Benign prostatic hyperplasia (BPH) is extremely common - approximately 50 per cent of all men have it but only 10 per cent of them need treatment.
My father-in-law has been going to the toilet to urinate very often at night. We went to the doctor and he was told that his prostate is enlarged, but that it's not cancerous. What is this condition?
Seeing as your father-in-law may be quite elderly, the condition is probably benign prostatic hyperplasia. As a man becomes older, there's a tendency for his prostate gland to enlarge.
This condition is called benign prostatic hyperplasia or hypertrophy (abbreviated to BPH). It usually starts when you are in your 30's, and evolves and grows with the years. You don't know what's happening until you hit 50, and the symptoms gradually come to plague you.
It's extremely common too. Approximately 50 per cent of all men have it and develop symptoms, but only 10 per cent of them actually need any treatment. It's something you have to live with forever if it's mild.
Where is the prostate gland?
Your prostate gland (present only in men, not women) is an organ which is about the size of a walnut.
It's situated just below the bladder, and it goes round your urethra, which is basically the tube that carries your urine from your bladder to the outside of the body.
Your prostate gland makes a type of fluid that helps to nourish your sperm. Prostatic fluid makes up 20 to 30 per cent of your semen and it is alkaline.
This helps to neutralise the acidity of the vagina that the semen is going into.
Your prostate gland also contains some smooth muscles to help expel your semen during ejaculation.
Why does it enlarge when men get older?
Why does the prostate gland enlarge when men get older?
What happens when you age is that multiple nodules made out of fibre and soft tissue start to grow in your prostate gland, especially in the region around the urethra. This makes the canal (or lumen) of your urethra grow progressively smaller.
This is stimulated by testosterone.
Therefore, your urine flow becomes obstructed slowly. When it gets really bad, your bladder can get distended by all the urine that is being kept back. Then your bladder starts to add muscle (called hypertrophy), and this causes a whole new set of different problems.
In really extreme cases that are not treated for a long time, this distension and back obstruction can spread up the ureters (the tubes connecting your kidney to your bladder) and even your kidneys themselves.
How would I know if my prostate gland is enlarged?
If you are a man and you are getting older and you start having to go to the toilet to pee more often (called urinary frequency), it's highly likely that you might be getting BPH.
Other things you may experience are urinary urgency - the feeling of having to go immediately to the toilet, or you may pee in your pants.
You may also go to the toilet more often at night, waking you up frequently during your sleep.
Will there be pain?
Will there be pain? I'm afraid of pain.
No. There usually is no pain, even when you are urinating. This is unlike a bladder infection or even having kidney stones.
After a while, it may be difficult to initiate urination (this is called hesitancy).
And when you urinate, your stream may be interrupted frequently, and you will have to take a long time to pee at the toilet.
When it becomes severe, you might have to strain to urinate. Straining may cause congestion of the veins in your urethra and bladder, which may rupture and cause bleeding into your urine.
Some people come to the hospital with sudden and complete urinary retention, meaning they cannot void their bladder at all. This may happen after they try not to go to the toilet for a long time, or if they are immobilised for a long time, or if it's particularly cold.
Will BPH ever progress to becoming prostate cancer?
Don't worry. BPH is not a tumour, nor will it ever become cancer of the prostate. It's not a risk factor for developing cancer later either.
However, the symptoms of BPH could mimic that of prostate cancer, so it's wise to seek medical attention when you experience such symptoms. The doctor will then make sure of the diagnosis.
How will doctors treat BPH?
Well, BPH is not always treated. Usually, when you go to the doctor with symptoms, the doctor will monitor you over a period of time to see if it gets worse. This is called "watchful waiting".
Then the doctor might give you a drug if your symptoms become worse. There are a group of drugs called the alpha blockers, which help relax the smooth muscles of your prostate gland and the neck of your bladder. This helps remove urinary obstruction.
But these drugs will only help improve your symptoms within a few weeks, and not decrease the size of your prostate.
Then there is the group of drugs called the 5-alpha reductase inhibitors, which block testosterone being converted into its active form. These drugs will actually decrease your prostate size by 25 per cent over a period of six to 12 months.
Then finally, there's surgery. A TURP (transurethral resection of the prostate) is a procedure where the doctor inserts an instrument through your urethra (under anaesthesia of course) and shaves away the inner part of your prostate.
And now there are laser and microwave therapies.
Dr YLM graduated as a medical doctor, and has been writing for many years on various subjects such as medicine, health advice, computers and entertainment.