By Dr. Brian Irwin

Benign Prostatic Hyperplasia, also known as BPH, is an extremely common condition. It's also an extremely despised condition that results in significant discomfort and inconvenience for those who have to live with the disorder. One study showed that up to 90 percent of all men will develop symptomatic BPH by age 90.

What is a prostate anyway? The prostate is a male reproductive gland that resides deep in the pelvis. Its function is to produce the fluid that comprises a significant portion of ejaculate. The urethra, the "tube" through which we urinate, leaves the bladder, tunnels through the prostate gland and eventually runs to the end of the penis. Because the urethra courses through the prostate, enlargement of the prostate presents primarily with urinary symptoms.

Because the prostate is a reproductive organ, its function depends on male sex hormone levels. Unfortunately, over a man's lifetime the relentless exposure to circulating testosterone also causes the gland to slowly grow. Enlargement of the prostate over time eventually causes impingement on the prostatic urethra, leading to discomfort and symptomatic BPH.

Benign Prostatic Hyperplasia can present a number of ways. The most common symptoms are urinary hesitancy, weak urinary stream or post-urination dribbling. Because the symptoms stem from occlusion of the internal urethra, urinary retention (the inability to void), bladder stones or even urinary incontinence (from an overflowing bladder) can also be symptoms of BPH. In some cases, the presentation is as vague as more frequent nighttime urination, which can in turn delay the diagnosis of BPH for a number of years.

A careful physical exam and history by your primary health provider is necessary to diagnose BPH. While the history provided by the patient is most likely to reveal underlying BPH, your provider will likely also perform a digital exam of the prostate. The prostate itself is located adjacent to the front most wall of the rectum, so it can only be felt by performing a rectal exam. In addition to this exam, your provider may tap on your bladder to screen for urinary retention.

If you are diagnosed with BPH, there are treatment options for you. Two classes of medications exist that help relieve BPH. One class, which includes medications such as terazosin, acts on the muscular portion of the prostatic urethra, allows it to dilate and pass urine more easily. The other class of drugs works by blocking the conversion of a hormone called DHT to testosterone, which eventually leads to shrinkage of the prostate itself. Saw Palmetto, an herbal remedy, is another option that in my experience does seem to work for some patients; however, studies have failed to prove true efficacy when compared to placebo.

While these medications provide significant relief, many cases of BPH still progress to a more severe degree that requires a more aggressive treatment. In these cases, sometimes the only successful treatment is surgery on the prostate itself. Urologists have many options, from surgically cutting the occluded portion of the prostate, to laser vaporization of the hyperplastic prostate tissue. These procedures are feared by many men due to their anticipated discomfort or the potential complications. However they are generally considered very safe, very well tolerated and most patients are delighted with the results.

If you have symptoms suggestive of BPH, talk with your health-care provider. Early treatment not only makes your life more livable, but also delays progression of the condition and decreases the chance you'll need a more invasive procedure. By treating BPH early, you'll be more comfortable and your condition will be, in a sense, water over the dam.

Dr. Brian Irwin is a family physician at Tamworth Family Medicine, a division of Huggins Hospital.

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Dr. Brian Irwin: BPH is a common but uncomfortable disorder - Conway Daily Sun

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