BPH Causes, Complications, and Who is Affected

September 15, 2022

What causes BPH, or benign prostatic hyperplasia, is not fully understood, but changes in hormonal levels as men age are thought to play a key role in developing an enlarged prostate. When men are young, they produce a large amount of testosterone and a relatively small amount of estrogen. However, as men age testosterone levels in the blood drop, leaving a higher percentage of estrogen. This may help bring about BPH. Prostatic hyperplasia may become problematic for older men over time, and they may develop annoying BPH symptoms and complications. Several popular prostate enlargement theories address BPH causes and why the prostate continues to grow as many men get older. These theories are discussed in the following section.

The prostate is a walnut-sized/shaped gland that sits below the bladder, in front of the rectum, and surrounds the urethra. It tends to keep growing as most men age. As the prostate continues to increase in size, it begins to overcrowd and squeeze the urethra until urine flow slows to a trickle or is completely blocked (urinary retention) in severe cases. At this point, the bladder can begin sustaining damage from benign prostatic hyperplasia since it now has to work harder to expel urine. This can lead to a thick bladder wall which in turn weakens the bladder.

BPH Causes

There are numerous theories on what causes BPH. Each one focuses on either hormonal absences or hormonal changes as the centerpiece of their respective hypotheses.

One theory is centered around men who had their testicles removed before puberty and never developed BPH. Some scientists believe that benign prostatic hyperplasia has something to do with aging and the androgens testosterone, dihydrotestosterone (DHT), and estrogen which the testicles produce. When those androgens aren’t produced in puberty, prostatic hyperplasia doesn’t form.

Another theory focuses on declining testosterone levels as men age, while estrogen levels remain the same. This gives a higher estrogen blood percentage as men age versus when they were younger. Benign prostatic hyperplasia may become entrenched when these hormonal changes take place, thus triggering additional prostate enlargement.

An additional theory, addressing BPH causes, hypothesizes that even with a drop in testosterone levels as a man ages, levels of DHT (a true androgen that enhances the development of male characteristics) remain high. DHT plays a critical role in prostate tissue growth in young men as they reach sexual maturity, but DHT overstays its welcome concerning prostate enlargement, as men age. Scientists reason that high levels of DHT encourage the prostate to continue growing.

They note that men who don’t produce DHT don’t get benign prostatic hyperplasia. On the flip side, however, it is thought that high levels of DHT could be protective against high-grade prostate cancer and prostate cancer deaths. Perhaps high levels of DHT, as a man ages, is nature’s way of protecting against prostate cancer deaths but offering up BPH symptoms as an unwelcome “trade-off.”

BPH Warning Signs & Symptoms

Although BPH can eventually become bothersome enough to warrant treatment as a man ages, there is no need to worry right away about BPH causes if mild symptoms are being experienced. Often, a wait-and-see approach can be taken. However, if moderate to severe BPH symptoms are being experienced, there are many exams, tests, and procedures available to diagnose benign prostatic hyperplasia. For some men, moderate BPH can be treated with medication, but If severe BPH symptoms are present, BPH can become a serious problem if urinary retention is experienced. The bladder can also suffer damage if severe symptoms persist for too long. The best treatment for severe BPH is surgery.

Some warning signs and symptoms of BPH are listed below:

  • Interrupted or weak urine stream
  • Trouble starting urination
  • Dribbling after urinating
  • Urinary frequency – 8 or more times/day
  • Urinary urgency – the immediate urge to go
  • Urinary incontinence – involuntary urine leakage
  • Urinary retention – can’t urinate
  • Feeling of not being able to fully empty the bladder
  • Nocturia – frequent urination at night
  • Unusual urine color or smell
  • Blood in the urine
  • Painful urination or ejaculation

BPH Complications

Complications from an enlarged prostate can become serious and warrant observation, medication, or surgery. A list of common BPH complications is included below.

Urinary Tract Infections (UTIs) – Infections of the urinary system can occur with more frequency if the bladder is unable to empty regularly. Medication can be prescribed, but surgery may be needed to reduce the size of the prostate if UTIs become a recurring issue.

Urinary retention – This is the immediate inability to urinate, which can quickly become a serious situation. If this BPH complication is experienced, a catheter may need to be installed through the urethra and into the bladder to drain urine that is backed up and causing discomfort, pain, and potential bladder damage.

Bladder stones – These are typically uric acid concretions formed over time due to the inability to fully empty the bladder of urine. These stones can obstruct urine flow, irritate the bladder, cause infections, create blood in the urine and cause discomfort.

Blood in the urine – Blood in the urine could be the result of many things, but as it relates to benign prostatic hyperplasia, it is typically irritation caused by the enlarged prostate that causes blood in the urine.

Kidney damage – Added pressure exerted by the bladder as the result of urinary retention can cause kidney damage and allow bladder infections to more easily travel to the kidneys.

Bladder damage – When urinary retention occurs regularly, the bladder is unable to contract like it should and becomes stretched out of shape. The bladder walls can then thicken over time and lead to permanent incontinence.

Who is Affected

BPH causes, symptoms, and complications primarily affect men 40 and older. Those who have a family history of prostate enlargement, participate in little to no exercise, experience heart disease, high blood pressure, or diabetes, are obese, or have erectile dysfunction are at even greater risk. However, as with any disease, there are always exceptions to the “rule”.

Young men in their 20s and 30s can get minor signs of BPH, but it is uncommon that severe benign prostatic hyperplasia symptoms present themselves that early in life. Men who exercise regularly, are fit, and have no heart disease, high blood pressure, or diabetes can get BPH too, especially if they have a family history of benign prostatic hyperplasia.

However, remaining as healthy as possible can keep some men from developing prostatic hyperplasia early on or even at all, even though most men will eventually experience some BPH symptoms if they live long enough. Age, genetics, lifestyle choices, and certain medical conditions appear to represent the largest contributing factors to BPH, yet some fortunate men will never be afflicted.

Proactive measures can be taken to stay healthy and keep the body functioning optimally while holding BPH causes derived from an enlarged prostate at bay as long as possible. This includes eating a nutritious diet, exercising regularly, maintaining a healthy weight, and receiving regular checkups.

There are numerous possibilities as to BPH causes and the resulting symptoms and complications. The true culprit could end up being a mixture of indications from all the various theories. The bottom line is: Benign prostatic hyperplasia is likely driven by hormonal changes and influenced by family history, lifestyle choices, and medical conditions as men age, since most cases of prostatic hyperplasia occur in older men in their 40s, 50s, and beyond.

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.

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