BPH

Complications of Enlarged Prostate (BPH)

Enlarged prostate, or BPH, is one of the most common problems among aging men. Problems with the prostate manifest themselves through a wide array of symptoms.

Even though these symptoms are uncomfortable and frustrating even, an enlarged prostate is a manageable problem. A proactive approach is crucial.

That is the best way to improve quality of life and avoid complications. In this post, we are going to cover complications of an enlarged prostate, how to recognize them, and more. 

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What is BPH?

So, what is BPH? Benign prostatic hyperplasia (BPH) is a medical term for enlarged prostate. However, prostate enlargement in men with this condition is not cancerous. The condition is also known by other names, such as benign prostatic hypertrophy and benign prostatic obstruction.

BPH develops as a strictly age-related phenomenon in nearly all men, starting at approximately 40 years of age. As the prostate gland enlarges, excess prostate tissue presses against and pinches the prostatic urethra. When enlarged prostate compresses the urethra, a man experiences bladder outlet obstruction. At the same time, the bladder wall thickens. Eventually, the bladder weakens. When that happens, a man loses his ability to empty the bladder completely. After urination, some urine still remains in the bladder. This is called urinary retention.

Urinary retention and narrowing of the urethra cause many problems associated with BPH. The symptoms of BPH develop gradually. Their severity varies from one patient to another. The enlargement of the prostate doesn’t dictate the severity of symptoms. Some men with bigger prostate enlargement may have less severe symptoms than their counterparts with a slightly enlarged prostate.

Most common signs and symptoms of a benign prostatic enlargement

  • Urinary urgency and a frequent need to urinate

  • Nocturia (frequent urination at night)

  • Inability to empty the bladder completely

  • Difficulty starting urination

  • Dribbling at the end of urination

  • The urine stream is weak, and/or it stops and starts

Less common but still possible, BPH symptoms include urinary tract infection, blood in the urine, and inability to urinate.

Who is at risk of BPH?

So, who is at risk of BPH? The exact cause of prostatic hyperplasia is unclear. Sex hormone imbalances that happen during the aging process could be the cause. While every man can develop an oversized prostate, some are at a higher risk. 

Risk factors for prostate enlargement belong to two categories:

  • Non-modifiable – factors you can’t influence 

  • Modifiable – usually lifestyle/environment factors you can influence

Non-modifiable risk factors

  • Age

  • Genetics 

  • Geography (prevalence of BPH is higher in western populations)

Modifiable risk factors

  • Hormone imbalances (testosterone, dihydrotestosterone, estrogen)

  • Metabolic syndrome

  • Diabetes

  • Obesity

  • Unhealthy diet

  • Sedentary lifestyle

  • Inflammation 

These risk factors apply to both BPH and LUTS (lower urinary tract symptoms).

What are the complications of BPH?

Most men with an enlarged prostate do not develop complications. Some patients do, especially with untreated BPH. Below, you can see the most common complications associated with BPH. 

Acute urinary retention

Even though most men with BPH experience some form of difficulty emptying the bladder, we’re talking about a more severe problem here.

Acute urinary retention (AUR) is the sudden and often painful inability to void despite full bladder. In other words, acute urinary retention is the inability to pass urine. It is the most common urologic emergency in men. The AUR is most often secondary to an enlarged prostate gland. Basically, BPH is the most common reason men experience this uncomfortable urinary problem.

The condition is more prevalent in older men. 

Why does AUR happen?

So, why does AUR happen?

The enlarged prostate may lead to bladder overflow obstruction and thereby pave the way to this complication.

Some patients may be passing small quantities of urine but with significant residual volumes (a lot more remains in the bladder). A man with acute urinary retention also experiences discomfort.

Most patients present with acute suprapubic pain and an inability to micturate (urinate), as mentioned above. A man with AUR also has a palpable distended bladder with suprapubic tenderness. The term suprapubic refers to the lower abdominal area which holds the urinary bladder. 

The condition can be life-threatening. So, if you experience the inability to urinate followed by other symptoms described above, you should seek emergency medical treatment right away. The healthcare professional will perform a physical exam and ask about symptoms and health status. Based on your answer, they will conclude BPH is the underlying cause (in case you’re seeing a different doctor than your regular healthcare provider). They may also perform a post-void bedside bladder scan to show the volume of retained urine and confirm their diagnosis.

Patients with acute urinary retention usually need immediate urethral catheterization. Management of this complication also involves treating the underlying cause accordingly. In this case, the doctor will assess your BPH and recommend the most suitable treatment approach to avoid this complication. 

Chronic urinary retention

Unlike acute urinary retention, chronic urinary retention (CUR) is relatively painless. Basically, CUR is the persistent inability to completely empty the bladder despite maintaining an ability to urinate. This leads to an elevated postvoid residual urine volume.

The incidence and prevalence of CUR are unknown. Generally speaking, chronic urinary retention develops gradually, unlike AUR, which occurs suddenly. It may take months or years for CUR to develop. 

In some cases, CUR is asymptomatic, but some men may experience lower urinary tract symptoms such as Urinary frequency, Urinary urgency, and Urinary incontinence

Men with CUR are at a higher risk of developing urinary tract infections and AUR. Many treatments are available for chronic urinary retention, including catheterization, surgery, and pharmacological treatments. 

Further, medical procedures and devices for CUR treatment depend on the underlying cause.

For men with enlarged prostate, the healthcare professional may recommend:

Prostate laser therapy

This relies on a strong beam of light to treat an area of enlarged prostate tissue. It works by breaking up the blockage and decreasing obstruction.

Transurethral electrovaporization

This uses heat to vaporize a region of enlarged prostate tissue.

Transurethral water vapor therapy (Rezum)

This relies on water vapor (or steam) to downsize an enlarged prostate.

Transurethral prostate resection (TURP)

This is a procedure that cuts and removes a section of the prostate. TURP is the most common surgical procedure for urinary symptoms and problems caused by an enlarged prostate. 

Pharmacological interventions include medications such as:

  • Alpha blockers (doxazosin, prazosin, tamsulosin, silodosin, alfuzosin, and terazosin)

  • 5-alpha reductase inhibitors (finasteride and dutasteride)

  • Alpha-blockers + 5-alpha reductase inhibitors (tamsulosin/dutasteride)

  • Neurogenic etiologies (Botox, i.e., botulinum toxin)

Urinary tract infection

Urinary tract infections (UTIs) are common in women because their urethras are shorter. But men can develop UTIs as well. Older men are more likely to have urinary tract infections than their younger counterparts. 

Enlarged prostate is one of the most common reasons men develop repeated urinary tract infections. How? The prostate gland wraps around the bladder neck, where the urethra connects with the bladder. As a result, it becomes more difficult to maintain a healthy and normal urine flow. And if your bladder doesn’t empty completely, bacteria may have fertile ground to multiply. Under normal circumstances, the urine would flush out bacteria, but BPH may make it difficult to do so.

The most common symptoms of urinary tract infections and bladder infections in men

  • Feeling like you need to urinate all the time

  • Frequent trips to the bathroom

  • Burning sensation, pain, and discomfort during or right after urination

  • Fever

  • Pain and/or tenderness below the stomach, right above the pubic bone

  • Cloudy urine with a foul smell

  • Blood in the urine (gross hematuria)

  • Pain in the sides or upper back

Some men with UTIs may even wet the bed. It’s also useful to mention some men may not have symptoms at all. 

Some men may develop bladder stones due to enlarged prostate and the inability to void the bladder completely. Bladder stones can be quite uncomfortable. In the most severe cases, an enlarged prostate can induce bladder damage and kidney damage.

In order to diagnose a UTI, a healthcare provider will perform a physical exam and ask you about the symptoms you’re experiencing. You may need to provide a urine sample. They will check for bacteria and pus. The presence of the latter is strongly associated with UTIs. 

The doctor may also perform a digital rectal exam if the suspect’s enlarged prostate caused the UTI.

The primary course of treatment of UTI is through antibiotics. You may need to take antibiotics once or twice a day for five to seven days. But the exact duration of the treatment depends on the type of bacteria that caused the UTI.

How can you reduce the risk of BPH complications?

The most important thing you can do to reduce your risk of BPH complications is to see your doctor as soon as you notice lower urinary tract symptoms, even if you are not diagnosed with BPH! Learn how to recognize enlarged prostate symptoms so that you can ask to see your doctor as soon as you notice them.

Your doctor will perform a physical exam and order the necessary tests to diagnose the problem. Then, they will recommend an adequate treatment approach.

The most common treatment strategies for BPH  

  • Medications (same as those for chronic urinary retention)

  • Transurethral resection of the prostate

  • Transurethral incision of the prostate

  • Laser therapy
  • Transurethral microwave thermotherapy
  • Embolization
  • Transurethral needle ablation

Lifestyle Modifications

  • Limit consumption of beverages at night

  • Keep warm

  • Limit intake of alcohol and caffeine

  • Practice double voiding (urinate and urinate again a few moments later)

  • Limit intake of decongestants and antihistamines

  • Exercise regularly and stay active

  • Eat a healthy, well-balanced diet

  • Go to the bathroom when you first feel the urge

A healthy lifestyle can aid the management of BPH and reduce the risk of complications.

To keep your prostate gland healthy, you should also strive to:

  • Quit smoking

  • Manage stress

  • Do pelvic floor exercises 

  • Stay hydrated

  • If overweight, you may want to try to slim down or maintain your weight in a healthy range (if you have normal weight)

Healthy lifestyle will not only protect this gland from complications but may also improve your sexual health. Many men experience erectile dysfunction due to their prostate problems. By modifying your lifestyle, you can aid the management of BPH and also manage your sexual dysfunction. Of course, this works for men whose ED is a result of this health problem; since many cases of erectile problems are not. 

Although many scientists believe BPH does not increase the risk of prostate cancer, some studies have shown otherwise. Evidence shows BPH may increase the risk of prostate cancer and bladder cancer, especially in Asian BPH patients. That being said, many studies explain it would be difficult to establish a causative relationship. Both BPH and prostate cancer have common pathophysiological driving factors such as genetic, hormonal, and inflammatory aspects. However, a lot more research is necessary to learn whether having enlarged prostate puts you at a higher risk of prostate cancer, irrelevant of other factors that lead to this common type of cancer.

Conclusion

Enlarged prostate is a common problem. And besides uncomfortable symptoms, it may also cause various complications.

In this post, we discussed the most common complications of BPH.

The best way to reduce the risk of these conditions is to adhere to doctor-recommended treatment and adopt healthy lifestyle habits to protect your prostate.

Always keep in mind that symptoms develop gradually, so subtle changes may occur. Don’t ignore them because the more proactive you are, the easier it’s going to be to avoid uncomfortable symptoms.

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Sources

  1. Roehrborn C. G. (2005). Benign prostatic hyperplasia: an overview. Reviews in urology7 Suppl 9(Suppl 9), S3–S14.
  2. Patel, N. D., & Parsons, J. K. (2014). Epidemiology and etiology of benign prostatic hyperplasia and bladder outlet obstruction. Indian journal of urology : IJU : journal of the Urological Society of India30(2), 170–176. https://doi.org/10.4103/0970-1591.126900
  3. Selius BA, Subedi R. (2008). Urinary retention in adults: Diagnosis and initial management. American Family Physician, 77(5), 643-650.
  4. Acute urinary retention. Teach Me Surgery. https://teachmesurgery.com/urology/presentations/acute-urinary-retention/
  5. Chronic urinary retention (CUR) treatment. U.S. Department of Health & Human Services – Agency for Healthcare Research and Quality https://effectivehealthcare.ahrq.gov/products/chronic-urinary-retention/research-protocol
  6. Dai, X., Fang, X., Ma, Y., & Xianyu, J. (2016). Benign Prostatic Hyperplasia and the Risk of Prostate Cancer and Bladder Cancer: A Meta-Analysis of Observational Studies. Medicine95(18), e3493. https://doi.org/10.1097/MD.0000000000003493
  7. Miah, S., & Catto, J. (2014). BPH and prostate cancer risk. Indian journal of urology : IJU : journal of the Urological Society of India30(2), 214–218. https://doi.org/10.4103/0970-1591.126909

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