Benign Prostatic Hyperplasia [BPH] Nursing Diagnosis & Interventions

Benign prostatic hyperplasia (BPH) is a prevalent condition among men over 50, with up to 90% of men aged 85 showing signs of it. Approximately 14 million Americans and 30 million people worldwide suffer from its symptoms, which can significantly impact their quality of life.

For those affected by BPH, it is essential to understand the nursing diagnosis associated with this condition to implement appropriate treatment plans.

This article will discuss the common nursing diagnoses for BPH and how nurses can effectively use them to care for patients suffering from this condition.

What is Benign Prostatic Hyperplasia [BPH]?

Benign Prostatic Hyperplasia (BPH) is a condition that affects millions of men as they age. It results in an enlarged prostate, which can cause symptoms such as difficulty with urination, weak urine flow, frequent nighttime urination, and urgency to urinate. BPH can be managed through lifestyle changes or medications, but surgery may sometimes be necessary.

Symptoms

Common symptoms

• Frequent or urgent need to pee, also called urination.
• Peeing more often at night.
• Trouble starting to pee.
• Weak urine stream, or a stream that stops and starts.
• Dribbling at the end of urination.
• Not being able to empty the bladder fully.

Less common symptoms

• Urinary tract infection.
• Not being able to pee.
• Blood in the urine.

What are the complications of BPH?

Complications of BPH include:

• Acute urinary retention.
• Urinary tract infections.
• Urine flow blockage leads to kidney problems and bladder stones.
• Bladder damage from an enlarged prostate

Causes

The cause of BPH is unknown. However, it is believed to be linked with hormonal changes as men age. It can also be caused by an underlying medical condition such as diabetes or prostate cancer.

What Is the Prostate Gland?

The prostate gland is a small but mighty organ in the male reproductive system. Located just below the bladder and in front of the rectum, the prostate gland is similar in size and shape to a walnut. Its primary function is to produce a fluid that makes up a part of semen.

The sperm’s proper functioning depends on prostatic fluid. It contains essential enzymes, proteins, and minerals that help protect and nourish the sperm.

However, as men age, their prostate gland can become enlarged and cause discomfort or even lead to more serious health issues.

Despite its small size, the prostate gland plays a significant role in men’s overall health and well-being. It’s important for men to stay informed about prostate health and to talk to their healthcare provider about any concerns or symptoms they may be experiencing.

Risk factors

Risk factors for an enlarged prostate include:

• Age: The risk of BPH increases with age. Men over 50 are more likely to have an enlarged prostate.
• Family history: If your father or brother has had an enlarged prostate, you may be at higher risk for developing it as well.
• Obesity: Being overweight can increase your risk for developing BPH.
• Diabetes: Diabetics may be more likely to develop an enlarged prostate than non-diabetics.

Treatment

The treatment for an extended prostate gland will depend on how badly the symptoms are affecting your qualify of life.

The main treatments are:

• lifestyle changes
• medicine
• catheters
• surgery and other procedures

Lifestyle changes

Making a few simple lifestyle changes could potentially alleviate your symptoms.

Drink fewer fizzy drinks & less alcohol, caffeine and artificial sweeteners

Drinks that have carbonation, alcohol, caffeine (like tea, coffee, or cola), and artificial sweeteners can cause discomfort in the bladder and worsen symptoms related to urination.

Drinking fewer fluids in the evening

Cut back on your consumption of fluids during the night time and abstain from drinking anything for two hours prior to going to sleep. Be sure to drink enough fluids earlier in the day, however.

Remembering to empty your bladder

Before embarking on long journeys or when you know that a bathroom won’t be easily accessible, make sure to relieve your bladder.

Double Voiding

Double voiding includes waiting a few minutes after you urinate and trying to go once more. This can help you completely empty your bladder; but be careful not to strain or push.

Evaluating Medications

Ensure that medications like antidepressants or decongestants are not worsening urinary symptoms by speaking with your doctor.

Eating more fiber

Consuming more dietary fiber (found in fruits, vegetables, and whole grain cereals) can prevent constipation, which puts pressure on the bladder and heightens enlarged prostate effects.

Utilizing absorbent pads/sheath

The Absorbent pads and pants can be worn inside underwear or as an alternative for it to catch any leakage. Urinary sheaths, which resemble condoms with a tube at the end connected to an attachable bag, can help with dribbling.

Bladder training

Bladder training is a program of exercises meant to help you last longer without needing to urinate and hold more urine in your bladder. The duration for this should be increased gradually by setting goals like waiting 5-15 minutes when feeling the urge to pee; it’s recommended that you make use of a bladder chart (downloadable from Bladder Matters) to track each peeing session and amount of urine passed, plus practice breathing, relaxation, and muscle exercises to take one’s focus off urinating. Speak with your doctor or specialist nurse for further information about any mentioned lifestyle change.

Medicines

There are various medicines available for treating BPH. The most common drugs used to treat this condition are alpha-blockers. These drugs work by relaxing the muscles of the bladder and prostate, making it easier to urinate. Other medications may be prescribed to reduce prostate size or prevent tissue from growing in the prostate, such as finasteride.

Catheters

In some cases, it may be necessary to insert a catheter into the bladder. This tube can help drain urine from the bladder and avoid complications such as acute urinary retention. The type of catheter used will depend on your individual circumstances.

Surgery and other Procedures

If medications and lifestyle changes are not enough or if symptoms are severe, surgery may be necessary. Prostate resection, transurethral resection of the prostate (TURP), and laser therapy are all options for treating BPH. In addition, microwave therapy (MWT) and high-intensity focused ultrasound (HIFU) are also available. Before deciding on a particular procedure, speak to your doctor about the pros and cons of each option.

It is important to remember that an enlarged prostate does not necessarily mean you have cancer, but if you do experience any symptoms, it is important to speak with your doctor immediately. 

Premature diagnosis and treatment can help reduce the risk of complications and long-term damage to the bladder or kidneys. Your healthcare provider can help determine the best course of treatment for you.

Required Test Needed for BPH

A physician or nurse practitioner typically diagnoses benign prostatic hyperplasia based on the patient’s symptoms and ruling out other potential medical causes. Symptoms are key in determining whether BPH is present or not. Specific tests include:

• BPH Symptom Score Index – This questionnaire can help the physician assess your symptoms and identify possible treatments.
• Digital Rectal Exam – A simple examination of the prostate gland using a glove-covered finger inserted into the rectum.
• Urine Flow Test – Measure your urine flow rate while urinating to determine how well your bladder is functioning.
• Prostate Specific Antigen (PSA) Test –  A blood test to check for elevated levels of PSA, which can be an indication for prostate cancer.
• Ultrasound – It uses an imaging technique that uses sound waves to create a picture of the prostate gland and identify any abnormal growth.
• Cystoscopy – Visual examination of the inside of the bladder using a thin tube with a camera at the end.
• CT and MRI –  Advanced imaging techniques that can help the physician look for any abnormalities in the prostate and surrounding organs.
• Urodynamic pressure flow study – A test that measures the pressures inside your bladder and urethra while you urinate.
• Retrograde Urethrogram – A procedure that allows your doctor to see how urine flows from your bladder through the urethra.
• Urethrocystogram – An imaging technique used to look for any blockages or narrowing of the urethra.

Common BPH Nursing Diagnosis

• Acute/Chronic pain related to enlarged prostate or bladder irritation
• Ineffective health maintenance related to a lack of knowledge about treatment options and lifestyle alterations
• Risk for falls related to decreased mobility, weak stream, and urgency to urinate
• Impaired urinary elimination related to enlarged prostate or medication side effects
• Risk for infection and urinary retention related to changes in bladder function

By using these nursing diagnoses BPH, nurses can assess the needs of BPH patients and provide them with individualized care plans. For instance, nurses may educate BPH patients on lifestyle modifications such as avoiding caffeine and alcohol, which can worsen symptoms.

Nurses can also support patients who may be considering surgery and encourage them to discuss the risks and benefits with their healthcare provider. Nurses can also monitor for any side effects from medications or potential complications from BPH, such as bladder infections.

Nursing BPH Interventions 

The following nursing interventions should be performed before and after surgery for a patient with BPH.

• Reduce anxiety. The nurse should inform the patient about pre- and postoperative routines to help ease any anxiety.
• Relieve discomfort. If needed, bed rest and pain medications can be used to manage any discomfort the patient feels.
• Educate Patient. Before surgery, the nurse should explain how the anatomy of the affected organs relates to the urinary and reproductive systems.
• Manage Fluid Balance. It is essential to restore fluid balance to an average level.

Evaluation

• Maintained fluid volume balance postoperatively.
• Absence of complications.
• Reduced anxiety.
• Reduced level of pain.

Discharge and Home Care Guidelines

The patient and the family require instructions about how to promote recovery.

• Instructions. The nurse should instruct the patient on medications, lifestyle changes, and follow-up appointments.
• Urinary control. The patient should be informed that urinary control may take several weeks or months to return and that some incontinence could occur.
• Avoid the Valsalva maneuver. This maneuver should be avoided as it can cause a rise in intra-abdominal pressure and worsen symptoms.
• Avoid bladder discomfort. The patient should be informed about the risk of bladder irritation and how to reduce it.
• Diet modifications. Diet may need to be modified to reduce the risk of bladder irritation, including avoiding caffeine and alcohol.
• Follow-up care. Follow-up appointments should be scheduled to assess the effectiveness of treatment and any potential complications.

Documentation Guidelines

The focus of the documentation in a patient with BPH includes:

• Degree of impairment.
• Client’s description in response to pain.
• Acceptable level of pain.
• Prior medication use.
• Level of anxiety and precipitating/aggravating factors.
• Awareness and ability to identify and express feelings.
• Treatment plan.
• Description of feelings.
• Teaching plan.
• Client’s response to interventions, teaching, and actions performed.
• Attainment and progress toward desired outcomes.
• Modifications to plan of care.
• Referrals made.

References

• https://en.wikipedia.org/wiki/Benign_prostatic_hyperplasia
• \https://my.clevelandclinic.org/health/diseases/9100-benign-prostatic-hyperplasia