Clinical Conditions

Causes & Risk Factors

BPH (benign prostatic hyperplasia) is a natural consequence of aging and is more likely to occur in men whose fathers or brothers experienced prostate enlargement. However, BPH occurs in nearly all men over time, as long as they have testes. About 50% of men who are 50 have evidence of microscopic enlargement of the prostate gland, and at least 30% of men require treatment by the time they reach 70 years of age.

Signs & Symptoms

The symptoms caused by BPH can be obstructive and irritative. Obstructive symptoms result from the mechanical obstruction of the flow of urine caused by the prostate. As a man's bladder contracts to empty, it has to overcome the obstruction caused by the enlarged prostate. Irritative symptoms are often a combination of the mechanical obstruction and the effects of obstruction. Because the prostate is enlarged, the bladder must work harder to empty. In doing so it undergoes a series of changes that result in a "hypersensitive bladder". The hypersensitive bladder then partly causes some of the irritative symptoms discussed below.

Obstructive Symptoms

  • Hesitancy/straining – When the urethra is obstructed, it is often difficult to start urinating despite the urge. Men strain or bear down, as if attempting to have a bowel movement, to start their urinary stream.
  • Weak stream/intermittency – Flow of urine may be slow or diminished and urination may be characterized by a repeated start-stop pattern that requires additional straining.

Irritative Symptoms

  • Frequency – Due to changes in the bladder wall, as well as incomplete emptying of the bladder, needs to urinate frequently.
  • Nocturia – Nighttime frequency, this symptom describes the inability to sleep through the night without having to get up to urinate.
  • Urgency – The sudden, intense and sometimes uncontrollable urge to urinate that results from having a hypersensitive bladder.