Benign prostatic hyperplasia or hypertrophy (BPH) is a gradual enlargement of the prostate gland (hyperplasia) with an increase in the size of the cells (hypertrophy). The breakdown of the balance between cellular proliferation and cell death results in excess prostate cells, causing BPH.
As men age, the prostate grows. The urethra runs through the prostate gland, so it becomes partially or completely blocked due to enlargement pressure, which results in difficulty urinating. It may also lead to kidney or bladder complications.
Factors that increase the risk of BPH include older age (with 50% of men over 80 experiencing BPH symptoms), metabolic syndromes (glucose intolerance, insulin resistance, and dyslipidemia), obesity, hypertension, and genetic factors (first-degree family history).
Prostate gland enlargement causes symptoms that tend to worsen over time, such as:
Early symptoms
- Decreased size and force of the urinary stream
- Increased urgency and frequency of urination
- Increased urination at night (nocturia)
- Inability to start (hesitancy) or continue urination
- An unsatisfied feeling of bladder emptying
Late symptoms
- Dribbling towards the end of urination
- Urinary retention
- Bladder distention
- Blood in the urine (hematuria)
- Urinary stasis
- Urinary tract infections
- Painful urination (dysuria)
Medical history and a physical exam are needed to diagnose BPH. Digital rectal examination by the healthcare provider can assess the size of the prostate.
In addition to physical examinations, the following tests are recommended for BPH:
Blood tests
- Renal function tests to monitor for any kidney problems
- Prostate-specific antigen (PSA) tests
Urine tests
- Urine dipstick checks for a possible cause, such as infection, microscopic hematuria, or glucose
- Post-void residual volume determines how much urine remains in the bladder after urinating
- Frequency-volume chart tallies the fluid intake and urine output
- Urinary flow studies measure the urine volume passed over time
Other tests
- IPSS (international prostate symptom score) to gauge the intensity of the symptoms
- Transrectal ultrasound measures and assesses the prostate with an ultrasound probe placed into the rectum
- Prostate biopsy utilizes transrectal ultrasonography to identify or rule out prostate cancer by examining the sample tissue
- Cystoscopy views the bladder and urethra with a flexible scope device in the urethra
Treatments for BPH include medication, minimally invasive procedures, and surgery depending on prostate size, the patient’s age, health status, and the intensity of symptoms.
Nursing Process
Before choosing a course of treatment, patients with BPH should be aware of the risks associated with BPH surgery. Dietary recommendations, weight loss, and glycemic management are additional ways to address adherence to lifestyle variables that impact BPH.
For patients who need catheterization (intermittent or long-term) due to urinary symptoms, teach the patient proper catheter care through appropriate training, support, and follow-up demonstration.
Nursing Care Plans Related to Benign Prostatic Hyperplasia (BPH)
Urinary Retention
Urinary retention and associated symptoms are expected findings with benign prostatic hyperplasia (BPH).
Nursing Diagnosis: Urinary Retention
Related to:
- Enlargement of the prostate
- Blockage of urine flow
- The inability of the bladder muscles to contract adequately
As evidenced by:
- Urinary frequency
- Urinary hesitancy
- Failure to empty the bladder
- Dribbling urine
- Overflow incontinence
- Sensation of bladder fullness
- Dysuria
- Bladder distention
- Residual urine
Expected outcomes:
- Patient will not experience a post-void residual greater than 50 mL.
- Patient will verbalize a reduction in hesitancy, dribbling, and bladder fullness.
Assessment:
1. Assess urine elimination patterns.
Changes in urination in BPH include increased urges and frequency (both during the day and at night), a weak urine stream, and urine leakage or dribbling.
2. Palpate the patient’s bladder.
Bladder distention is caused by increased pressure. It can lead to diverticula, trabeculation, and hypertrophy of the bladder detrusor. Urine output is gradually hindered when the prostatic urethra’s lumen extends and constricts.
3. Observe urine characteristics.
Due to urinary retention, urine may have a dark color and a foul scent. Patients may also have blood in the urine. These symptoms could signal an underlying infection.
4. Identify additional signs and symptoms.
Additional signs and symptoms include hypertension, edema, changes in mentation, bloody urine or semen, painful ejaculation, and frequent lower back, hip, pelvis, or thigh pain.
Interventions:
1. Assess post-void residual (PVR) volume.
After the patient has urinated, assess the amount of urine left in the bladder using a bladder scanner. A PVR of less than 50 mL is considered normal, while greater than 200 mL is inadequate emptying.
2. Provide catheterization.
Catheterization prevents urinary retention and eliminates the possibility of ureteral stricture in patients with BPH. An enlarged prostate can make inserting a catheter difficult. If the nurse is unable to complete the task, a urologist can be consulted to insert a catheter using a guidewire.
3. Relax the muscles.
Provide alpha-adrenergic antagonists as ordered to ease the muscle tissue in the prostate gland and arteries, enhancing blood and urine flow.
4. Administer antibiotics.
Administer antibiotics as prescribed if an infection is present due to the growth of bacteria from urinary stasis.
5. Refer to a urologist.
Because urinary retention interferes with the natural flow of urine, urinary retention is regarded as an urgent medical issue. Urologists are specialists who care for patients with urinary retention and BPH.
Acute Pain
A distended bladder, renal colic, urinary tract infection, and procedures can cause acute pain associated with benign prostatic hyperplasia (BPH).
Nursing Diagnosis: Acute Pain
Related to:
- Distended bladder
- Renal colic
- Urinary tract infection
- Catheter insertion
- Surgical procedures
As evidenced by:
- Complaints of bladder or rectal spasm
- Facial grimacing
- Distraction behaviors
- Restlessness
- Altered vital signs
- Diaphoresis
Expected outcomes:
- Patient will verbalize relief from bladder or urinary tract pain.
- Patient will demonstrate interventions to ease discomfort.
Assessment:
1. Perform a pain assessment.
Poor pain management can result from inadequate assessment of acute and chronic pain. The key to effective pain management begins with an accurate pain assessment.
2. Identify triggering factors.
Assess for factors that trigger or worsen pain, such as movement, urination, or ejaculation.
3. Review urinalysis results.
A urinalysis should be performed to assess for an infection contributing to pain, causing burning with urination, flank or bladder pain.
Interventions:
1. Encourage sitz baths and warm soaks.
Soothe perineal discomfort with a warm sitz bath for 20 minutes several times per day to relax the prostate and surrounding muscles.
2. Secure the catheter.
Securing the urinary catheter correctly to the client’s thigh prevents pain from an injury in the penile-scrotal junction and pulling on the bladder when turning or ambulating.
3. Relieve bladder spasms.
Administer antispasmodics as prescribed to minimize bladder spasms brought on by catheter sensitivity.
4. Promote prostate massage.
Prostate massage can relieve excess fluids that build up in the prostate and reduce the inflammation and pressure causing the pain. The patient can be instructed on how to do this themselves.
5. Relieve pain with medications.
Narcotics may be given following surgical procedures to relieve acute pain.
Disturbed Sleep Pattern
Disturbed sleep patterns associated with benign prostatic hyperplasia (BPH) can be caused by increased urination at night (nocturia).
Nursing Diagnosis: Disturbed Sleep Pattern
Related to:
- Nocturia
- Pain caused by BPH
- Increased urgency to urinate
- Increased frequency of urination
As evidenced by:
- Insomnia
- Irregular sleeping pattern
- Inadequate sleep quality
- Bladder pain
- Bladder irritability
- Frequent urination
- Restlessness
Expected outcomes:
- Patient will be able to verbalize restful sleep.
- Patient will demonstrate a calm and well-rested appearance.
- Patient will receive at least 8 hours of sleep nightly.
Assessment:
1. Ask the patient to document nocturia.
Have the patient document how often they awake at night to urinate. Patients can identify sleep disturbances and other elements that may affect the quality of their sleep for the provider to review.
2. Identify sleep habits.
Assessing practices/habits that may interfere with sleep can reveal patterns that aid in explaining sleeping issues.
3. Review medications.
Diuretics should not be taken close to bedtime if it can be avoided.
Interventions:
1. Encourage limiting fluid intake before bed.
Limit fluid intake 2-4 hours before bedtime, as advised. Instruct the patient to drink plenty of fluids during the day (particularly water) to prevent dehydration. Emphasize limiting their intake of alcohol and caffeine (soda, tea, and coffee), which causes diuresis.
2. Administer desmopressin as prescribed.
Desmopressin, a synthetic form of vasopressin, is used to replenish decreased levels of the hormone. It manages excessive thirst and prevents dehydration, and urine production, especially at night, limiting nocturia.
3. Shrink the prostate.
5-alpha reductase inhibitors like finasteride shrink the prostate and prevent hormonal changes that cause prostate growth which can reduce symptoms of BPH.
4. Provide compression stockings.
During the day, keep the legs elevated or apply a pair of compression stockings to promote fluid circulation to lessen the need to urinate at night.
References
- Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nurse’s pocket guide: Diagnoses, interventions, and rationales (15th ed.). F A Davis Company.
- Mayo Clinic. (2021, April 13). Benign prostatic hyperplasia (BPH) – Diagnosis and treatment – Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/diagnosis-treatment/drc-20370093
- NallN, R. (n.d.). Everything you need to know about nighttime urination. Healthline. Retrieved January 2023, from https://www.healthline.com/health/sleep/excessive-urination-at-night#treatment
- National Center for Biotechnology Information. (2022, May 8). Benign prostatic hyperplasia – StatPearls – NCBI bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK558920/
- Silvestri, L. A., & Silvestri, A. E. (2022). Saunders comprehensive review for the NCLEX-RN examination (9th ed.). Elsevier Inc.
- WebMD. (2016, November 10). What is BPH? https://www.webmd.com/men/prostate-enlargement-bph/what-is-bph
