Advances in medical technologies have paved the way for healthy living and longer lifespans. Ageing, however, still comes with a baggage of health conditions.
Difficulty in passing urine and decreased flow of urine are common in men over 50. Often, the cause is benign prostatic hyperplasia (BPH), which is enlargement of the prostate.
The prostate gland is located below the bladder and in front of the rectum in men. Its main function is to produce the fluid that helps in the movement of sperms. According to the American Urological Association (AUA), BPH is a non-cancerous condition, and it occurs when the prostate gland and the tissues around it start growing because of hormonal changes in the body.
As the prostate enlarges, it can compress the tube that expels urine out of the body (urethra), causing urinary and bladder issues. Almost half of all men over the age of 50 are diagnosed with BPH, the AUA points out.
What are the risk factors for BPH?
In a study published in the Indian Journal of Urology, researchers ND Patel and JK Parsons list age, genetics/family history, sex hormones (such as testosterone, dihydrotestosterone and estrogen) and metabolic disorders (including obesity, hypertension and high blood sugar levels) as the major risk factors for BPH.
What are the symptoms of BPH?
“When men reach the age of 40–45 years, testosterone (male hormone) levels start declining while estrogen in the body starts increasing, triggering prostate growth,” says Dr Sriram Krishnamoorthy, professor and senior consultant urologist and andrologist, department of urology and renal transplantation, Sri Ramachandra Institute of Higher Education and Research, Chennai. “The first thing we do when individuals come with symptoms that point to BPH is to reassure them this is not a disease, but part of bodily changes in all males when they reach their 40s.
“Mostly, by 50 years of age men will notice a decline in the force of the urine flow and by 60 years they may develop bothersome urinary symptoms, which is when they often seek medical help. The condition can be treated effectively with medicines and in some cases, it may need surgical intervention.”
The symptoms of BPH include:
- Frequent urge to pass urine
- Longer time taken to empty bladder
- Poor stream or decline in force of urine flow
- Feeling of incomplete evacuation (as if the urine has not been fully emptied from the bladder)
- Delay in initiating urine flow, also called hesitancy
- Post-void dribble — that is, after completing urination, few drops may leak out and wet the pants.
“The first four symptoms are common to other conditions such as urethral stricture (narrowing of the tube that carries urine due to scarring that can cause blockage and infection) and a weakened bladder,” says Dr Krishnamoorthy, who is also managing director of Nauro Kidney Speciality Clinic, Chennai. “However, in men over 50 years of age, delay in initiation of urine flow and post-void dribble are classic symptoms of BPH. So, the individual should be asked the right questions and careful evaluation must be made to avoid a misdiagnosis and identify the condition, since treatments for all these conditions are different.”
Diagnosis and treatment of BPH
“Timely detection is important because when an individual ignores the symptoms and BPH goes untreated for a long time, the obstruction caused by the enlarged prostate may cause pressure in the bladder, resulting in backflow of the urine to the kidney,” Dr Avinash Ignatius, senior consultant nephrologist and transplant physician, Noble Hospital, Pune, Maharashtra, tells Happiest Health. “Over time, this can cause kidney damage. Residual urine in the bladder can also cause urinary tract infections.”
Other complications include bladder stones and, in rare cases, bladder rupture.
Some tests to diagnose BPH
- Symptom score questionnaire: The AUA has developed a standardised questionnaire called the International Prostate Symptom Score that helps evaluate urinary symptoms. This helps categorise the condition as mild, moderate or severe, based on the score patients assign to each question.
- Physical examination: The doctor may examine the rectum and surrounding tissues to check for abnormalities in the prostate.
- Uroflowmetry test: This is done to check the force and quality of urine flow and if there is delayed initiation.
Apart from these tests, urinalysis, ultrasound scan and sometimes cystoscopy (examination of the bladder or urethra by inserting a lighted tube-like device with a camera at one end) may be conducted to get a correct diagnosis or rule out other issues. Rarely, a blood test called prostate-specific antigen (PSA) test may be done if the doctor suspects malignancy.
“Regular monitoring of a patient with an enlarged prostate, even if the symptoms are mild, is necessary to avoid complications in the long term,” says Dr Ignatius. “Those who have risk factors such as family history or obesity should seek medical advice at 40-45 years of age, while others can get screening done after they turn 50. If the enlarged prostate is causing urinary problems, medications can help arrest growth of the gland. When the symptoms are severe or are adversely affecting the quality of life, surgery may be recommended.”
Prevention and management of symptoms of BPH
- Regular screening
- Avoid smoking
- Ensure healthy food habits and consume less salt and spice.
- Empty the bladder at regular intervals and do not hold urine for a long time.
- Practise double voiding so that residual urine is passed out. This means passing urine again, a few seconds after the first time.
- Eat adequate fruits and vegetables; reduce consumption of red meat.
- Avoid applying pressure on the lower abdomen to get the urine out.
