BPH is a common condition in men above 50 years old. It can be managed if detected early but, if left untreated, there are long-term consequences on the bladder and kidney.

 

Do you know that one in two men above 50 years old in Singapore suffer from an enlarged prostate? As the nation ages, recognising the symptoms of Benign Prostatic Hyperplasia (BPH) has become more important than ever. This requires a collective effort, not just from men, but also from their family, friends and loved ones.

As part of GSK’s efforts to address this issue locally, the company has been continuously working with healthcare professionals to educate Singaporeans about the importance of early screening and treatment of the condition. Addressing the root cause of this issue will not only reduce the pain associated with these symptoms, but also help to improve the quality of life of men, and their families.

Ageless Online sat down with Associate Professor Henry Ho, head and senior consultant, Department of Urology at Singapore General Hospital, who unveiled insights into the burden of BPH and how we can tackle this issue:

 

Can you share an overview of the burden of BPH in Singapore – what is the prevalence for those over 50 and 60, and for those over 80? Do you feel the numbers are increasing and if so, why?


In 2010, BPH affected 210 million men worldwide, or about six percent of the male population. As the world population ages, the incidence and prevalence of BPH increases rapidly. With the ageing population in Singapore, the incidence of BPH will continue to increase. Its prevalence has increased from 14 percent to 16.5 percent from 2005 to 2012. A convenient way to remember is that 50 percent of all men over 50 are affected by BPH, over 60 years will be 60 percent and so forth.

What are some of its effects from common to worse? 


BPH commonly results in bothersome lower urinary tract symptoms such as difficulty urinating, straining and interrupted urine stream. There can be a sensation of incomplete void after urination which can also manifest as frequent night urination (nocturia). In moderately serious cases, the man may present with urinary tract infection which will manifest as blood in the urine and painful urination.

If BPH is left untreated, the bladder will be weakened to the extent that a man will not be able to pass urine at all. He will present with distended bladder and an urinary catheter needs to be inserted into the bladder to relieve the blockage. If the condition is further allowed to worsen, the kidneys will be damaged and dialysis may be needed. Occasionally, bladder stones are also encountered in these long-term obstructions and surgery is necessary in these late cases.

What is BPH? I understand sometimes there are no symptoms, can you explain?

BPH is a non-cancerous condition in which the prostate gland is enlarged. The prostate is a small gland about the size of a walnut, which produces fluid that forms a part of the semen and surrounds the urethra just below the bladder. The urethra is the duct that carries urine from the bladder out of the body. When the prostate enlarges, it compresses the urethra which can result in symptoms that irritate or obstruct the bladder.

Puzzlingly, some men with BPH may have few or no symptoms. As a chronic disease, the narrowing of the urinary passage by the enlarging prostate is a very gradual process. Depending on the tolerance of the individual men, some will notice their symptoms more than others. For the latter group, they may ignore the symptoms or even assume that it is part of ageing and not seek for medical help. Thus, the bladder is allowed to be damaged and eventually the kidneys without his knowledge.

 

An enlarged prostate could also mean other causes like urinary tract infections (mentioned earlier), prostate cancer, diabetes, heart failure and neurological diseases, is this correct? Can BPH be prevented?


When a man presents with lower urinary tract symptoms as mentioned earlier, it can be due to several causes and BPH is most common amongst those above 50 years old. Your family doctor or urologist will be the best person to determine the main diagnosis. Several of them may co-exist in the same patient.

Currently, there are no known methods to prevent BPH. However, there are treatment options that can reduce bothersome symptoms of BPH as well as its progression. Men with risk factors for BPH, which includes those who lack physical exercise, with family history or medical conditions such as obesity, heart and circulatory disease, and Type 2 diabetes, should talk to their doctor upon experiencing symptoms of BPH.

 

Besides age, what are the other risk factors? 


The risk of BPH can be influenced by several other factors such as having a family history of BPH, medical conditions such as obesity, heart and circulatory disease, Type 2 diabetes and a lack of physical exercise.

 

If one goes to see the doctor, what types of tests are given? 


At the family doctor’s clinic, he or she will take a history and examine the prostate. There are various tests available to diagnose BPH, from a simple questionnaire to a basic urine or blood test. Further testing may be required, but only if a medical professional deems it necessary.

Some non-invasive methods to test for BPH include:

• IPSS (International Prostate Symptom Score) – An eight-item questionnaire, consisting of symptom and quality of life questions that are used as an initial screening tool to diagnose BPH.
• PSA (Prostate-Specific Antigen) test – A simple blood test used to exclude prostate cancer as the cause of his symptoms.
• Urine dipstick – This is a simple test to exclude urinary tract infection.

At the urologist’s clinic, further tests such as an ultrasound of the prostate and uroflowmetry are done. The ultrasound will be able to measure the prostate size and shape which will determine the severity of the condition. The uroflowmetry is likened to a “urination speed test”. In this test, the patient will urinate into the funnel to determine how fast his urine can flow objectively.

 

Can you share the treatments currently available and are there any new advancements in medicine?


Depending on the severity of the condition, there is a wide range of treatment options. For those with mild symptoms, lifestyle modifications such as night-time fluid intake reduction and minimise or avoid caffeine and alcohol can help.

Those men with moderate symptoms from their bladder obstruction may need medications. The two main groups of medication are those that relax the bladder door to permit easier urinary flow and those that reduce prostate size. The former is quick but short-lived in its action. In severe cases, a combination of both groups of medication is needed. In the late stage of BPH, when men present with retention of urine, stone or kidney failure, surgery is the main option. This is usually known as TURP (transurethral resection of prostate). This can be performed by both electrical or laser cutting.

 

Lifestyle changes are also another way of reducing the symptoms of BPH. Can you share five tips?

• Exercise and meditate regularly to reduce stress – it may cause men to urinate more frequently.
• Take your time in the bathroom – whenever you go to the bathroom, take as much time as you need to empty out your bladder completely, reducing the need for multiple trips to the bathroom.
• Avoid drinking fluids in the evening – this is especially so for alcoholic and caffeinated drinks. These fluids can affect the muscle tone in the bladder, leading to more frequent urination at night.
• Spread out drinking fluids throughout the day, rather than drinking all at once.
• Urinate when you first get the urge, to reduce the difficulty in urinating.

 

What is your recommendation for men over 50? Go for a yearly prostate exam? 


A man over 50 years old with lower urinary tract symptoms should seek medical attention to exclude BPH. In the early stage, non-surgical option is the main approach to prevent further damage to the bladder and kidneys.

If you have BPH, you should take a yearly exam to monitor symptoms, and check if you require any changes in treatment.

Anything to add?

BPH is a common condition in men above 50 years old. Detected at an early stage, it is highly manageable with or without the need for medications. However, if left untreated, the long-term consequence on the bladder and kidney can be life-long. Therefore, do not be embarrassed to speak to your doctor about it and start taking care of your prostate health.

 

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