Benign Prostatic Hyperplasia (BPH) and Urinary Symptoms
The Prostate
An integral part of the male reproductive system, the prostate is located under the bladder and in front of the retinus, being crossed by the urethra. The prostate is a gland that is part of the male reproductive system that produces part of the seminal fluid. As age progresses, many men tend to suffer from prostate-related problems. It naturally increases in volume as men age, eventually compressing the urethra and hindering urinary function. This condition is called benign prostatic hyperplasia.
Adopting a healthy lifestyle, with regular physical activity, a good diet and regular preventive examinations are attitudes that help maintain prostate health and prevent a range of diseases.
Benign Prostatic Hyperplasia (BPH) - what is it?
It is one of the most common benign diseases in men and is characterized by an increase in the volume of the prostate. The prostate is normally the size of a chestnut. When it gets bigger, it can become about the size of a tennis ball. As a result of the increase in size of the prostate, there is a compression of the urethra which consequently hinders the normal flow of urine.
It initially causes symptoms when the enlarged prostate begins to block the flow of urine. Men may find it difficult to start urinating. Urination can also give the feeling of having been incomplete. As the bladder does not empty completely, men have to urinate more often, usually at night. As a result, men may be more susceptible to developing urinary tract infections (UTIs). The volume and strength of urinary flow can decrease considerably.
Benign prostatic hyperplasia is more common after the age of 50, affecting around 40% of men by the age of 50 and around 90% by the age of 90. Its exact cause is still unknown, but it probably involves hormonal changes including testosterone and dihydrotestosterone.
Symptoms
The symptoms of BPH result from the obstruction of urine flow as a result of the prostate enlarging. In the initial phase, there is a difficulty in starting to urinate or a feeling of incomplete urination. As the bladder doesn’t empty completely, the number of trips to the toilet tends to increase, especially during the night (nicturia) and the need to urinate becomes increasingly present. The volume and strength of the urine flow itself tends to reduce and a drop may remain at the end of urination. At a more advanced stage, the bladder may overfill, causing urinary incontinence.
In some cases, straining to urinate can lead to the appearance of blood in the urine. If the obstruction is complete, urination becomes impossible, causing acute, very intense pain in the lower abdomen. Bladder infections can also occur, with a burning sensation during urination and fever.
Urine that remains in the bladder can be a source of urinary calculi, the elimination of which causes pain.
Rarely, if diagnosis and treatment are not carried out, the urine residue tends to increase the pressure on the kidneys, with the potential for kidney damage.
How is BPH diagnosed?
The diagnosis is made through clinical history and medical observation, which allows the size and texture of the prostate to be assessed. Laboratory tests are important and allow dosing concentrations of prostate-specific antigen (PSA), useful for the diagnosis of prostate hyperplasia and for prostate cancer. Uroflowmetry allows the quantification of the characteristics of urination and quantify the degree of obstruction and the prostatic ultrasonography provides very accurate images of this organ. In other cases, it may be useful to perform an endoscopic examination through the urethra.
Prevention and lifestyle
Given that its main risk factor is age, there is no validated prevention method for this disease.
Some data suggest that regular physical activity, a low-fat diet, regular consumption of vitamin C-rich vegetables and zinc-rich foods may reduce the risk of developing this condition.
The most important thing is early diagnosis, through medical consultation and laboratory tests, which allow for earlier and therefore more effective therapeutic intervention.
Treatment
Treatment for Benign Prostatic Hyperplasia (BPH) varies according to the severity of the symptoms and the response to initial treatment. The main treatment options include:
AlphablockersThey relax the muscles of the prostate and bladder neck to facilitate urination. Examples: Tamsulosin, Alfuzosin.
5-alpha reductase inhibitorsThey reduce the size of the prostate by preventing the conversion of testosterone into dihydrotestosterone (DHT). Examples: Finasteride, Dutasteride.
Combination therapyCombines alpha-blockers and 5-alpha reductase inhibitors for improved efficacy.
Laser therapy: Used to remove or shrink obstructive prostate tissue.
Thermal therapy (Microwave Therapy, TUMT): uses microwaves to heat and destroy prostate tissue.
Open prostatectomy: Removal of part or all of the prostate through an abdominal incision. Used in cases of a very enlarged prostate.
Transurethral resection of the prostate (TURP)Removal of prostate tissue using an instrument inserted into the urethra. It is the most common surgical method for BPH.
There are currently many options on the market that can play a positive role in prostate health and help reduce the urinary symptoms associated with BPH.
Dietary changes, regular exercise and bladder training, for example, are some measures that help to improve general health as well as bladder control, reduce urinary frequency and relieve urinary symptoms.
These treatment options are chosen based on the patient’s specific symptoms, the extent of the hyperplasia and the response to initial treatments. The urologist is best placed to advise on the most appropriate option in each case.
Urinary symptoms associated with BPH
What are they and how are they characterized?
Symptoms of the lower urinary tract are classified as symptoms of:
- Emptying;
- Storage;
- Post-motivational.
The symptoms of emptying (obstructive) are a delay in the start of urination, straining to urinate, a decrease in the strength and caliber of the urinary stream and prolonged or intermittent urination.
The intensity of obstructive symptoms can range from a slight hesitation when starting to urinate in the morning to acute urinary retention.
Storage symptoms are the result of bladder alterations, both anatomical and functional. These are micturition imperiosity (“urgency”, sudden urge to urinate), incontinence associated with this sudden urge, pollakiuria (increased frequency of urination) and nocturia (increased number of times urinated at night).
Post-micturition symptoms concern the sensation of incomplete bladder emptying and dribbling after urination.
Remember that Urology is the medical specialty dedicated to the diagnosis and medical and surgical treatment of diseases of the urinary tract and the male genital tract. If you have any questions, you should consult your urologist.
Editorial Note: This page and all other contents present in
lifewell.pt
are prepared and reviewed by medical experts in Portugal.
