Benign prostatic hypertrophy, or BPH for short, is a non-malignant condition in which the prostate enlarges. This is quite common, especially as men get older. Although it isn’t fully understood, scientists do know that an excess of certain male hormones encourages parts of the prostate to grow more than usual. Causes of BPH have garnered significant interest in the research community, and we’ll go over some of the theories shortly.
Symptoms
BPH typically presents with changes in urinary habits. Common symptoms are often referred to as “voiding symptoms” because they involve the process of urination or emptying the bladder. This includes a weak or slow urine stream, an uptick in frequency, difficulty urinating or starting to urinate, and waking up at night to urinate more than usual. Another set, called “storage symptoms,” includes sudden urges to go and occasional leakage. Sometimes they can be part of the BPH pattern, but they can also indicate other urinary-related conditions.
Globally, studies have shown that about one in four men will experience these symptoms at some point in their lives, and this rate has remained relatively stable over the past two decades. Though BPH is common, it can still interfere with quality of life, disrupting sleep, increasing bathroom trips, hampering social and work activities, and sometimes affecting sexual and emotional health.
Causative Theories
Forewarning: this part gets super scientific, but don’t worry, it’ll be over soon.
As researchers continue to uncover the mechanisms behind BPH, one recurring theme is the role of chronic inflammation. Other theories include age-related hormonal changes, altered signaling between various cells, and imbalances in growth factor activity. Together, these factors may create an environment that supports abnormal, yet noncancerous, tissue growth.
Another area of growing interest is the idea that BPH may represent a kind of “reawakening” of embryonic growth patterns in the prostate. This theory, first proposed in the 1970s, suggests that aging-related factors can trigger stem cells (cells that develop into other cell types) to become active again. These cells may originate in the prostate itself or be recruited from the bone marrow. Once they arrive, they respond to inflammatory signals and growth factors, leading to abnormal but benign growth of prostate tissue. In particular, mesenchymal stem cells (which can form connective and smooth muscle tissue) seem to play a key role by altering the local environment and encouraging further proliferation of prostate cells.
Untreated BPH
If BPH isn’t treated, the problems can get worse than just annoying bathroom trips. The complications go from uncomfortable to serious. These include impaired bladder emptying, where the bladder fails to fully drain, which increases the risk of urinary tract infections and bladder stones. Sometimes, gross hematuria (visible blood in the urine) can occur, signaling the need for medical attention.
More severe complications include acute urinary retention, a sudden and painful inability to urinate that requires emergency care. In the worst cases, urine can back up into the kidneys, leading to kidney failure, which can cause permanent damage.
Beyond the urinary system, untreated BPH can lead to chronic sleep loss that affects energy, mood, and concentration. In older adults, sleep disruption increases the risk of falls, which can lead to fractures or head injuries.
When Is It an Emergency?
BPH becomes an emergency mainly when it causes acute urinary retention (AUR) – a sudden inability to urinate that’s painful and needs immediate medical attention. If you can’t urinate at all, it’s important to get help right away to avoid serious complications.
When urine builds up suddenly and can’t be released, it puts extreme pressure on the bladder, potentially damaging the bladder muscle and reducing its ability to function correctly over time. Urine trapped in the bladder can also become a breeding ground for bacteria, increasing the risk of urinary tract infections (UTIs). If these infections spread into the bloodstream, they can cause sepsis, a serious medical emergency.
Because the kidneys filter waste from the blood, any blockage that causes urine to flow backward can impact kidney function. The effects on other body systems further afield are often related to the complications that arise from infections or the body’s response to severe pain and stress.
Treatment Options
Treatment for BPH depends on the extent to which the symptoms are impacting daily life. For men with mild or stable symptoms, active monitoring with regular check-ins with a healthcare provider may be sufficient. However, if the symptoms are more severe, many treatment options become available.
In situations where procedures or surgery aren’t possible due to other health conditions, catheter-based management may be used. This involves placing a tube (catheter) into the bladder to allow urine to drain, either as a temporary solution or for longer-term management. The goal of each of these treatments is the same: to relieve obstruction, improve bladder emptying, and alleviate symptoms. However, they differ in terms of their invasiveness, speed of action, and alignment with a person’s overall health and preferences.
The Bottom Line
Importantly, there’s no reason to suffer and just put up with urinary symptoms. If your urinary function is at all bothersome or if something feels off, talk to a urologist. At the very least, you deserve less stress and better sleep. And who knows? A simple conversation could spare you a lot of trouble down the road.