What is Benign Prostatic Hyperplasia (BPH)?

Benign Prostatic Hyperplasia (BPH) is a condition in which the prostate is enlarged but not cancerous. It is also known by a few other names, such as benign prostatic obstruction, benign prostatic hypertrophy, and enlargement of the prostate. According to the National Health Morbidity Survey Malaysia (NHMS), 16% of Malaysian men over the age of 40 suffer from this problem. The signs and symptoms of this problem usually worsen as men get older, which is why the NHMS reported that the percentage of men with symptomatic BPH increased from 10% among 40-year-old men to 33% among 75-year-old men.

Among the signs and symptoms of this problem are:

  • Frequent or urgent urinating problem.
  • Increased frequency of urination at night (nocturia).
  • Difficulty starting urination
  • A weak or interrupted urine stream.
  • Dribbling at the end of urination
  • Urine incontinence
  • Pain after ejaculation or during urination
  • Unusual urine colour or smell
  • Inability to completely empty the bladder.

Most of these symptoms usually come from a blocked urethra or an overworked bladder from trying to pass the urine through the blockage in the bladder. For BPH, the size of the prostate does not necessarily indicate the severity of the problem; men can have a greatly enlarged prostate with little blockage and a few symptoms or a minimally enlarged prostate with greater blockage and more symptoms.


The cause of this condition is rather poorly understood, but there are probably two reasons for this, according to scientists. First, throughout their lives, men produce testosterone (male hormone) and a small amount of oestrogen (female hormone), but as men age, the amount of active testosterone decreases, leaving a higher proportion of oestrogen, which promotes prostate cell growth, hence the enlargement of the prostate. Second, it is due to the dihydrotestosterone (DHT) hormone, which plays roles in prostate development and growth. As men get older, they continue to produce and accumulate high levels of DHT in the prostate, which encourages prostate cells to continue growing. This is also theorised because men who do not produce DHT do not develop BPH.

 There are various treatments that can help with BPH, depending on the individual's severity and condition. Discuss your condition with your healthcare professionals so they may suggest a better treatment plan for you. The treatment plan usually involves lifestyle modifications such as:Urinating as soon as you feel the urge

  •  Go to the bathroom to urinate, even when you don’t feel the urge.

  • avoiding over-the-counter decongestants or antihistamine medications, which can make it harder for the bladder to empty.

  • Avoid alcohol and caffeine, especially in the hours after dinner.

  • Reduce your stress level, as nervousness can increase the frequency of urination.

  • Exercise regularly, as a lack of exercise can aggravate your symptoms.

  • Learn and practise Kegel exercises to strengthen your pelvic muscles.

  • Keep warm, since being cold can make symptoms worse. 

As for the treatment from healthcare professionals, its usually includes prescription of medication (alpha blockers, alpha reductase inhibitors, etc.), minimally invasive procedures (transurethral needle ablation, high intensity focus ultrasound, prostatic stent insertion), and surgery (laser surgery, open prostatectomy, transurethral incision of the prostate (TUIP). Bottom line: talk to your doctor regarding your condition. No matter how insignificant you may think things that occur to you are, they might actually be a symptom of a disease.

References

  1. Mayo Clinic. Benign Prostatic Hyperplasia (BPH). https://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/symptoms-causes/syc-20370087 (Accessed on Feb 25, 2021).

  2. National Institute of Health (NIH). National Institute of Diabetes and Digestive and Kidney Diseases. Benign Prostatic Hyperplasia (BPH). https://www.niddk.nih.gov/health-information/urologic-diseases/prostate-problems/prostate-enlargement-benign-prostatic-hyperplasia (Accessed on Feb 25, 2021).

  3. What do you want to know about enlarged prostate? https://www.healthline.com/health/enlarged-prostate (Accessed on Feb 25, 2021).

  4. Ministry of Health Malaysia (MOH). National Health Morbidity Survey (NHMS) (2018) Infographic Booklet