Benign Prostatic Hyperplasia Diagnosis

The International Prostate Symptom Score questionnaire, also called the American Urological Association Symptom Index, is used to assess the severity of lower urinary tract symptoms. It can also help with treatment decisions.

But the questionnaire alone cannot be used for diagnosis for two main reasons. First, other diseases can cause lower urinary tract symptoms similar to those of BPH. Second, as men (and women) age, the bladder naturally becomes less efficient at storing urine, and symptoms of urinary frequency and urgency become more common.

In fact, the prevalence of lower urinary tract symptoms is similar in males and females. Therefore, a careful medical history, physical examination, and laboratory tests are required to exclude conditions such as narrowing of the urethra (urethral stricture) and bladder disease.

Some reports indicate that as many as 30 percent of men who undergo surgery for BPH are found not to have urethral obstruction (meaning their symptoms were caused by something other than BPH).

Medical History and BPH Diagnosis

A medical history helps doctors identify conditions that can mimic BPH, such as

  • urethral stricture
  • bladder cancer
  • bladder stones
  • bladder infection
  • problems with holding or emptying urine due to a neurological disorder (neurogenic bladder)

Another condition that can be confused with BPH is overactive bladder.

Strictures can result from urethral damage caused by trauma, catheter insertion, or an infection such as gonorrhea. A history of blood in the urine suggests bladder cancer, whereas pain in the penis or bladder area may indicate bladder stones or infection.

Neurogenic bladder is a possible diagnosis if a man has diabetes or a neurological disease, such as multiple sclerosis or Parkinson's disease, or if he has experienced a recent deterioration in sexual function.

A thorough medical history includes questions about previous urinary tract infections and prostatitis. The doctor will also ask about the use of over-the-counter and prescription medications (particularly cold or sinus medications), nutritional supplements, and herbal remedies, some of which can either worsen or improve symptoms of BPH.

Physical Examination and BPH Diagnosis

To detect any urinary irregularities, the physical examination may begin with the doctor observing the patient urinating. The lower abdomen is checked for the presence of a mass, which could indicate an enlarged bladder due to retained urine.

A digital rectal exam (DRE) is performed to assess the size, shape, and consistency of the prostate. This examination, which involves the insertion of a gloved, lubricated finger into the rectum, is mildly uncomfortable but extremely important. Detection of hard or firm areas in the prostate raises the suspicion of prostate cancer.

If an individual's medical history suggests neurological disease, the physician may look for abnormalities such as a loss of sensation or weakness in the lower body, which may indicate that the urinary symptoms are due to a neurogenic bladder.

Publication Review By: H. Ballentine Carter, M.D.

Published: 07 Apr 2011

Last Modified: 31 Aug 2015