Enlarged prostate, also referred to as Benign Prostatic Hyperplasia (BPH), is a common health issue in aging men. As men age, their prostate glands increase in volume, which can create additional pressure on the urethra (the passageway for urine from the bladder) even though this increase is not cancerous or harmful on its own.
Under this added pressure, LUTS (Lower Urinary Tract Symptoms) occur due to difficulties with urination. However, we need to be aware of what happens within the urinary tract to understand the relationship between BPH and LUTS.
Table of Contents
Key Takeaways
- The prostate surrounds the urethra, and when it becomes enlarged, it can place pressure on and block the urethra, which causes LUTS.
- LUTS are a result of mechanical blockage and the bladder’s compensatory response to urethral pressure.
- Typical signs of LUTS include voiding symptoms such as a weak stream and hesitancy, and storage symptoms including frequent urination and the urge to urinate.
- The goal of early treatment includes lifestyle changes like diet, medications, or surgical techniques to help avoid complications and improve your patient’s quality of life.
- If you notice weak stream, urgency, or incomplete emptying, get evaluated immediately by a urologist.
1. The Prostate’s Location is Critical
The prostate gland is found directly beneath the bladder. The urethra functions as a way that transports urine from the body to the outside. As the prostate enlarges, rather than expanding outward, it presses inward, forcing the urethra to stretch and compress.
This pressing or closing of the urethra is known as obstructive uropathy or bladder outlet obstruction (BOO). BOO is the leading cause of lower urinary tract symptoms (LUTS).
2. Two Mechanisms: Static and Dynamic Obstruction
The two main ways that Benign Prostatic Hyperplasia (BPH) causes LUTS are through static and dynamic obstruction.
Static Obstruction:
Prostatic enlargement can create a static obstruction by narrowing or compressing the urethra, thus preventing urine from flowing through easily. Because of this increased effort to void, the bladder will have to push harder and further to get the urine out.
It can cause voiding symptoms such as hesitancy, diminished stream, and incomplete emptying, as well as storage symptoms including urgency, nocturia, and increased frequency.
Dynamic Obstruction:
In addition to the enlargement of the prostate, the neck of the bladder has smooth muscle, which can lead to narrowing of the urethra and dynamic obstruction because of its hyperactivity or tightness in conditions like benign prostatic hypertrophy (BPH).
Thus, the flow of urine from the bladder is delayed, resulting in symptoms of lower urinary tract dysfunction, including:
- Urgency
- Frequency
- Weak stream
- Difficulty beginning to urinate
3. Bladder Response: The Mechanisms Behind Irritative Symptoms
Bladder Muscle Thickening (Hypertrophy)
When the bladder works harder to get past urethral obstruction, its muscles initially thicken and strengthen. Over time, this causes overactivity and increased sensitivity, leading to urgency, frequent urination, and even nighttime urination (nocturia).
Reduced Bladder Compliance
The bladder slowly loses its ability to stretch properly. Even small amounts of urine can make someone feel the urge to urinate, which contributes to storage symptoms like urgency and frequency.
Incomplete Bladder Emptying
Urine cannot flow fully through the narrowed urethra, so some remains in the bladder after urination. This results in dribbling, a constant feeling of fullness, and raises the risk of urinary tract infections.
Treatment
If you have mild symptoms, then lifestyle modifications may be helpful. For those who are experiencing moderate to severe LUTS, self-care practices have little benefit; therefore, medications may be necessary. Medications include both alpha-blockers and 5-alpha reductase inhibitors.
Treatment options such as minimally invasive methods or surgery would only be recommended for severe LUTS, urinary retention, recurrent infections, bladder stones, or failure of medication.
Consult a urologist for personalized advice on BPH and LUTS
Conclusion
Lower urinary tract symptoms (LUTS) are caused by the compression of the urethra by an enlarged prostate (BPH) and increased muscle tone around the bladder neck.
LUTS include voiding symptoms and storage symptoms. If recognized in the early stages of BPH, LUTS may be treated with a variety of methods, which can include lifestyle changes, non-invasive treatments (such as medication), and more invasive approaches such as surgery.
Frequently Asked Questions (FAQs)
No, LUTS can also result from urinary tract infections, bladder stones, neurological disorders, medications, and spinal cord injuries or their effects.
Yes. Lifestyle changes may lessen the severity of LUTS symptoms. Avoiding caffeine and alcohol, limiting fluids in the evening, staying physically active, and doing pelvic floor exercises can help ease mild LUTS symptoms.
