As men enter middle age, they may feel the urge to get up more often at night and go to the bathroom. This increased frequency and urgency to urinate, due to an enlarged prostate gland (benign prostatic hyperplasia), usually starts slowly and then begins to affect other aspects of a man’s life, according to medical professionals. Some men may accept this as a normal part of aging, but local urologists explain there are new options for relief.
The ABCs of BPH
“Benign prostatic hyperplasia, or BPH, is a common condition among men as they age. An enlarged prostate gland can cause uncomfortable urinary symptoms, such as blocking the flow of urine out of the bladder,” says Dr. Nicholas Boncher, a urologist with Providence Portland Medical Center.
The prostate gland continues to grow throughout a man’s life, explains Boncher, but it’s not until his late 50s or early 60s that a man starts to experience negative effects from that growth. “As the prostate grows, it’s like a hand gripping a hose and clamping down,” he said.
An enlarged prostate gland amounts to two things: time (the age of the patient), and testosterone, according to Dr. Patrick Davol, a urologist with Rogue Valley Urology in Medford. “Testosterone stimulates the prostate gland to grow. As you age, the prostate has been exposed to more testosterone, so it gets larger,” he explains. Genetics also plays a big role. “It’s not necessarily hereditary, but you’ll often see benign prostatic hyperplasia in first-degree family relatives.”
Signs and symptoms
“If we start treatment early, we can avoid a lot of serious problems in the future.” Dr. Patrick Davol, Rogue Valley Urology
For most men, middle age is when an enlarged prostate gland starts to reach a critical point, says Boncher, adding there’s a large spectrum of symptoms. “Some men will only wake up once during the night to urinate and others will get up multiple times. Or some are unable to get a stream going,” he explains.
Davol agrees. By the age of 80, he says many men will have some element of BPH or an obstruction, but clinically they may not manifest with symptoms. “It’s not a linear relationship where a bigger prostate gland equates to more problems. Some men may never experience issues serious enough to require medication or surgery,” he adds.
However, there are signs that indicate you should visit the doctor. There are generally two categories of problems: an obstruction or storage symptoms. Hesitancy to urinate and not completely emptying the bladder are common signs of an obstruction, says Davol, while increased frequency and urgency of urination are typically a storage problem. “Many men come in because they’re waking up at night more often to urinate,” he adds.
Boncher sees a similar pattern with his patients, but he says any change in urination should warrant a visit to the urologist. “Men need to realize that an obstruction has a similar effect on the bladder as hypertension does to the heart,” he explains. Fortunately, there are treatment options available, so men don’t have to live with BPH as an inevitable part of aging.
New and existing treatments
Davol practices a multi-tiered approach, which begins with assessing the patient’s fluid intake. If a patient comes in because of increased urination at night, he first advises them to manage the amount they drink before bed. “For some men, if you manage their fluid intake, they can avoid more invasive treatments.”
Medication is the next step, says Boncher. Alpha blockers work by relaxing the musculature in the prostate, he explains. “Shrinkers” are another type of medication, which he says prevent the growth of the prostate and can even reduce its size.
While there are different surgical options, Boncher is a proponent of UroLift. “This takes the obstructive tissue around the urethra, pinches it around itself and pushes it out of the way of the urinary stream. It’s like taking curtains, pulling back and clipping them. The recovery is about a week, which is significantly shorter than other procedures.”
Davol and Boncher advise men to come in if they are experiencing urinary problems. “If we start treatment early, we can avoid a lot of serious problems in the future,” says Davol.