Benign prostatic hyperplasia (BPH) is a non-cancerous enlargement of the prostate. There are two prostate growth periods: one during early puberty and another around the age of 25. As it grows, the gland can press and pinch the urethra, and the bladder walls thicken. Over time, the bladder can become weaker and lose its ability to empty fully. If the urethra continues to narrow and the bladder still can’t empty, complications associated with benign prostatic hyperplasia can arise.
Benign prostatic hyperplasia does not increase a man’s risk of developing prostate cancer. Prostate cancer begins in the outer peripheral zone and grows outward to invade surrounding tissue. In BPH, the growth moves inward towards the prostate’s core, causing the urethra to become tighter and making it difficult to urinate.
The growth dynamics of BPH determines the symptoms. BPH can have annoying symptoms, such as the inability to urinate or releasing a small amount only.
Hormonal changes that occur through aging contribute to the BPH onset. Genetics, too, can be a possible cause for BPH. The prostate continues to grow from the age of 25, but when the prostate grows too much, it can cause complications in older men.
Complications of enlarged prostate
Bladder stones, not to be confused with kidney stones, are formed when minerals inside the bladder lump together and harden.
Bladder stones may be a result of an already existing problem such as a urinary tract infection. They often form when the bladder is not fully emptying, so the urine that is left behind crystallizes into a stone.
Aside from enlarged prostate, bladder stones are also associated with nerve damage, inflammation, the use of catheters, kidney stones, damaged urethra, and weak bladder.
Symptoms of bladder stones include frequent urination throughout the day, lower abdominal pain, a burning sensation when urinating, urine that appears cloudy or contains blood, and the inability to control urine.
Acute urinary retention
Urinary retention is the inability to fully empty your bladder. This condition can either be acute (temporary), or chronic – in which case it is something you must deal with for life. Albeit short-lived, acute urinary retention may be indicative of a life-threatening condition, so it does require immediate medical attention. Patients with chronic urinary retention are able to pass urine, but their bladders never fully empty. Many people are actually unaware of their urinary retention until another issue – like a urinary tract infection – arises.
There are two main types of urinary retention: obstructive and non-obstructive. If there is an obstruction such as a bladder or kidney stone, then urine cannot properly be released, resulting in some urine remaining in the bladder after urination. In this case, urinary retention can be life threatening, and you will require immediate medical intervention.
Obstructive causes of urinary retention include an enlarged prostate, certain tumors or cancers, urethral stricture, cystocele, rectocele (the bladder sags into the colon), constipation, and bladder or kidney stones.
Non-obstructive urinary retention is caused by the weakening of the bladder muscles or nerve problems disrupting the communication between the bladder and the brain. Causes of non-obstructive urinary retention include stroke, pelvic injury or trauma, nerve diseases, impaired muscle or nerve function, and accidents that have injured the spinal cord or brain.
Symptoms of acute urinary retention include:
- Inability to urinate
- Painful or urgent need to urinate
- Severe pain or discomfort in the lower abdomen
- Bloating in the lower abdomen
Chronic, or long-lasting, urinary retention
Chronic urinary retention mainly affects men as a result of prostate enlargement. Although the condition is not life threatening, it can lead to hydronephrosis or kidney impairment, which can put a patient at risk for acute-on-chronic retention. In chronic urinary retention, a person is unable to fully void their bladder, so urine stays within the bladder, increasing the risk of urinary tract infections. Furthermore, urinary retention can have a negative effect on quality of life as a result of voiding-related symptoms.
Symptoms of chronic urinary retention include urinary frequency, urgency and hesitancy, nighttime urination, symptoms similar to a urinary tract infection, and lethargy (tiredness, lack of energy).
Urinary tract infections
As mentioned, in men, urinary tract infections are often associated with urinary retention. Symptoms include cloudy or foul-smelling urine, blood in urine, difficulty urinating, pain while urinating, nausea, vomiting, shaking and chills, and fever.
Blood in urine
Hematuria, or blood in urine, can be a frightful experience, especially if you don’t know what could be causing the condition. For the most part, hematuria is a benign condition, but there may be a risk of a more serious condition, too. Being able to identify the underlying cause of the blood in urine can ease your anxiety and direct you to a proper treatment to avoid other health complications.
To determine the cause of hematuria, your doctor will need to run a number of tests. These can be tedious and stressful, but it’s important to rule out any condition that could result in blood in urine.
Oftentimes, a simple blood test can point to the diagnosis, but in cases when it’s not so clear, alternative tests may be required. These include imaging tests like ultrasound and MRI, and cystoscopy, which involves a camera inserted into the bladder to uncover the source of bleeding.
As mentioned, majority of hematuria causes are benign, but in some instances, blood in urine could signal a very serious health problem. Here is a list of the possible causes of hematuria you need to be aware of.
Recognizing the accompanying symptoms that are present while you are experiencing blood in urine can help you narrow down on a possible cause and even inform the diagnosis.
- Urinary tract infections (UTIs)
- Kidney infections
- Bladder or kidney stones
- Enlarged prostate
- Kidney disease
- Inherited disorders – sickle cell anemia, Alport syndrome
- Kidney injury
- Certain medications like anti-cancer drugs or aspirin – some medications may be heavily pigmented and what you believe to be blood in urine is actually dye
- Strenuous exercise – may cause trauma to the bladder or dehydration
Pressure placed on the kidneys by a bladder retaining urine can contribute to kidney damage. Also, bladder infections can infect the kidneys, increasing the risk of damage.
As the bladder retains urine, it continues to stretch. Excess stretching weakens the bladder muscles, impairing its ability to contract, which can worsen the problem of urine retention. Recurrent urinary tract infections can also lead to bladder damage.
When to see a doctor for an enlarged prostate
If you are a male over the age of 40, you should see your doctor to monitor the size of your prostate – especially if you have a family history of bladder cancer. You should also see your doctor if you notice blood in your urine, experience pain while urinating, or if you encounter any other symptoms related to a urinary tract infection.