About His Condition

What is BPH?

BPH stands for benign prostatic hyperplasia. It's an overgrowth of the cells in the prostate gland, which then becomes enlarged. Benign means that it's not malignant (i.e. it's not cancer) and it won't spread to other parts of your body.

The prostate gland (or, simply, prostate) is a walnut-shaped organ found just underneath the bladder in men. It’s normally about 4cm wide and 3cm thick (approximately 1.5” by 1”).³

The prostate produces a milky fluid which, together with sperm and other secretions, makes up semen. Women don’t have a prostate.

The urethra is the tube that carries urine from the bladder out through the penis and runs through the middle of the prostate. As the prostate gets bigger, it starts to obstruct the urethra. This is what causes the symptoms of BPH.

How common is it?

BPH is very common. Young men aren’t often affected but, overall, one in four (25%) men over the age of 40 can expect to suffer from it as they get older.¹

What are the symptoms of BPH and what causes them?

The symptoms of BPH are called 'lower urinary tract symptoms' (LUTS) because they affect the lower urinary tract (the bladder and urethra).

Symptoms of BPH occur because the prostate presses on the urethra (the tube that carries urine), causing it to narrow. This means that urine can't pass down it as easily as before - it's obstructed. This is why some symptoms are called 'obstructive symptoms'. The following are typical obstructive symptoms:⁴

• Poor stream - The flow of urine is weaker, and it takes longer to empty your bladder
• Hesitancy - You may have to wait at the toilet for a while before urine starts to flow
• Dribbling - Towards the end of passing urine, the flow becomes a slow dribble
• Poor emptying - You may have a feeling of not quite emptying your bladder

Obstructive symptoms cause the bladder to work to push the pee out. After a while, the muscle of the bladder wall starts to thicken because of the extra work it's been doing. This means it becomes less stretchy, so the bladder can't hold as much pee. That's why your partner has to go more often, including at night, and why he often can't hold on when he need to go. These are called 'irritative symptoms'.

The following are typical irritative symptoms:⁴

• Frequency (passing urine more often than normal). This can be most irritating if it happens at night. Getting up several times a night is a common symptom and is called 'nocturia'.
• Urgency. This means you have to get to the toilet quickly when you 'need to go'.

It's often these symptoms that are most bothersome and cause the most disruption to his daily life.

What impact can BPH have?

Many men find that BPH really affects their enjoyment of life, not to mention yours. For example, you might feel tired all the time because he’s up so many times you can’t get a decent night’s sleep. You might feel anxious and embarrassed at social gatherings because he keeps having to disappear to the loo. Maybe he always has to think about what he's drinking and when – one more drink before the journey home might mean he can’t make it back without stopping for a pee.

Outings and car journeys can be frustrating if you have to stop at every public convenience just to make sure he won’t be caught short. It’s understandable that you might get annoyed with his toilet habits, and you’re not alone.

These behaviour adaptations are very common in men with BPH. In a website survey with BPH sufferers, nine out of ten men say their condition has forced them to make significant adjustments to their lifestyle. In addition, 59% avoid drinking before bedtime, 41% plan their day around the availability of a toilet and 31% avoid travelling long distances.⁵

Sex and BPH

It’s not inevitable, but some men with BPH also have problems with sex (called sexual dysfunction or erectile dysfunction). Because the prostate plays a role in sexual function, prostate problems and LUTS, may cause him to have difficulties. The worse his urinary symptoms are, the poorer his erection quality can be.⁶ This is a sensitive subject, but it’s worth trying to talk to your partner about sex because it affects you both.

Doctors don’t know why these problems occur. It may just be that the likelihood of having both sexual dysfunction and BPH increases with age. Or it could simply be because he’s so tired from having to get up several times at night to pee. All sorts of things can cause erectile problems, some of which (eg. heart disease and diabetes) increase with age. Other possible causes include:⁷

• Alcohol, smoking and illegal drugs
• Some medicines, including anti-depressants and drugs for high blood pressure (such as ACE inhibitors and beta-blockers)
• Conditions affecting nerves or blood supply, including multiple sclerosis or a stroke
• Hormonal conditions
• Conditions affecting the erectile tissue in the penis, such as major surgery in the abdomen, particularly prostate operations
• Long-term conditions such as diabetes

It's really important that you encourage your partner to seek advice from a healthcare professional if he experiences any serious or ongoing symptoms, such as problems with his peeing habits. Your partner's health and the health of your relationship may benefit from treatment, as well as any identifying any underlying cause.