November 20, 2024
The average adult pees up to seven times daily. So, if you’re having trouble with urination — as aging men often do — it can eventually take a toll.
“We don’t realize how important urination is,” says MU Health Care urologist Dr. Daniel Au. “We do it multiple times a day without thinking, but when it’s not going well, it can be devastating.”
For many men, the problem is an enlarged prostate — a condition known as benign prostate hyperplasia (BPH). The prostate is a male reproductive gland located deep in the groin. Its primary function is supplying semen. But the urethra — a narrow tube that carries semen and urine — runs directly through the prostate. An enlarged prostate can push against the urethra and your bladder, causing urinary symptoms.
“BPH is a huge quality of life issue for most men as they get older,” Dr. Au says. It occurs in about 50% of men in their 50s and 60% in their 60s. It only continues to increase, affecting more than 80% of men in their 80s.
Many men don’t realize that they don’t have to live with the symptoms of an enlarged prostate. To shed some light on the topic, Dr. Au shares six facts about BPH that every man should know:
1. 90% of Men Between Ages 45 and 80 Experience Urinary Symptoms
The prostate naturally gets bigger as you age — and the size and growth are unique to each man, which can make the cause of urinary symptoms tricky to diagnose. BPH is the most common cause of male urinary symptoms, but not the only cause, so it’s important to have a full evaluation to get the right treatment.
Prostate enlargement progresses slowly over time, so the symptoms of BPH can creep up on you. You may notice things getting only slightly worse each year, but the degree of decline may be shocking when you compare how you pee now to 10 years ago.
Urinary symptoms that suggest an enlarged prostate include:
- Feeling like you can’t fully empty your bladder
- More frequent urination
- Pain while peeing or after ejaculation
- Pushing or straining to begin a urine stream
- Starting and stopping often while urinating
- Sudden need to urinate
- Weak or dribbling urine stream
Dr. Au adds prostate size doesn’t always match the severity of BPH symptoms. “Men with smaller prostates can have terrible blockages,” Dr. Au says. “It may have more to do with the shape of the prostate and how it sits against the opening of the bladder.”
Regardless of size, if you are having symptoms, a comprehensive assessment can help identify what’s happening. If you have a larger prostate but no symptoms or red flag issues, then Dr. Au says you probably don’t need to take any action.
2. An Enlarged Prostate Can Cause High PSA Levels
Prostate cancer screening involves testing prostate-specific antigen (PSA) levels. But a high PSA level can also be caused by BPH.
“The bigger your prostate is, the more PSA it will make,” Dr. Au says. “But PSA is just one part of the equation.”
Diagnosing BPH may also include:
- Assessing your health history and looking at prior imaging of your pelvic region
- Internation Prostate Symptoms Survey (IPSS), which allows you to privately answer questions about your urinary and sexual health
- Imaging, including bladder scans, CT scans and rectal ultrasound
- Lab work to understand kidney function
- Digital rectal exam to estimate your prostate size and density
- Cystoscopy, which involves inserting a camera through the urethra and into the bladder to look for a blockage
“The tests can be uncomfortable, but they aren’t painful,” Dr. Au says. “People that undergo testing usually admit that it wasn’t as bad as they imagined.”
3. Untreated BPH Can Have Long-Term Effects
A blockage in your urinary tract can eventually affect your bladder and kidneys, as urine backs up with nowhere to go. In addition to uncomfortable urinary symptoms, untreated BPH can cause other complications, such as:
- Bladder stones
- Infections
- Urinary retention (inability to pee)
“Sometimes, the bladder muscle becomes damaged and can no longer function,” Dr. Au says. “When it gets that severe, there isn’t always a way to fix it, and draining your bladder may require a catheter.”
4. BPH Treatment May Depend on Your Prostate Size and Shape
Your anatomy often dictates the best course of action when treating BPH. Your provider will consider your prostate size and shape. But they will also assess your bladder condition and the blockage before recommending a watch-and-wait approach, medication or surgery.
“We need to look at physical changes in the bladder, too,” Dr. Au says. “That can help push us one way or another in terms of what kind of intervention we recommend.”
Your personal preferences also help guide BPH treatment. Some options do have side effects, and you may need to determine if there are urinary and sexual side effects that you can live with.
“You need to balance the risk of an intervention with the risk of your condition worsening,” Dr. Au says. “But there are plenty of options to consider.”
5. Laser Prostate Surgery May Eliminate the Need for Medication
Medication can help reduce or eliminate the symptoms of BPH. It’s the best treatment for many men. But if you still have symptoms while taking BPH medication, there are other options. Surgery helps you avoid taking too many drugs (polypharmacy) and the possible sexual side effects associated with some BPH medications.
“If you take multiple blood pressure medications and still have high blood pressure, no one thinks that’s OK,” Dr. Au says. “So why are you satisfied with BPH medication if it’s not working? There’s a lot more we can do.”
Dr. Au says laser prostate surgeries — either Holmium laser ablation of prostate (HoLAP) or Holmium laser enucleation of prostate (HoLEP) — are the most modern and effective interventions for most guys. “The procedures are precise and allow us to sculpt a new urinary channel for you,” Dr. Au says. “You’ll be able to pee better than you have in years, and most men do not need to continue medication following surgery.”
6. You Can Reduce the Risk of BPH
You may not be able to control BPH risk factors such as age or family history, but you can take steps to reduce your risk, including:
- Maintain a healthy weight: Obesity, metabolic syndrome and Type 2 diabetes are risk factors for BPH.
- Make healthy lifestyle choices: A nutritious diet, physical activity and quality sleep can reduce inflammation — a BPH risk factor.
- Report urinary symptoms: See your primary care doctor regularly and discuss any symptoms. If needed, they can refer you to a urologist.
“There’s no crystal ball that can reveal how your prostate will age,” Dr. Au says. “But we can provide guidance about what tends to happen, what might happen to you and your options. That way, you can make the best decision for your health and quality of life.”
Next Steps and Useful Resources
- Want to learn more about BPH? See our treatment options.
