The prostate makes some of the milky fluid (semen) that carries sperm. The gland is the
size of a walnut and is found just below the bladder, which stores urine. The prostate
wraps around a tube (the urethra) that carries urine from the bladder out through the tip
of the penis. During a man's orgasm (sexual climax), muscles squeeze the prostate's fluid
into the urethra. Sperm, which are made in the testicles, also go into the urethra during
orgasm. The milky fluid carries the sperm through the penis during orgasm.
Benign prostatic hyperplasia (BPH) is an enlarged but otherwise normal prostate.
It is common in older men and may cause no problems at all.
The cause of BPH is not well understood. For centuries, it has been known that BPH
occurs mainly in older men and that it doesn't develop in men whose testes were removed
before puberty. For this reason, some researchers believe that factors related to aging
and the testes may spur the development of BPH.
Throughout their lives, men produce both testosterone, an important male hormone, and
small amounts of estrogen, a female hormone. As men age, the amount of active testosterone
in the blood decreases, leaving a higher proportion of estrogen. Studies done with animals
have suggested that BPH may occur because the higher amount of estrogen within the gland
increases the activity of substances that promote cell growth.
Some researchers suggest that BPH may develop as a result of "instructions" given to
cells early in life. According to this theory, BPH occurs because cells in one section of
the gland follow these instructions and "reawaken" later in life. These "reawakened" cells
then deliver signals to other cells in the gland, instructing them to grow or making them
more sensitive to hormones that influence growth.
The most common symptom of BPH is trouble urinating. Many men with BPH have no
bothersome symptoms. But BPH may cause some men to have problems urinating. Put a check
next to the symptoms that you have:
- I feel that I have not completely emptied my bladder after I stop urinating.
- I urinate often.
- I stop and start when I urinate.
- I have a strong and sudden desire to urinate that is hard to delay.
- My urine stream is weak.
- I need to push or strain to start the urine stream. I often wake up at night to
urinate.
As the prostate grows in BPH, it squeezes the urethra (urinary tube). This narrows the
tube and can cause problems with urination. Sometimes with BPH you can also have urinary
infection or bleeding.
In the early stages of BPH, the bladder muscle can still force urine through the
narrowed urethra by squeezing harder. But if the blockage continues, the bladder muscle
gets stronger, thicker, and more sensitive. The result is a stronger need to urinate.
In some cases, you may have trouble forcing urine through the urethra. This means the
bladder cannot empty completely. Some men may find that they suddenly cannot urinate (a
condition called acute urinary retention). Over time, a few men might have bladder or
kidney problems or both.
Sometimes BPH causes infection of the urinary tract. This can cause burning or pain
when you urinate. The urinary tract is the path that urine takes as it leaves the body.
The tract includes the kidneys, ureters, bladder, and urethra.
If you have symptoms that bother you, see a doctor. He or she can find out if BPH -- or
another disease -- is the cause. If you do have BPH, your doctor can also see if it has
caused other problems.
Currently, the five ways of treating BPH are:
- Watchful waiting.
- Alpha blocker drug treatment.
- Finasteride drug treatment.
- Balloon dilation.
- Surgery.
Surgery will do the best job of relieving your urinary symptoms, but it also has more
risk than the other treatments. Unless you have a serious complication of BPH that makes
surgery the only good choice, you can choose from a range of treatments. Which one you
choose if any depends on how much your symptoms bother you. Your choice also depends on
how much risk you are willing to take to improve your symptoms. You and your doctor will
decide together.
