KUALA LUMPUR, July 2 – If you are a man with urination problems, such as frequently needing to pass urine especially disturbing your night sleep or trouble starting to pee, you should consider getting checked to see if you have benign prostatic hyperplasia (BPH).
BPH is a condition in which a man has an enlarged prostate that may affect how he urinates. It doesn’t usually pose serious harm to one’s health, according to NHS UK,1 but while symptoms may be mild for some without necessitating treatment, BPH can be very troublesome for other men.
BPH, which primarily occurs among older men aged above 50, is not a cancer and does not lead to higher risk of developing prostate cancer, although symptoms can be similar.
According to the National Health and Morbidity Survey (NHMS) 20192 about 16.3 per cent of adults in Malaysia aged 40 and above have probable BPH with moderate to severe symptoms – lower than the 26.2 per cent estimated lifetime global prevalence rate.
Malaysia’s prevalence of probable BPH increased from 10.5 per cent in men aged 40 to 44, to 33.4 per cent in men aged 75 and older.
The NHMS 2019 found that three in five men with probable BPH had poor quality of life and were dissatisfied with their urination experience.
The Health Ministry’s NHMS 2019 said findings indicated an “urgent” need to address BPH in Malaysia, recommending the establishment of men’s health clinics, comprehensive care for senior citizens, and healthy lifestyles and awareness campaigns on the signs and symptoms of BPH.
What Is BPH?
According to the United States’ National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK),3 the prostate undergoes growth twice throughout a lifetime. The first is during puberty, and the second starts when a man is about 25 years of age, with the growth continuing almost all his life.
BPH occurs during this second stage of growth when the prostate gets too large, squeezing the urethra.
This causes the bladder wall to become thicker and over time, the bladder is unable to empty fully. The narrowing urethra and urinary retention then cause the various problems linked to BPH.
In some cases, this may cause renal failure, according to the US’ Urology Care Foundation,4 necessitating immediate medical attention. But many with symptoms of less severity usually only need active monitoring with regular visits to one’s urologist and annual check-ups.
Symptoms vary among patients but tend to worsen as they age. According to the NIDDK,3 the size of the prostate does not correlate with the severity of symptoms.
Some men with greatly enlarged prostates may experience minor symptoms and little blockage of the urethra, whereas some with a slightly enlarged prostate may have more symptoms and greater blockage.
The MedlinePlus health information resource5 by the National Library of Medicine under the US’ National Institutes of Health reported that less than half of all men with BPH have lower urinary tract symptoms.
- Persistent need to urinate, about every one to two hours, especially at night
- Inability to delay urination
- Difficulty in starting to urinate
- Weak or interrupted urine stream
- Dribbling at the end of urination
- Nocturia (needing to wake up at night more than twice to pass urine)
- Urinary retention
- Urinary incontinence (accidental loss of urine)
- Pain after ejaculation or during urination
- Urine with an unusual colour or smell
According to NIDDK,3 most men with BPH do not develop complications from their condition, which can include: acute urinary retention; chronic urinary retention; blood in the urine; urinary tract infections (UTIs); bladder damage; kidney damage; and bladder stones. Kidney damage, in particular, can lead to a serious condition.
NIDDK advises men with BPH symptoms to see a doctor. Urology Care Foundation4 notes that BPH gets worse with age in most men.
Men should seek immediate medical attention if they have these symptoms: complete inability to urinate; painful, frequent, and urgent need to urinate, with fever and chills; blood in the urine; and great discomfort or pain in the lower abdomen and urinary tract.
Who Is At Risk?
NIDDK3 lists the following factors that increase a man’s likelihood of developing BPH:
- Aged 40 years and older
- Family history of BPH
- Pre-existing medical conditions, such as obesity, heart and circulatory disease, and type 2 diabetes
- Lack of physical exercise
- Erectile dysfunction
Testing And Diagnosis
BPH can be diagnosed through various tests, according to the Urology Care Foundation:4
Symptom Score Index
Developed by the American Urological Association, the Symptom Score Index is also sometimes called the International Prostate Symptom Score (IPSS). This index is generally used to assess urinary symptoms, with scores ranging from mild to severe. This is often the first step in diagnosing BPH.
This involves a doctor inserting a gloved finger into the rectum of a patient to check for enlargement, tenderness, lumps, or hard spots at the back wall of the prostate gland, a physical exam lasting 10 to 15 seconds to look for problems.
Several types of urine tests are available to diagnose BPH, used to measure one’s urine release to check if the urethra is blocked:
- A urinalysis tests one’s urine sample for blood, signs of infection, glucose, protein, and other factors that may point to BPH or even bladder cancer.
- Post-void residual volume (PVR) measures residual urine in the bladder after the patient urinates.
- A uroflowmetry test measures the speed of a patient’s urine flow.
- A urodynamic pressure flow study measures the pressure in the bladder during urination.
Scans can be undertaken to examine the size and shape of a man’s prostate in diagnosing BPH:
- Ultrasounds measure the size and shape of the prostate by looking inside one’s body.
- Cystoscopy uses a scope to look at the urethra or bladder.
- Magnetic resonance imaging (MRI) and computed tomography (CT) scans are usually conducted if surgery is required, enabling the doctor to see a very clear image of the prostate that will show exactly how and where the prostate is enlarged.
Blood tests may be ordered to rule out prostate cancer. Prostate-specific antigen (PSA) blood tests are used to check the level of PSA, a protein made only by the prostate gland.
If the level of PSA is low, the prostate is deemed healthy. Likewise, an increase in PSA would mean that there are problems in the prostate. Non-cancerous enlargement of the prostate or inflammation can cause a rise in PSA, and so can cancer.
If you have symptoms of BPH, please take the first step in diagnosing your condition so that a health care professional can advise you on how to manage your symptoms or get treated.
- Benign prostate enlargement. NHS UK. Link. Accessed June 14, 2022.
- National Health and Morbidity Survey 2019: Technical Report – Volume I. National Institutes of Health (NIH), Ministry of Health Malaysia. Link. Accessed June 14, 2022.
- Prostate Enlargement (Benign Prostatic Hyperplasia). National Institute of Diabetes and Digestive and Kidney Diseases. Link. Accessed June 14, 2022.
- Benign Prostatic Hyperplasia (BPH). Urology Care Foundation. Link. Accessed June 14, 2022.
- Enlarged prostate. MedlinePlus. Link. Accessed June 14, 2022.