What Does BPH Feel Like?

(This information is from Dr. Patrick Walsh's Guide to Surviving Prostate Cancer)

How does what's happening on the inside translate to the outside—into symptoms and their impact on a man's life? It varies: BPH is a different disease in every man, depending on a delicate interplay of factors, including the shape of the growth, the specific tissue involved, and how these variables affect the bladder. As the cell growth progresses, the tissue becomes lumpy. Bulbous nodules begin sprouting like mushrooms, forming characteristic clusters, or lobes. These lobes tend to arrange themselves in one of three basic configurations. Lateral lobe enlargement features big knobs that sandwich the urethra. When a man urinates, these lobes can swing open and shut like double doors (think of a saloon in a cowboy movie), so despite their size, they may not produce much urinary obstruction. In middle lobe enlargement, the lobe bobs around the bladder neck, plugging it like a cork in a bottle and causing a man great difficulty with urination. (Because this form of BPH is much harder to ignore than lateral lobe enlargement, men who have it are far more likely to seek medical relief for their symptoms.) And in trilobar enlargement, the obstruction can happen in the bladder neck as well as in the urethra.

As the prostate squeezes the urethra, it impedes urine flow. This may manifest itself as frequent urination, needing to go to the bathroom several times an hour; hesitancy, or having to wait for the urinary stream to start; urgency, or the sudden sensation of needing to urinate, which may culminate in involuntary urine leakage before you reach the bathroom; repeatedly awakening in the night to urinate; starting and stopping during urination; and a constant feeling of fullness in the bladder. BPH can also lead to urinary tract infections and, rarely, can cause damage to the bladder or kidneys. It is often frustrating, annoying, and disruptive.

Think of a man's necktie slowly starting to tighten around his collar. This is what happens, over time, as the prostate's inward growth toward the urethra takes its toll. At first or in mild cases, this can mean an irritating but still tolerable change in quality of life. However, when it progresses beyond the nuisance point—when the bladder is never completely empty, or when the kidney or bladder become damaged—it needs to be treated.

At first, BPH is invisible. It causes few symptoms, because the powerful bladder muscle compensates for the narrowed urethra by making more vigorous contractions and forcing urine through the prostate. But over time, this extra effort takes its toll on the bladder, making it less efficient. This is when a man may notice a decreased flow rate and obstructive symptoms. The bladder, after months of heavy duty, also becomes a victim of its own powerful muscles: The muscle-bound bladder wall thickens and loses its elasticity. With all that extra muscle, the bladder can't hold as much as it used to; it becomes unstable and overly reactive. When this happens, a man feels the need to urinate more often—unfortunately, sometimes spontaneously. These are irritative symptoms: urge incontinence (when a man knows he has to urinate but can't make it to the bathroom in time) and nocturia (the need to urinate often during the night). Nocturia can also happen (or be made worse) if a man is unable to empty his bladder completely. If the bladder is always partly full with leftover urine, it doesn't take much—half a glass of water, even—to fill it all the way. Some of our patients joke that they've spent the first half of their lives making money, and they're spending the second half making water. Imagine how disruptive and frustrating it is for a man to have to go to the bathroom twice as often as he normally would.