Have you noticed that you’re getting up more frequently at night to go to the toilet to pee? Does it take you a longer period of time to void and empty your bladder? Are you going more frequently in the daytime? Is your flow a trickle or gravity fed?
If you’ve answered yes to any of these questions it is possible that you could be suffering from a benign enlargement to your prostate or BPH. This blog is here to highlight and to explain a very common condition that affects men as they progress through life.
Firstly, some of the anatomical considerations to be aware of. The bladder sits above the prostate. In essence the prostate is shaped like a donut, in that there is a central cavity through which passes the urethra which is the outlet pipe of the bladder.
There are several zones inside the prostate, two of which, you need to be aware of. The central part is called the transition zone. This is the area of the prostate that is prone to BPH. The cells within this area multiply gradually and progressively through life thus taking up more space.
This results in obstruction like a clamp on a pipe. This then results in urinary symptoms. The outer part of the (the peripheral zone) is away from the pipe. It’s where the majority of prostate cancers arise from.
Zones of the Prostate
BPH is very uncommon the younger a man is, increasing in frequency becoming clinically relevant for the majority of people when men progress beyond the age of 40. By the time a man is 80 years of age around 80% will have some histological evidence of BPH. With time there is progressive and gradual obstruction to the outlet pipe of the bladder. With things comes the development of lower urinary tract symptoms (LUTS).
We characterize lower urinary tract symptoms into two main categories: those that are related to obstruction of the bladder and those that are related to storage of urine or irritated symptoms. With progressive obstruction to the bladder the flow or the pressure a man generates will be slower. It can take longer for him to pee and sometimes the stream can be intermittent.
Symptoms that are due to the bladder arise because of changes which happen in the bladder wall. As you can imagine every pee that a man does over the course of several years when there is increasing outlet resistance, the pressure that the bladder needs to generate to try to force urine out beyond the obstruction needs to increase. This results in increased deposition of muscle fibres in the bladder wall muscle (Detrusor muscle). This muscle actually gets thicker with time. This progressive thickening or hardening of the bladder causes a loss of elasticity and a reduction in compliance. Instead of being a big, elastic, floppy bag the bladder then becomes stiffer and more rigid. In this situation a man’s perception of fullness happens at a lower capacity, resulting in more frequent trips to the toilet. Urgency can also develop. This can become severe enough to the point where men race or rush to the toilet.
Sometimes, they get caught short not making it to the toilet in time. Leaking urine before they actually arrive at the bathroom. A similar thing can happen at night, which is called nocturia. This is the situation where men need to get up multiple times at night to go to pee.
By and large when I’m talking to men about their urinary symptoms the thing that causes them the biggest bother relates to bladder dysfunction. The need to get up multiple times at night or alternatively to rush to the toilet in the day.
So to summarize with BPH, it’s a very common condition that increases in frequency as we progress through life. It is a benign enlargement of the prostate, a non-cancerous enlargement. Treatment choices for the management of this condition really relate to quality of life and the degree of inconvenience that a man perceives related to his voiding function.