Benign Prostatic Hyperplasia

What Is It?

The prostate is a small gland approximately the size and shape of a walnut that is located at the base of the penis. It sits in front of the rectum and directly below the bladder. The prostate is an integral part of the male reproductive tract. It produces fluid that helps to move the sperm through the urethra during sexual climax.

At birth, the prostate gland is tiny. When testosterone levels rise during puberty, the prostate grows rapidly, doubling in size by age 20. Growth slows down for the next two decades and the prostate usually does not cause problems for many years. Less than 10 percent of 30-year-old men have an enlarged prostate. When a man reaches his 40s, the prostate goes through a second growth spurt. Half of all men have an enlarged prostate by the time they reach age 60, and by age 85, 90 percent of the men are affected.

The prostate surrounds the urethra where the urethra connects to the bladder. During puberty, the prostate expands evenly. The enlargement that occurs in the second half of life is concentrated in the part of the gland next to the urethra. As the gland gets bigger, it interferes with the flow of urine out of bladder. That makes the bladder work harder to empty urine. Eventually, the bladder becomes thicker and can start having too many contractions. Over time, this extra effort causes the bladder muscle to weaken, and all the urine cannot be emptied. The combination of these problems leads to discomfort and complications.

Symptoms

An enlarged prostate can make it more difficult to urinate. Not all men who have an enlarged prostate experience symptoms. However, about one fourth of all men in the United States report some trouble urinating.

At first, symptoms may be mild because the bladder muscle is able to compensate for the pressure from the enlarged prostate on the urethra.

The pressure of the prostate on the urethra causes an interrupted or weak stream of urine. Other symptoms include:

• Difficulty starting to urinate
• Continuing to dribble after urination
• A feeling that you have not completely emptied your bladder

The severity of these problems depends on how much the prostate is putting pressure on the urethra.

Another set of symptoms happens when the urine that collects in the bladder causes irritation. These symptoms include:

• Painful urination
• A frequent need to empty the bladder, especially at night
• A feeling of urgency that accompanies the sensation to urinate

Potentially serious complications can occur if the bladder does not empty completely. The stagnant urine is a prime environment for the growth of bacteria, which can cause frequent urinary-tract infections. Also, urinary stones can form in the bladder lining due to an accumulation of debris and chemicals. Broken blood vessels can cause blood in the urine, often because of torn or enlarged veins on the inner surface of the prostate. Blood in the urine also can be caused by the sudden stretching of the bladder wall, which compromises its blood flow. If left untreated, so much urine can be retained in the bladder that urine backs up into the kidneys, which can cause the kidneys to malfunction.