BPE, we call it. This three-letter acronym stands for a common malady among intact male dogs: benign prostatic enlargement (hyperplasia). This week alone I’ve seen three cases in varying stages of severity.

The first was in a beagle mix—and his prostate was causing him no serious hardship—yet. His owner had seen the occasional spot of blood on her hardwood floors but his urination seemed normal still.

Let me explain: The prostate is an organ that helps males produce fluid that aids in the production of semen. Necessary for effective reproduction, it loses its potency after neutering. So all affected dogs are intact males. These dogs’ prostates get big and inflamed for reasons we don’t completely understand. Neutering is the surefire cure but antibiotics can often silence the symptoms for a while.

BPE is very common and is most often the reason we neuter older dogs. Usually they pee in irregular streams and drip the occasional drop of bright-red blood. Some dogs never show any symptoms—so a responsible vet will typically perform a rectal exam on any intact male at their yearly visit to make sure things are A-OK. (Gross as that sounds, it’s much less disgusting than a productive anal gland squeeze.)

The second case was a Lab mix. His prostate didn’t seem large on my rectal exam but an X-ray proved otherwise. After a course of antibiotics, he was no better. His owner was loath to neuter him but a description of the disaster case I’d seen earlier in the week thoroughly convinced him of its advisability. Here’s the story:

Jack is an A-class hunting dog. He needs his testosterone (per his owner). I wouldn’t have disagreed but for his horrorshow presentation. Although Jack’s prostate never seemed bigger than a plum on palpation, it had morphed to a large grapefruit by the time I saw him this week. Worse still, the sudden onset of his symptoms (straining forcefully to defecate past a protruding prostate) endowed him with a hernia—right next to his anus.

Perineal hernias are invariably surgical—and they’re typical of intact males (testosterone tends to make their backside muscles thin). Most dogs in this predicament are horribly constipated by the time I see them (they can’t get any stool past the rectum due to the mass of abdominal tissues now clustered there).

It’s an ugly occurrence (a big ball on their butt, usually skewed to one side). But Jack’s was especially impressive. It was huge. And what’s worse, his bladder was stuck in it. Jack hadn’t been able to urinate productively for over 48 hours. Now that’s an emergency.

I tried unsuccessfully to pass a catheter to relieve his bladder. Finally, I stuck it with a needle and drained its contents. At that point it plunked back down into its normal position. Though I could now breathe a sigh of relief, there was much more work to be done. And this is where a boarded surgeon’s skills come play as these hernias are notoriously difficult to repair—a real life pain in the a--, as it were.

After a day of fluids to rid Jack of the nasty toxins he’d accumulated while unable to pee, my friendly neighborhood surgeon fixed his butt—and neutered him, too, of course. Lots of antibiotics to calm the prostate as his testosterone levels wane (and lots of pain meds later) and Jack will be good as new.

The moral of this story is that benign prostatic enlargement ain’t always so benign. Waiting to neuter affected dogs is never advisable. Despite owners’ desire for their boys to keep their balls, this is one time I push owners to consider otherwise. Let Jack’s prostatic attack be a lesson to you.