Benign Prostatic Hyperplasia – Symptoms

Prostate enlargement: symptoms in general

Increasing the size of the prostate gland narrows the upper portion of the urethra, which passes through the prostate gland. This phenomenon is referred to in technical language as subvesical obstruction (“subvesical” = located below the bladder, “obstruction” = closure of a hollow organ).

By narrowing the urethra, the benign prostate enlargement causes symptoms that are almost all related to urination. They can be divided into two symptom complexes (obstructive and irritative micturition complaints). In addition, benign prostatic hyperplasia (BPH) can interfere with sexual function.

Obstructive micturition complaints

The term void in medicine refers to the emptying of the bladder. Micturition complaints are therefore disorders in the bladder emptying. Obstructive micturition complaints are when they are caused by a narrowing of the urethra, as is typical for benign prostate enlargement. Symptoms summarized under this collective term are as follows:

• weak urinary stream or even complete urinary retention
• interrupted urinary stream
• delayed start of micturition
• Pressing at the micturition
• dribbling
• residual urine

These symptoms come about as follows:

The narrowing of the urethra in benign prostatic hyperplasia is the Harnstrahl mitigated and maybe partially interrupted, It always comes back to a short Pause the voidbecause the pressure that the bladder builds up is temporarily insufficient to overcome the resistance from the subvesical obstruction. As a result, the affected men often try through Press nachzuhelfen.

The constriction often leads to one delayed onset of micturition: Although, as it were, willingly given the “order” to urinate, it takes the BPH then a certain time until the void actually begins. If the obstruction is particularly pronounced, it may even become one complete urinary retention lead: Then no urine can be eliminated at all. It increasingly accumulates in the bladder or accumulates back to the kidneys. Read more in the section “Complications” below.

Because the narrowing of the urethra often prevents the urinary bladder from being completely emptied, those affected by prostatic hyperplasia often experience an unpleasant after micturition. “residual urine“. In addition, it often happens that after urination even a small amount of urine involuntarily drips, which then as “dribbling” referred to as.

Irritative micturition complaints

In addition to the obstructive micturition symptoms, a benign prostate enlargement causes symptoms that are summarized under the term “irritative micturition symptoms”. These are complaints caused by irritation (irritation) of the bladder and bladder outlet. The bladder neck is the area where the bladder tapers downwards and opens into the urethra.

The entire bladder is surrounded by a muscle called the detrusor vesicae, or detrusor for short. When he contracts, he builds up pressure that, when he is big enough, initiates the micturition. However, the increased resistance that the bladder must overcome in a BPH to allow for micturition, the detrusor is increasingly loaded, which may result in a change in its structure and irritation. In simple terms, it is increasingly hypersensitive, triggering the following symptoms:

• frequent urination in small quantities (Pollakisurie)
• multiple urination at night (nocturia)
• strong urinary urgency, which can not be withheld (imperative urinary urgency)
• Pain when urinating (dysuria)

Urinary pain does not have to occur with every BPH, and often they are absent.

Basically, the severity of the symptoms is very different individually. It does not depend directly on the extent of prostate enlargement. So it happens that some patients with only slightly benign prostatic hyperplasia feel more intense symptoms than men whose prostate gland is already larger.

Benign Prostatic Hyperplasia: Sexual Disorders

Micturition symptoms are typical of an enlarged prostate. Symptoms in the field of sexual function are also not uncommon. Above all, erectile dysfunction (inability to get an erection, impotence) bothers some men with BPH. Furthermore, reduced ejaculation and pain during ejaculation can occur.

Benign prostatic hyperplasia: complications

The biggest problem that causes benign prostatic hyperplasia with pronounced subvesical obstruction is the increased accumulation of urine in the urinary bladder. As a result, it is not only common to urinary tract infections and bladder stones, but untreated sometimes even more serious complications.

Rebuilding the bladder wall

Due to the continuous increase in bladder filling and the increased pressure during the micturition, a reactive growth of the muscle cells of the detrusor (detrusor hypertrophy) occurs after a certain time. By doing so, the body wants to ensure that a sufficiently high pressure can be built up that can overcome the greater resistance to bladder emptying. However, the bladder wall loses elasticity through muscle growth. In addition, it stores more collagen. There may even be small saccules in the bladder wall, called the pseudodiverticula.

The changes in the bladder wall in turn promote the formation of residual urine. The final state of this pathological reconstruction is called “Balkenblase” because the detrusor is thickened like a bar. If benign prostatic hyperplasia is treated, a bladder blister can in principle be reversed.

Complete urinary retention and overflow bladder

If the narrowing of the urethra through the prostate enlargement allows no more bladder emptying, then it comes to complete urinary retention. The urine then accumulates in large quantities in the bladder, causing it to be overstretched. The result is a noticeable and visible protrusion of the lower abdomen and severe pain. A sudden complete urinary retention is an emergency and needs to be treated quickly! It should be noted that certain risk factors may further promote this complication. These include alcohol consumption, continued bed rest, certain medications and sexual activity.

In some cases, the complete urinary retention due to the enormous pressure increase in the bladder leads to a so-called overflow bladder. The occlusion pressure in the urethra is finally overcome, but only slightly, so that it comes to a constant, light urine dripping, but not to a regular void. This phenomenon is also called “Ischuria paradoxa”.

Kidney congestion and kidney failure

The increased pressure in the urinary bladder with concurrent obstruction of the urethra and slightly raised bladder can lead to a urinary retention in the context of a benign prostate enlargement. The urine passes through the urethra and back into the renal pelvis. In the long term, the kidneys are damaged, in the worst case it even comes to kidney failure. The urinary retention is referred to in the jargon as “vesicoureal reflux,” a consequent damage to the ureter and kidneys as a “hydroureter” or “hydronephrosis”.

uremia

Certain degradation products of the metabolism – such as urea, uric acid or creatinine – must be eliminated via the kidneys with the urine, because they can otherwise cause damage in the body. Such substances are called “urinary”. When they are no longer adequately excreted, for example because the kidneys are damaged as a result of benign prostatic hyperplasia, they accumulate in the body. Physicians then speak of uremia: It can lead to symptoms such as pronounced itching, nausea and vomiting and untreated even life-threatening.

Blood in the urine (hematuria)

At the bladder exit area are veins that may become jammed by prostatic hyperplasia. Doctors then talk about bladder neck varices. These jammed veins are relatively sensitive and may tear. As a result, larger amounts of blood in the urine (gross hematuria), which can be seen in a clear red color when urinating. The phenomenon is less dangerous than it looks.

Prostate enlargement: graduation according to alkene

The urologist Carl Erich Alken described in the middle of the 20th century a three-stage graduation for benign prostatic hyperplasia, which is still in use today. Decisive for the classification is how strong in a benign prostate enlargement symptoms and possible complications are. This is especially important for the choice of therapy.

Stage I of benign prostate enlargement

Stage I benign prostatic hyperplasia is also called the “stimulus stage”. It describes the condition of a BPH in which clinical symptoms are already present (such as attenuated urinary stream, nocturnal urination or pollakisuria), but no residual urine formation still occurs.

Stage II of benign prostate enlargement

In stage II (“residual urine stage”) the symptoms continue to increase and there is already a residual urine amount of 50 to 150 milliliters.

Stage III of benign prostate enlargement

If the residual urine exceeds a volume of 150 milliliters, the state is defined as stage III. In this “backflow stage” it can then lead to an overflow bladder and kidney damage, usually for a residual amount of 500 milliliters must be exceeded.

Benign prostate enlargement: take symptoms seriously

BPH receives a disease value only when the Prostatic hyperplasia symptoms caused. These should be taken seriously by patients and clarified by a doctor.