Benign Prostatic Hyperplasia

Description

Alternative Names

Causes of Lower Urinary Tract Symptoms

A number of structural or medical conditions, either independently or in conjunction with BPH, can cause lower urinary tract symptoms. Prostate growth, in fact, does not always explain symptoms normally attributed to BPH. Men with large prostates do not always have symptoms, and men with small or normal-sized prostates sometimes have symptoms that are more severe than in those with enlarged glands.

Abnormalities in the Urinary Tract

Abnormalities in the urinary tract can cause BPH-like symptoms in men with or without enlarged prostate glands. Such conditions can produce obstruction, impair or weaken the detrusor muscles surrounding the bladder, or cause other damage that impacts the urinary tract. They include the following:

• Muscle contractions in the area where the bladder and urethra meet.
• A narrowing of the urethra.
• A weakened bladder.
• Over-activity in prostate muscles.

The male and female urinary tracts are relatively the same except for the length of the urethra.

Aging

The process of aging weakens the detrusor muscles that surround the bladder, which causes the bladder to become unstable and lose capacity. Unstable detrusor muscles may also impair bladder storage capacity, which then produce irritative or storage symptoms. Studies also indicate that as men get older they may produce more urine at night, although the total daily output of urine is similar to that in middle-aged men. It is not fully known why this occurs.

Prostatitis

Prostatitis is an inflammation of the prostate gland. It can be caused by bacterial infection, which is the easiest cause to diagnose. However, the most common form of prostatitis is nonbacterial.

Bacterial Prostatitis. A prostatitis infection can be acute (occurring abruptly) or chronic (long term). Chronic bacterial prostatitis (CBP) is often subtle and may persist for weeks or months with low-grade symptoms, including an urgent need to urinate, frequent urination, and the need to urinate at night. Pain may occur in the lower back or rectum, or it may develop after ejaculation. Because the prostate isnt swollen, physicians may mistake chronic prostatitis for BPH. A urine culture should always be taken, which, in the case of both acute and chronic bacterial prostatitis, will reveal bacteria and confirm a diagnosis. Antibiotics are required to treat CBP; fluoroquinolones and trimethoprim-sulfamethoxazole (Bactrim, Septra) are particularly effective, but prolonged treatment may be necessary.

Nonbacterial Prostatitis. In nonbacterial prostatitis, inflammation occurs but no bacteria are present. It is eight times more common than bacterial prostatitis. The causes of nonbacterial prostatitis have not been determined. In one study, alfuzosin, a drug called an alpha-blocker, which is used for BPH, provided some modest relief in patients with prostatitis and chronic pain. The routine use of drug therapy antibiotics or anti-inflammatory drugs does not seem to be beneficial for treating this condition. More research is needed.

Prostatodynia. Although it is considered a form of prostatitis, prostatodynia is a noninflammatory disorder characterized by prostate pain but neither inflammation nor bacteria are present. The causes of prostatodynia are unknown.

Interstitial Cystitis

Interstitial cystitis is an inflammation of the bladder that may be associated with an allergic or autoimmune response. Some physicians believe this is a psychologic condition but there is a significant amount of evidence that it represents a physical problem. It is occurs much more frequently in women, but some experts believe it is more common in men than many physicians believe and may be misdiagnosed as prostatitis or BHP.

Congestion of the Prostate (Prostatosis)

Congestion of the prostate, sometimes called prostatosis, is a benign condition in which the prostate seems to be swollen by excess fluid. It can cause frequent, slow, or uncomfortable urination, but it responds well to a program of frequent ejaculation and sitz baths.

Cancer

On occasion, prostate cancer can mimic BPH, since both conditions may cause obstruction of the urethra. Bladder cancer can sometimes cause urinary bleeding, frequency of urination, or a sense of urgency, also symptoms of BPH.

Click the icon to see an image of prostate cancer.

Other Conditions Affecting the Urinary Tract

A number of other conditions can impair the lower urinary tract, including tumors, reactions to medications, and spinal cord injuries. Diseases that affect the nervous system, such as diabetes, multiple sclerosis, and shingles, can desensitize the nerves so that they fail to sense fullness and do not trigger the contraction of the bladder.