Benign prostatic hyperplasia (BPH)

What is BPH?

Enlarged prostate, benign prostate enlargement (BPE) or benign prostatic hyperplasia (BPH) is a condition that goes by many names. It mainly affects middle aged men. It’s where the prostate, a small gland found near a man’s bladder, is bigger than usual.

There can be numerous symptoms, but the main one is urinary problems (like not being able to pass urine easily).

Men with an enlarged prostate find it more difficult to empty their bladder completely, and at times may need to strain to pass urine. Sometimes this is accompanied by discomfort or a ‘reduced flow’, and in some cases blood may appear in the urine.

Who gets BPH?

Men over the age of 50 are most likely to get an enlarged prostate. A lot of men don’t get any symptoms, or only get mild symptoms that don’t bother them.

It’s thought that a change in the balance of hormones as men get older may cause the prostate to grow. There isn’t much evidence to suggest hereditary factors will lead to an enlarged prostate, but some research says you’re more likely to get BPH if your father or brother has it.

Some studies also suggest that obese or diabetic men could be more likely to get an enlarged prostate. A study of 659 men in China who were undergoing treatment for BPH found evidence to suggest that men with higher blood sugar levels, especially those with diabetes, tend to have larger prostates and experience faster prostate growth. This was true for older men younger than 70, but the relationship wasn’t significant for men older than this.^[1]

A review of studies on obesity and prostate health did find a link between obesity and an increased risk of benign prostate hyperplasia (BPH), or an enlarged prostate. The studies consistently found that obesity, (measured by body mass index and waist circumference), is a significant risk factor for BPH.^[2]

How common is BPH?

BPH is much more common if you’re over 40, and increases the older you get. According to the Urology Care Foundation, it’s thought that about half of men between 51 and 60 will get it, rising to 90% of men over the age of 80.^[3]

It’s estimated that a third of men over 50 are thought to get moderate to severe LUTS (which stands for lower urinary tract symptoms) related to the condition.^[4]

What causes BPH?

The exact cause of prostate enlargement is unknown, but it’s believed to be linked to hormonal changes as a man gets older. The balance of your hormones in your body changes with age, and this may cause your prostate to grow. There is also some evidence that healthy lifestyle changes like increasing exercise and eating more fruit and vegetables can reduce your risk of developing BPH symptoms. ^[1]

Research suggests that there may be a connection between testosterone and an enlarged prostate. ^[2] Testosterone naturally converts in the body to dihydrotestosterone. This is a much more potent hormone than testosterone, and it’s thought that this causes the prostate to grow.

Over time this growth causes pressure to build on the urethra, which makes it harder to pass urine.

What are the symptoms of an enlarged prostate?

If you have BPH, you might notice:

• your flow of urine becoming weaker
• having a feeling that your bladder isn’t empty
• not being able to start urinating easily
• dribbling urine after you finish
• stopping and starting as you pee
• needing to go to the toilet often and going at night
• urgency
• leaking urine before you can make it to the toilet.

If you have BPH, you may only get some of these symptoms, or you may not get any at all. They can also be caused by other health problems or lifestyle factors, so if you get them, it’s not necessarily an enlarged prostate.

If you do notice any of these symptoms, then always contact a clinician for further advice. If an enlarged prostate is left untreated this can lead to more serious problems.

Can BPH lead to other problems?

Having an enlarged prostate isn’t considered particularly serious. But if left untreated, it can cause complications, and most of these are related to not being able to pass urine. Bladder or kidney problems (like infections) are examples, and sometimes surgery may even be required to remove the prostate completely.

Contrary to what some people think, there’s no link between having an enlarged prostate and prostate cancer.