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The prostate is a small, muscular gland in the male reproductive system. Surrounding a portion of the bladder and urethra, the prostate produces most of the fluid in semen that allows sperm mobility during ejaculation. The muscular action of the prostate helps propel the fluid and semen through your penis during sexual climax.
Benign prostatic hypertrophy, or benign prostatic hyperplasia (BPH) occurs when the cells of the prostate gland begin to multiply. These additional cells swell your prostate gland, which squeezes the urethra and limits the flow of urine.
Obstruction may be so severe that no urine can leave the bladder at all. This is called bladder outlet obstruction (BOO) and it is a complication of BPH. It can be dangerous because urine trapped in the bladder will cause urinary tract infections and damage your kidneys.
BPH is considered a normal condition of male aging, and it is estimated that 90 percent of men over the age of 80 have BPH. Although the exact cause is unknown, changes in male sex hormones as you age may be a factor. Any family history of prostate problems or any abnormalities with your testicles may raise your risks for BPH. Men who had their testicles removed at a young age do not develop BPH.
Fewer than 50 percent of men with BPH have severe enough symptoms to make them seek a doctor’s care. Symptoms include:
Evaluation for BPH begins with a physical exam and review of your medical history. The physical exam includes a rectal examination that allows the doctor to estimate the size and shape of your prostate. Other tests can include:
Treatment of BPH can begin with self-care. If symptoms don’t subside through self-care, medication or surgery may be recommended. Your age and general health will also influence the prescribed treatment. Self-care includes the following:
Alpha-1-blockers, these medications relax the muscles of the bladder neck and prostate. Medications to reduce the levels of testosterone such as dutasteride and finasteride are commonly prescribed. Antibiotics are also prescribed when inflammation of the prostate accompanies BPH.
Alpha-blockers relax the neck of the bladder and make it easier for urine to flow. Examples of alpha-1-blockers are doxazosin, prazosin, alfulzocin, terazosin, and tamsulosin.
Dutasteride and finasteride are two medications that lower the levels of hormones produced by the prostate gland. With some cases, when hormonal levels decrease, the size of the prostate decreases and urine flow improves. On the downside, however, these medications may also cause impotence and decreased sex drive.
Antibiotics can be used if your prostate becomes chronically inflamed, a condition known as prostatitis. Treating prostatitis with antibiotics can also improve your symptoms of BPH. Antibiotics are also helpful with urinary tract infections (UTIs). These infections can occur whenever urine flow from the bladder is decreased.
There are minimally invasive procedures available that may be used in an outpatient setting.
These involve inserting an instrument into your urethra and into the prostate gland. Here is a list of these non-surgical alternatives:
Surgery in a hospital setting might be recommended if you have any of the following symptoms:
Surgery can relieve symptoms of BPH, but BPH can return even after surgical intervention. Here’s a list of surgeries relevant to an enlarged prostate.
Men who have long-standing history of BPH may develop the following complications:
Many men ignore their symptoms of BPH. However, early treatment can help you avoid potentially dangerous complications. Call your doctor if you are urinating less than usual and your bladder is not emptying completely. Let your doctor know if you are experiencing chills, fever, pain in you back, side or abdomen, and if you see blood or pus in your urine.
Also, talk with your doctor about any of your medications that might be affecting your urinary system, such as antidepressants, diuretics, antihistamines or sedatives. Your doctor can make any necessary medication adjustments. Do not attempt to adjust your medications or doses yourself. Let your doctor know if you have taken self-care measures for your symptoms (for at least two months) without any noticeable improvement.
Written by: Verneda Lights and Matthew Solan
Medically reviewed by George Krucik, MD
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