Benign prostatic hyperplasia, or BPH, is a common non-cancerous condition that men over the age of 40 typically have to deal with. It is caused by an enlarged prostate that gets big enough that it begins encroaching upon and pinching the urethra and pressing against the bladder, making it difficult for men to urinate normally. Even though BPH is not prostate cancer, both can occur simultaneously, so it is a good idea to get a prostate exam and a PSA and PSA Free check annually. Also called prostatic hyperplasia, the condition can cause many lower urinary tract symptoms, or LUTS, such as urinary frequency, difficulty in starting urination, urgency, starting and stopping, dribbling, and other related urinary issues. These LUTS can require lifestyle changes, medication, or surgery to address, and continue to increase in severity for many men as they continue to get older. Even though sexual issues such as ejaculatory or erectile dysfunction are not related to BPH itself, they could be related to 5-alpha reductase BPH medications taken to help shrink the prostate. Prostate tissue naturally surrounds or cradles the urethra, so any enlargement beyond a certain size can cause issues. When discussing BPH and age with patients, it’s typically a matter of when and not if BPH shows up. Some fortunate men will not get BPH at all – or get it but suffer no symptoms, but many men won’t be as fortunate.
The age at which men experience benign prostatic hyperplasia can vary depending on family history, lifestyle, or environmental factors, but an enlarged prostate is most common in men over the age of 60. “About half of all men between ages 51 and 60 have BPH and up to 90% of men over age 80 have it.”1 The exact cause of BPH isn’t yet fully understood, but age is considered a big factor. Inflammation within the prostate may also contribute. Mostly, it is believed to stem from hormonal changes men experience as they get older. Because the prostate is a hormone-sensitive organ, increased levels of testosterone encourage it to grow larger. This is great when a male is going through puberty and into his early to mid-20s because prostate enlargement at this time in a man’s life is important for reproduction. However, that same prostate growth in a man’s late 20s and beyond is not such a great thing because the larger the prostate grows at this stage, the more it can cause troubles for the urethra and bladder.
Benign prostatic hyperplasia typically begins presenting symptoms when a man reaches his 50s and beyond, but a very small percentage of men in their 20s, 30s, and 40s can begin developing an enlarged prostate and start showing some minor BPH symptoms. There have even been extremely rare incidences when teens under the age of 18 have developed BPH2
Here is some additional information about BPH and age:
- About 8% of men will develop BPH in their 40s3
- Approximately 50% of all men aged 51 to 60 will develop BPH1
- Roughly 60% of men between the age of 60 and 69 will have BPH4
- The risk of developing benign prostatic hyperplasia increases with age. By the age of 80, about 90% of men will have some degree of BPH.1
- Lower urinary tract symptoms, or LUTS, due to BPH can worsen with age. Older men are more likely to experience urinary incontinence, difficulty emptying the bladder fully, and recurrent urinary tract infections with an enlarged prostate.
- Since the prostate continues to grow for most men throughout their life, there is no absolute cure for BPH, outside of removing the prostate altogether, but there are very effective treatments that can help manage LUTS and improve the quality of life for many years and possibly for the rest of a man’s life.
- Men with benign prostatic hyperplasia should see their doctor regularly to monitor their condition and make sure that the treatment is working.
BPH Cause and Symptoms
As men age, their testosterone levels begin declining, and the changing balance between testosterone and estrogen percentages leads to changes. Conversely, levels of dihydrotestosterone (DHT), a more formidable form of testosterone, remain high. This DHT increase is hypothesized to be an important factor in the onset of benign prostatic hyperplasia, or BPH. Although not a life-threatening condition, BPH can be life-altering and cause a host of issues that can dramatically impact a man’s quality of life. Ten of the most common lower urinary tract symptoms brought on by BPH include:
- Urinary frequency: BPH prompts men to urinate more frequently, especially at night (nocturia). Many men go to the restroom every couple of hours or even more often in severe cases.
- Hesitancy: Some men with an enlarged prostate may have difficulty starting urination, experiencing delay or hesitation before urination begins.
- Weak or intermittent urine stream: Over time, urine flow may slow down and become weaker or intermittent, resulting in a less forceful urine stream. The bladder may also take longer to empty because of this issue.
- Urgency: There can be a sense of urgency to urinate, often accompanied by difficulty postponing or delaying urination. Environmental sounds, like running water, can be a possible trigger.
- Dribbling after urination: After urination, some men may experience post-void dribbling, where a small amount of urine leaks out.
- Painful urination or ejaculation: Sometimes urinating can be painful when benign prostatic hyperplasia is present. The pressure put on the urinary and reproductive system by an enlarged prostate can cause pain. Some men may have to push hard to urinate and that can result in pain as well.
- Urinary retention: When urine can’t be fully expelled from the bladder and some urine remains, it is called chronic urinary retention and can cause the feeling of incomplete emptying. Additional follow-up trips to the restroom may be needed to fully empty the bladder. Sometimes urinary retention becomes acute and gets so bad no urine can be released from the bladder and a catheter may need to be installed to relieve urine back up.
- Frequent urinary tract infections: As men get older, BPH can cause more frequent urinary tract infections (UTIs) as the prostate continues to enlarge.
- Urinary incontinence: The involuntary discharge of urine can be caused by an overactive bladder that can get worse as benign prostatic hyperplasia progresses. Normally the brain gives a fair warning and signals the bladder muscles when it’s time to empty the bladder, but with an overactive bladder, the bladder muscles contract on their own with very little warning.6
- Urine with unusual color or smell: If urine is retained for too long in the bladder without being fully emptied each time, bacteria may start growing in the bladder and result in the darkening of the urine and the release of a foul odor.
If any of the BPH symptoms above are experienced, it’s important to see a doctor to receive a diagnosis and to discuss treatment options. There are several treatment options available for addressing benign prostatic hyperplasia, including:
- Lifestyle changes: Numerous lifestyle changes are available that can help reduce the risk of developing BPH or improve symptoms if BPH is present. These include:
- Eating a healthy diet
- Exercising regularly
- Losing weight
- Drinking plenty of fluids
- Avoiding alcohol and caffeine
- Medication: There are several medications available that can help improve urinary symptoms caused by an enlarged prostate and even reduce the size of the prostate gland.
- Surgery: Surgery may be an option for men who do not respond to lifestyle changes, medication, or who have severe symptoms. There are many effective surgical procedures available.
If BPH is diagnosed, it is important to work with a doctor to find the best treatment option available. With proper treatment, most men can manage their symptoms and live a normal, active life.
Studies show that men can develop microscopic signs of BPH as early as in their 20s and 30s, however, it is very uncommon for men in their 20s to experience significant lower urinary tract symptoms due to an enlarged prostate.5 There have even been a handful of extreme cases where BPH has been diagnosed in boys under the age of 18, but this is a rare event.2 Typically, urinary symptoms in men who are 20 – 30 years of age, are caused by other problems that cause the enlargement of the prostate, such as from infection rather than growth.5 Symptomatic BPH is not very common in men who are 30 – 39 years old, but a significant enough number of men start to show symptoms of an enlarged prostate at this age. Typically, symptoms are mild, but occasionally they are moderate or severe enough that treatment may be required.5
Most men will begin encountering the effects of BPH in their 50s and 60s and the percentage of men who will eventually require treatment for benign prostatic hyperplasia will continue to increase as men age into their 70s, 80s, and beyond. The key to treating BPH at any age is to be proactive and try the least invasive treatment option possible until such a time when that treatment no longer works and then move on to the next treatment. BPH can be dealt with successfully and even “cured” with an appropriate, individualized treatment specific to each man.
All surgical treatments have inherent and associated side effects. Individual’s outcomes may depend on a number of factors, including but not limited to patient characteristics, disease characteristics and/or surgeon experience. The most common side effects are mild and transient and may include mild pain or difficulty when urinating, discomfort in the pelvis, blood in the urine, inability to empty the bladder or a frequent and/or urgent need to urinate, and bladder or urinary tract infection. Other risks include ejaculatory dysfunction and a low risk of injury to the urethra or rectum where the devices gain access to the body for treatment. Further, there may be other risks as in other urological surgery, such as anesthesia risk or the risk of infection, including the potential transmission of blood borne pathogens. For more information about potential side effects and risks associated with Aquablation therapy for Benign Prostatic Hyperplasia (BPH) treatment, speak with your urologist or surgeon. Prior to using our products, please review the Instructions for Use, Operator’s Manual or User Manual, as applicable, and any accompanying documentation for a complete listing of indications, contraindications, warnings, precautions and potential adverse events. No claim is made that the AquaBeam Robotic System will cure any medical condition, or entirely eliminate the diseased entity. Repeated treatment or alternative therapies may sometimes be required.