Benign Prostatic Hyperplasia: Symptoms, Diagnosis, and Management

Q: Benign Prostatic Hyperplasia: Symptoms, Diagnosis, and Management

Hello： <br>2. <br>When urinating, if the flow is strong or if I exert a little effort, I experience a brief pain and a sensation of obstruction. <br>Is it okay to exert some effort while urinating? — Generally, for middle-aged and older individuals, a strong urge to urinate may r

Benign Prostatic Hyperplasia (BPH)

1.
In the past six months, there have been two instances where I experienced a sudden discharge of a large amount of blood from the penis while sitting on a chair watching TV or using the computer.
I went to a major hospital for a consultation and underwent urinalysis, blood tests, and X-ray examinations.
The doctor who examined me initially diagnosed me with benign prostatic hyperplasia (BPH).

2.
When urinating, if the flow is strong or I exert a little force, I experience a brief pain and a sensation of blockage.
Is it advisable to exert some force while urinating? If there is a feeling of a foreign object in the penile urethra, should I forcefully try to expel it?
3.
I would like to ask Director Li about the correct way to drink water.
What is the appropriate amount of water to consume? Is it acceptable to drink water before bedtime? I would greatly appreciate your insights on these matters.
Thank you!

Jack, 70~79 year old female. Ask Date: 2024/01/25

Dr. Li Minghui reply Urology

Hello:
2.
When urinating, if the flow is strong or if I exert a little effort, I experience a brief pain and a sensation of obstruction.
Is it okay to exert some effort while urinating? — Generally, for middle-aged and older individuals, a strong urge to urinate may require some effort due to obstruction caused by the prostate.
Medication can help improve this condition.
Additionally, men with heart disease who are on anticoagulants may be prone to hematuria.
If there is a sensation of a foreign body in the penile urethra, should I exert effort to expel it? — It is permissible, but if the sensation of a foreign body is frequent, a medical evaluation may be necessary.
3.
I would like to ask the doctor about the correct way to drink water.
What is the recommended amount? Is it okay to drink water before bed? — I personally recommend starting fluid intake after urinating in the morning.
Generally, the urine color should be a light yellow (typically over 1500 mL).
However, if there is edema, fluid intake should be limited, and a clinic visit is advised.
After dinner, it is advisable to drink less, and only drink when thirsty to avoid frequent nighttime urination, which can affect quality of life.
Wishing you good health.

Reply Date: 2024/01/25

More Info

Benign Prostatic Hyperplasia (BPH) is a common condition in older men, characterized by the enlargement of the prostate gland, which can lead to various urinary symptoms. Understanding the symptoms, diagnosis, and management of BPH is crucial for effective treatment and maintaining quality of life.

Symptoms of BPH
The symptoms of BPH can vary in severity and may include:
1. Frequent Urination: Increased urgency to urinate, especially at night (nocturia).

2. Weak Urine Stream: A decrease in the force of the urine stream.

3. Difficulty Starting Urination: Hesitancy or difficulty in initiating urination.

4. Incomplete Bladder Emptying: A sensation of not fully emptying the bladder after urination.

5. Painful Urination: Discomfort or pain during urination, which can occur if there is irritation or infection.

In your case, the sudden occurrence of blood in the urine (hematuria) and the pain during urination are concerning symptoms that warrant further investigation. Hematuria can be caused by various factors, including urinary tract infections, prostate issues, or even more serious conditions like bladder or kidney stones.

Diagnosis of BPH
Diagnosis typically involves:
1. Medical History and Physical Examination: A thorough history of symptoms and a physical examination, including a digital rectal exam (DRE) to assess the prostate size and texture.

2. Urinalysis: To check for signs of infection, blood, or other abnormalities.

3. Blood Tests: Including PSA (Prostate-Specific Antigen) levels to rule out prostate cancer.

4. Imaging Studies: Such as ultrasound or X-rays, to visualize the urinary tract and prostate.

Management of BPH
Management strategies for BPH depend on the severity of symptoms and their impact on quality of life. Options include:
1. Lifestyle Modifications:
- Fluid Management: Drinking adequate fluids throughout the day but reducing intake before bedtime can help manage nocturia. Aim for about 2 liters of water daily, but adjust based on individual needs and activity levels.

- Dietary Changes: A diet rich in fruits, vegetables, and healthy fats can support prostate health.

2. Medications:
- Alpha Blockers: These medications help relax the muscles around the prostate and bladder neck, improving urine flow.

- 5-Alpha-Reductase Inhibitors: These can reduce the size of the prostate over time.

3. Surgical Options: If symptoms are severe and do not respond to medication, surgical interventions such as Transurethral Resection of the Prostate (TURP) or laser therapy may be considered.

Addressing Your Concerns
1. Pain During Urination: It is generally not advisable to force urination, as this can lead to further irritation or injury. If you feel an obstruction or discomfort, it is best to consult a healthcare provider rather than attempting to forcefully expel anything.

2. Drinking Water: The correct approach to hydration involves drinking water consistently throughout the day. Avoid excessive fluid intake before bedtime to minimize nighttime urination. If you experience significant thirst or dehydration, consult your doctor for tailored advice.

3. Follow-Up: Given your symptoms, especially the presence of blood in your urine, it is essential to follow up with your healthcare provider. They may recommend further tests or imaging studies to rule out other potential causes of your symptoms.

In conclusion, BPH is a manageable condition, but it is essential to address symptoms promptly and consult with a healthcare professional for personalized advice and treatment options. Regular follow-ups and monitoring are crucial to ensure that any changes in symptoms are appropriately managed.

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