Benign Prostatic Hyperplasia (BPH)

The prostate is a small, heart shaped, chestnut sized gland located below the urinary bladder. It surrounds the urethra (tube that carries urine from the bladder out of the body) like a doughnut. The prostate has two major functions: (a) to secrete fluids that make up a portion of the ejaculate volume; and (b) to provide secretions with possible antibacterial effect.
A normal prostate gland in an adult male weighs 4-20 grams. People with severely symptomatic BPH can have a prostate as large as 50-80 grams. As the prostate enlarges, it may restrict the flow of urine.


All symptoms of BPH can be divided into two categories: obstructive and irritative urinary symptoms. Obstructive symptoms may include:
Difficulty starting a urine stream
Decreased strength of the urine stream, weak flow
Dribbling after urination
Feeling the bladder is not completely empty
Urge to urinate again soon after urinating
Pain during urination
Waking up ftequently at night to urinate
Frequent urination
Sudden, uncontrollable urge to urinate
About 50-80% of men with BPH have an irritative voiding symptom. This usually occurs late in the course of the condition. Irritative symptoms result ftom a long-standing blockage at the bladder neck. To make up for it, the bladder muscle increases in size so that it can generate a greater force to push urine past the blockage at the bladder opening. Over time, the overstretched muscle is no longer able to hold urine in the bladder. Bedwetting or clothes wetting can occur. People often wake up every 1-2 hours to urinate at night, which causes a poor night's sleep.
Symptoms, signs, and complications of BPH generally worsen in severity over time, with symptom severity greatest in older men. It is important to treat BPH to avoid complications. It is also important to tell your doctor about all the symptoms that you are experiencing, because some of symptoms can resemble other medical conditions, such as prostate cancer.


A physical exam should be done to diagnose BPH. This should include a digital rectal exam, which examines of the prostate, although the size of the prostate gland does not always correspond to the symptoms.
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Timothy L. Biliouris, M.D.
65 Route 134 Dennis, MA 02660
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