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Benign Prostatic Hyperplasia (BPH) means enlargement of the prostate.

At birth, the prostate is about the size of a pea. It grows only slightly until puberty when it begins to enlarge rapidly.

It reaches normal adult size and shape, about that of a walnut, when a man is in his early 20s.

The gland generally remains stable until about the mid-40s, when, in most men, the prostate begins to grow again through a process of cell multiplication. As you age more, your prostate may get larger and in some cases, beyond the acceptable size; that’s when it is called Benign Prostatic Hyperplasia.

As the prostate keeps on enlarging, it may reach a size that eventually starts squeezing down on your urethra. The bladder wall becomes thicker. Ultimately, the bladder wall itself may weaken and lose its ability to evacuate urine completely, leaving some urine in the bladder.

The narrowing of the urethra and associating inability to empty the bladder completely the reason behind many of the problems associated with benign prostatic hyperplasia. Nevertheless, it is a benign ailment; that is, it is not cancer.

BPH is very common among older men, affecting about 60% of men over age 60 and 80% of men over age 80.

The Prostate

The Prostate is part of the male reproductive tract and is located beneath the urinary bladder and in front of the rectum.

The Prostate surrounds a tube called the urethra. The urethra carries urine from the bladder out through the penile organ.

The main job of the prostate is to generate nourishing fluid for semen. During ejaculation, sperm made in the testicles is moved to the urethra. At the same time, fluid from the prostate and the seminal vesicles also moves into the urethra. This mixture goes through the urethra and out of the penis through ejaculation.


The cause of Benign Prostatic Hyperplasia is not well understood. It is suspected that the changes affecting the male sex hormone levels as part of the aging process appear to play a role in the enlargement of the prostate gland.

Throughout their lives, men produce testosterone “the male hormone” and small amounts of estrogen; a female hormone.

With male age progression, the amount of active testosterone in their blood decreases, leaving a higher proportion of estrogen. Some scientists are confident with the theory that Benign Prostatic Hyperplasia may occur because of the higher proportion of estrogen within the prostate triggers certain activities related to prostate cell growth.

Another theory emphasizes Dihydrotestosterone (DHT), a male hormone that plays a role in prostate development and growth, as the prime suspect for prostate enlargement in later adulthood. Some research work inclined that even with a drop in blood testosterone level, older men continue to accumulate high levels of DHT in the prostate. This accumulation of DHT may encourage prostate cells to continue to grow.


The symptoms of BPH are often very mild at the beginning, but they become more serious if they aren’t treated. Common symptoms include.

Incomplete bladder emptying.

The need to strain when urinating.

Dribbling at the end of the urinary stream.

Incontinence, or leakage of urine.

Nocturia, which is the need to urinate one or more times per night.

Trouble starting to urinate.

Blood in the urine.

A weak urinary stream.

Feeling that urinating “can’t wait”.

Painful urination.


If you have urinary symptoms, your doctor will do a number of things to find the cause; a full personal and family medical history and description of symptoms; a physical examination that includes a digital rectal examination (DRE) which constitutes the main part of a physical examination when checking for prostate disease; blood or urine tests; as well as special urological investigations as urodynamic study to test pressure in the bladder during urinating; uroflowmetry to measure how fast urine flows; and ultrasound for the prostate could be beneficial according to clinical assessment


There are many treatments for BPH according to the outcome of the assessment. You and your doctor shall decide on which treatment modality is suitable for your status.

Mild cases of BPH may need no treatment at all; just self-care at home. In more symptomatic cases, medical treatment could be the mainstay of treatment. In advanced or problematic cases or when there is back pressure on the kidneys, prostatectomy would be the ideal solution.

The main treatments for BPH are:

Watchful Waiting

Once you feel the urge, urinate.

Make it a habit to visit the toilet, even when you don’t feel the urge.

Avoid over-the-counter decongestants (e.g. during a flu attack). They can make it harder for you to have the bladder emptied.

Exercise regularly.

Keep warm. Coldness can aggravate the symptoms.


Medications are the best option for men with mild-to-moderate symptoms who seek medical intervention. Choices include alpha-blockers, anti-androgens, or a combination of your doctor will be able to inform you of the best suitable medication for your case.


When medical treatment fails and in advanced cases, surgery to remove obstructing prostate tissue can be the ideal solution. Surgery is almost always recommended if you are unable to urinate due to urinary retentions, ensuing renal insufficiency, recurrent urinary tract infections, recurrent bloody urination, or development of bladder stones.

Transurethral resection of the prostate (TURP) is the most commonly used surgical treatment for BPH.

Transurethral Incision of the prostate (TUIP).

Laser vaporization of the prostate; used to cut or destroy prostate tissue.

Open Prostatectomy.

Our advice: Tell your doctor if you’re concerned about any symptoms you’re having. These symptoms are treatable, and prompt treatment will prevent complications.