Slower Urine Flow. As men get older, their prostate slowly grows larger. While the exact cause of this is unknown, it could be due to the build-up of the male hormone dihydrotestosterone, which helps men develop the physical characteristics typical of an adult male. Almost every man will eventually have benign prostatic hyperplasia (BPH), a condition where an enlarged but non-cancerous prostate blocks the flow of urine through the urethra. 

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As a result of BPH, men may: 

• Feel the need to urinate more often both during the day and at night
• Have difficulty starting to urinate, and dribble after they finish
• Find their urine streams becoming smaller and weaker
• Wake up at night to urinate
• Feel as if they’ve not completely emptied their bladder

BPH is extremely common, and only about 10 per cent of men who have it need medical or surgical intervention, either because the symptoms have become too severe or have led to complications such as urine infections or kidney failure. Men who experience these symptoms, however, should still see a doctor as they could be caused by problems other than BPH. 

Calculating your International Prostate Symptom Score

Before men go to see a doctor, they should fill out the online International Prostate Symptom Score (IPSS) questionnaire. Created by the American Urological Association in 1992, it asks men seven questions about their urine over the past month to determine the severity of their urinary problems, and one question about how they feel about the current state of their urine. The questions are: 

• How often have you had a sensation of not emptying your bladder completely after you finish urinating?
• How often have you had to urinate again less than two hours after you finished urinating?
• How often have you found you stopped and started again several times when you urinated?
• How difficult have you found it to postpone urination?
• How often have you had a weak urinary stream?
• How often have you had to push or strain to begin urination?
• How many times did you most typically get up to urinate from the time you went to bed until the time you got up in the morning?

In addition, an eighth question checks the patient’s quality of life due to existing urinary symptoms. 

• If you were to spend the rest of your life with your urinary condition the way it is now, how would you feel about that?

The questions each have a range of answers, with a score assigned to each answer. Doctors may use a patient’s total IPSS to help plan treatment. They may also ask a patient to complete the questionnaire again after the treatment to assess its effectiveness. 

Diagnosing BPH – Benign Prostatic Hyperplasia

To determine the cause of the urinary symptoms, doctors may conduct a digital rectal examination. This involves inserting a gloved and lubricated finger into the patient’s rectum to feel the prostate for hard or lumpy areas that may indicate the need for more tests. 

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They may also carry out a blood test called the prostate-specific antigen (PSA) test. Note that BPH, prostate cancer, and other medical problems such as an inflamed prostate can lead to higher levels of PSA. If the test finds a high level of PSA in a patient’s blood, further tests are done to establish the cause.   

This article has been verified medically by Dr Chong Kian Tai, consultant urologist of Surgi-TEN Specialists at Farrer Park Hospital (Singapore).