Benign prostatic hyperplasia (BPH) is a noncancerous enlargement of the male prostate, the walnut-shaped gland surrounding the urethra at the neck of the bladder. It’s the most common prostate problem for men over age 50, and its occurrence and symptoms increase with age. BPH affects about 50 percent of men between the ages of 51 and 60 and up to 90 percent of men over 80. According to the National Kidney and Urologic Diseases Information Clearinghouse(NKUDIC), 14 million men in the United States had lower urinary tract symptoms (LUTS) suggestive of BPH in 2010.
Now, a new study of men with LUTS and enlarged prostate associates diabetes with more severe urological symptoms. Subjects with Type 2 diabetes had greater urinary frequency and nocturia (frequent awakenings during periods of sleep to urinate) than their nondiabetic counterparts.
Exploring the Diabetic Link
Kang Su Cho of Yonsei University College of Medicine in Seoul, South Korea, led the team that analyzed information on 278 elderly men who had received new LUTS diagnoses over a two-year period. Some 139 also had pre-existing Type 2 diabetes diagnoses. The researchers matched subjects with and without diabetes for age and prostate volume, using propensity scoring. Their mean age was 65.3 years, the mean prostate volume was 35.1 milliliters, and mean totals on the International Prostate Symptom Score (IPSS) and Overactive Bladder Symptom Score (OABSS) were 16.83 and 5.07, respectively.
The authors reported finding no differences in age, prostate volume, transitional zone volume, prostate-specific antigen level, voided volume, or maximum flow rate between the diabetes and control groups. But the residual urine volume was significantly higher in the diabetes group than in controls at 29.34 versus 22.45 milliliters. The total IPSS score was considerably greater in diabetes patients than controls (17.80 versus 15.88). Elevated IPSS storage symptom scores (7.45 versus 6.58) and postmicturition (normal urine discharge) symptom scores (2.57 versus 2.19) in diabetics accounted for this difference.
Among storage symptoms, the diabetes group scored substantially higher for frequency and nocturia while urgency was the same for both groups. The OABSS total score was markedly greater in diabetes patients than controls (5.62 versus 4.54). This difference resulted from a higher nocturia score in diabetics (2.14 versus 1.71). Other subscales were equal between the groups.
These scientists noted that diabetes is a well-known risk factor for LUTS, but studies have reported conflicting results on whether diabetes can cause overactive bladder. Noting that their findings imply that increased frequency and nocturia in the diabetes group may be due to polyuria (excessive urine amounts) rather than reduced bladder capacity, the authors conclude, “Urodynamic results would be useful to obtain in future studies to provide objective evidence to support and understand our current observations.”
Understanding Benign Prostatic Hyperplasia
Your prostate goes through two main growth periods as you age. In early puberty, this gland doubles in size. The second growth phase begins around age 25 and continues during most of your life. Enlarged prostate occurs in the final growth stage often. As this gland grows, it presses against and pinches your urethra. Your bladder wall becomes thicker. Eventually, your bladder may weaken and lose the ability to empty completely, retaining some urine. Narrowing of your urethra and urinary retention, the inability to empty your bladder completely, cause many BPH problems.
Discovering Possible BPH Causes
Throughout your life, you produce the male testosterone hormone and small amounts of the female estrogen hormone. As you age, the active testosterone quantity in your blood decreases, leaving a higher proportion of estrogen. Scientific studies show that the higher proportion of estrogen in the prostate increases the activity of substances that promote prostate cell growth.
Some research indicates that even with a drop in blood testosterone levels, older men continue producing and accumulating high levels of dihydrotestosterone (DHT) in their prostates. The accumulation of this male hormone that plays a role in prostate development and growth may encourage cells to continue growing. Scientists note that men who don’t produce DHT also don’t develop benign prostatic hyperplasia.
According to the NKUDIC, lower urinary tract symptoms suggestive of enlarged prostate may include:
Frequency: urinating eight or more times a day
Urgency: the inability to delay urination
Trouble starting urine streams
Weak or interrupted urine stream
Dribbling at the end of urination
Retaining urine in your bladder
Urinary incontinence: the accidental loss of urine
Pain after ejaculation or during urination
Urine that has an unusual color or smell
Most often, BPH symptoms come from:
Overworked bladder from trying to pass urine through the blockage
Seeking Medical Care and Treatment
Visit your doctor to diagnose the cause of your symptoms. If it’s benign prostatic hyperplasia, he may prescribe Flomax (Tamsulosin). This alpha-blocker relaxes muscles in your prostate and bladder to help improve urine flow. BPH symptoms also can signal more serious conditions including prostate cancer, so don’t delay. You also need treatment if a urinary tract infection (UTI) or prostatitis (inflammation of your prostate) causes urinary symptoms unrelated to enlarged prostate.
See your doctor immediately if you experience:
Complete inability to urinate
Painful, frequent, and urgent need to urinate with fever and chills
Blood in your urine
Great discomfort or pain in your lower abdomen and urinary tract