The Growing Importance of Identifying BPH Early

This may come as a surprise to you, but did you know that one in two men above 50 years old in Singapore suffer from an enlarged prostate?

The condition is also known as Benign Prostatic Hyperplasia (BPH), and recognising its symptoms has become more and more important than ever as the nation ages.

GlaxoSmithKline’s (GSK) has been continuously working with healthcare professionals to educate Singaporeans about the importance of early screening and treatment of the condition – which was how we got the opportunity to speak to Dr Valerie Gan, Consultant, Dept of Urology, Singapore General Hospital, who explained to us the burden of BPH as well as what is needed to tackle this issue.

Given that the odds of suffering from BPH are practically a coin flip, why is it not better known?

Firstly, it is a sensitive topic and men may not be comfortable with talking about it or too embarrassed about the subject to consult their doctor. This could be the reason why it is not as well known or talked about compared to other diseases.

To add, a handful of men with BPH may have few or no symptoms, and therefore may be unaware about their disease. 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, some will notice their symptoms more than others.

BPH is not something that comes up often in conversations about age-related ailments. Is this a recent phenomenon?

This is not a recent phenomenon; however, it has been increasing in the past decade. 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 will increase rapidly.

Alike the ageing population in Singapore, the incidence of BPH will continue to increase. Its prevalence has increased from 14 % to 16.5 % from 2005 to 2012. A convenient way to remember is that 50% of all men over 50 are affected by BPH, > 60 years will be 60 % and so forth.

What are the social issues and potential physical problems that those affected will go through?

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 have a urinary tract infection which will manifest as blood in the urine and painful urination.

If BPH is left untreated, it may progress and such individuals may present with acute urinary retention i.e. not be able to pass urine at all. He will have a distended bladder and a urinary catheter needs to be inserted into the bladder to relieve the blockage. In some cases, the blockage has been present for a long time but the individual may be unaware (chronic retention) and in these cases, 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.

With regards to social issues, the above problems will cause discomfort and changes in behaviour that can affect their daily routine and quality of life. This includes embarrassment, lowered self-esteem, sleep disturbance and disruption of social life to name a few. To add, BPH can also affect a person’s relationship with his partner through the same behavioural changes as well reduced intimacy.

If it’s not big enough of a scare, people tend to avoid the problem. Is education enough? What do you think needs to be done to change mindsets?

Apart from educational activities, a man’s family also plays a large role in helping them cope with BPH. One of the top reasons why men seek treatment for BPH is to stop their family from worrying as well. It is common for men to stay quiet about their symptoms and tolerate its effects if not encouraged or motivated to seek treatment, as it can be a difficult and embarrassing topic for them. However, a spouse, family member or loved one can help create a comfortable environment for the sufferer by addressing his condition without judgement, encouraging him to seek medical treatment, and being there for him throughout the process.

How would you reassure people regarding taking tests as it is one of those potentially embarrassing things?

In Singapore, 1 in 2 men over 50 years old are affected by BPH, making it a common condition. It is important to constantly reassure and encourage them so that they will come to realise that regular check-ups may potentially reduce their suffering in the long-term. Moreover, if detected at an early stage, BPH is highly manageable with or without the need for medications.

Who should take the test immediately, and how often should they follow up?

A man above 50 years old with lower urinary tract symptoms should speak with their doctor given that they are at risk of BPH. In the early stage, BPH is highly manageable with lifestyle changes, with or without the need for medication.

For those with BPH, it is recommended to take a yearly exam and monitor symptoms, to check if there are changes in treatment required.

Is there anything men can do to as a preventive measure or to mitigate its effects?

There are some lifestyle activities that men can practice to reduce the symptoms of BPH. However, one should seek help from their doctor should they notice early symptoms of BPH.

Here are five lifestyle tips:

• Exercise and meditate regularly to reduce stress – it may cause men to urinate more frequently
• Avoid drinking fluids in the evening – this is especially so for alcoholic and caffeinated drinks. These fluids have a diuretic effect, 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

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