have painful urination with nausea or vomiting

Sudden inability to urinate, known as acute urinary retention, is a medical emergency.

How Is BPH Diagnosed?

The doctor may use several assessments to determine the cause and severity of the urinary symptoms.

Medical History and Symptom Assessment

The doctor will ask about:

๐ Urination patterns

๐ Night-time urination

๐ Difficulty starting or stopping urine flow

๐ Current medicines and supplements

๐ Previous urinary infections

๐ Other medical conditions

A symptom questionnaire may be used to assess how much the condition affects daily life.

Physical Examination

A digital rectal examination, or DRE, may be performed. The doctor gently examines the prostate through the rectum to assess its size, shape, texture, and any suspicious abnormalities.

Blood and Urine Tests

Tests may include:

๐ Urinalysis to check for infection, blood, or other abnormalities

๐ Kidney-function tests

๐ Prostate-specific antigen, or PSA, testing

PSA testing may help assess prostate conditions, but an elevated result does not automatically mean cancer, and a normal result cannot completely exclude it.

Urinary-Flow and Bladder Tests

The doctor may measure:

๐ The strength and speed of the urine stream

๐ The amount of urine remaining in the bladder after urination

๐ Bladder pressure or function in selected cases

Ultrasound

Ultrasound may be used to assess:

๐ Prostate size

๐ Bladder condition

๐ Residual urine volume

๐ Kidney and urinary tract abnormalities

Treatment for BPH

Treatment depends on:

๐ Symptom severity

๐ Prostate size

๐ Age

๐ General health

๐ Bladder and kidney function

๐ The effect of symptoms on daily life

๐ The patient’s treatment preferences

Options include observation, lifestyle changes, medication, minimally invasive procedures, and surgery.

Lifestyle and Behavioural Management

Men with mild symptoms may be advised to:

๐ Reduce fluid intake before bedtime.

๐ Limit caffeine and alcohol, which may increase urination.

๐ Avoid delaying urination for long periods.

๐ Empty the bladder before travelling or sleeping.

๐ Review medicines that may worsen symptoms with a doctor.

๐ Maintain a healthy body weight and remain physically active.

Do not reduce fluid intake excessively, as this may lead to dehydration or concentrated urine.

Medication

Alpha Blockers

Alpha blockers relax the muscles around the prostate and bladder neck, allowing urine to flow more easily.

They often improve symptoms relatively quickly but do not significantly reduce prostate size.

Possible side effects include:

๐ Dizziness

๐ Low blood pressure

๐ Fatigue

๐ Changes in ejaculation

5-Alpha-Reductase Inhibitors

These medicines reduce the conversion of testosterone into dihydrotestosterone, or DHT, a hormone involved in prostate growth.

They may gradually reduce prostate size and lower the risk of urinary retention, but several months may be required before symptoms improve.

In some patients, an alpha blocker and a 5-alpha-reductase inhibitor may be prescribed together.

Transurethral Resection of the Prostate

Transurethral Resection of the Prostate, or TURP, is a common surgical treatment for BPH when symptoms are severe, medication is ineffective, or complications have developed.

During TURP:

๐ A surgical instrument is passed through the urethra.

๐ No external abdominal incision is normally required.

๐ The surgeon removes prostate tissue obstructing the urethra.

๐ Electrical energy may be used to cut tissue and control bleeding.

Removing the obstructing tissue allows urine to flow more freely.

Preparing for Surgery

Preoperative instructions may include:

๐ Getting sufficient rest

๐ Avoiding food and drink for approximately six to eight hours before surgery, as instructed

๐ Completing required blood, urine, heart, or imaging tests

๐ Informing the doctor about all medicines and supplements

๐ Attending all scheduled appointments

Blood-thinning medicines and certain supplements may need to be stopped temporarily. However, they should never be discontinued without instructions from the surgeon or prescribing doctor.

Care Immediately After TURP

Position and Monitoring

Some patients receive spinal anaesthesia and may need to remain in bed for a period after surgery. The exact position and duration depend on the anaesthetic and hospital protocol.

Follow the instructions provided by the medical team.

Urinary Catheter and Bladder Irrigation

A urinary catheter is commonly left in place for approximately two to three days.

Continuous bladder irrigation may be used for the first one or two days to:

๐ Prevent blood clots from blocking the catheter

๐ Wash blood and small tissue fragments from the bladder

๐ Monitor bleeding

The catheter may be secured to the leg. Patients should not pull, adjust, or remove it themselves.

A feeling of bladder pressure, urinary urgency, or discomfort may occur. Inform a nurse if the pain becomes severe or the catheter stops draining.

Pelvic-Floor Exercises

Pelvic-floor exercises may help improve urinary control after the catheter is removed.

To perform the exercise:

๐ Tighten the muscles used to prevent passing gas or urine.

๐ Hold the contraction for several seconds.

๐ Relax completely.

๐ Repeat according to the doctor’s or physiotherapist’s instructions.

Do not routinely practise by repeatedly stopping urine flow during actual urination, as this may interfere with normal bladder emptying.

Fluid Intake

Patients may be encouraged to drink more water to help flush the bladder and reduce clot formation.

The amount should follow the doctor’s advice. A high fluid intake may not be appropriate for people with heart failure, kidney disease, or other fluid restrictions.

Care at Home After Surgery

Avoid Straining and Heavy Activity

During the first four weeks, avoid activities that increase abdominal pressure or irritate the healing area, including:

๐ Heavy lifting

๐ Strenuous exercise

๐ Constipation and straining

๐ Cycling or riding a motorcycle

๐ Long or rough journeys

๐ Repeated climbing of stairs when avoidable

Light walking is generally encouraged and can be increased gradually.

Prevent Constipation

๐ Drink sufficient water unless fluid restriction has been advised.

๐ Eat vegetables, fruit, whole grains, and other fibre-rich foods.

๐ Use stool-softening medication only when prescribed.

Avoiding straining reduces the risk of postoperative bleeding.

Sexual Activity

Sexual intercourse and ejaculation may need to be avoided for approximately four weeks or until the surgeon confirms that healing is adequate.

Medication

Take all prescribed medicines correctly and complete antibiotics when instructed.

Do not restart stopped medicines until approved by the doctor.

Warning Signs After Surgery

A small amount of blood in the urine may occur during recovery, particularly after increased activity.

Rest and drink water as advised. Seek medical attention if:

๐ The urine becomes increasingly red.

๐ Large blood clots appear.

๐ Urine flow stops.

๐ Severe lower abdominal pain develops.

๐ Fever or chills occur.

๐ Urine becomes cloudy or foul-smelling.

๐ Pain or burning during urination becomes severe.

๐ Bleeding does not improve after rest.

These symptoms may indicate bleeding, infection, a blocked catheter, or urinary retention.

Follow-Up Care

Attend all follow-up appointments so the doctor can:

๐ Monitor urinary symptoms

๐ Assess recovery

๐ Review the surgical tissue examination

๐ Check for infection or bleeding

๐ Adjust medicines when necessary

๐ Evaluate bladder control

BPH is a common and treatable condition. Early assessment can relieve urinary symptoms and reduce the risk of bladder, urinary tract, and kidney complications.

 

Reference:

Bangphai Hospital Benign Prostatic Hyperplasia (BPH)

ArokaGO Providers Bangphai Hospital