Benign Prostatic Hyperplasia

Benign prostatic hyperplasia (BPH), also called enlarged prostate, is a condition where the prostate gets larger and affects many men as they get older. The prostate is a walnut-sized gland found under the bladder in men. BPH is not cancerous and does not increase your risk for prostate cancer. 

Understanding BPH 

The prostate produces fluid that nourishes and transports sperm. As you get older, changes in hormones may cause the prostate to grow slowly. This is because the number of cells in the prostate increases and the number of cells that die decreases. 

Genetics and inflammation may also make a prostate grow more quickly, while physical activity may slow its growth. BPH happens to almost all men, and many men see their health care provider because they notice symptoms in their 50s.

The prostate surrounds the first part of the urethra, which is the duct that carries urine out of the bladder. As the prostate gets bigger, it can pinch the urethra and weaken the bladder. Symptoms of BPH include:

• Frequent urination, especially during the night
• Difficulty starting to urinate
• An urgent need to urinate
• A weak or interrupted urine stream
• Dribbling urine after you urinate
• Trouble emptying the bladder

Symptoms usually get worse over time. BPH isn’t a serious risk to your health, but it can be uncomfortable and disrupt your life. Untreated, it can cause complications like the inability to urinate, urinary tract infections (UTIs) and bladder stones.

If you have symptoms, consult a health care provider. They can create a treatment plan to help you manage symptoms.

Diagnosing BPH

Your provider can see how severe BPH is and rule out other causes of your symptoms with these methods:

• Medical history: A review of your symptoms and how long they have lasted.
• Voiding diary: A record of the fluids you’ve taken in and your urine output.
• Digital rectal exam (DRE): Gently feeling the size, shape and consistency of the prostate through the rectum. 
• Prostate-specific antigen (PSA) blood test: High PSA levels can be linked with prostate cancer, less commonly BPH or prostate inflammation. 
• Postvoid residual volume test: A test to see if you are emptying your bladder fully.
• Urinalysis: A urine test to evaluate for several things including infection and blood in the urine. 
• Uroflowmetry: A test that measures the speed and volume of urine flow to see how well the urinary tract is working. 
• Transrectal ultrasound (TRUS): An exam that visualizes the prostate through the rectum. 
• Cystoscopy: Examining the bladder and prostate by inserting a thin tube with a camera into the urethra. 
• Blood urea nitrogen (BUN) and creatine tests: These tests check your kidney function.
• MRI or CT scans: You may need these imaging studies if you need surgery to improve your urinary stream.
• Prostate biopsy: Your provider may want to take tissue samples from your prostate if they need to check for prostate cancer.

It’s very important to have your symptoms evaluated since they could also be caused by other conditions such as urethral narrowing, prostate cancer, bladder cancer, inflamed prostate, overactive or underactive bladder, nerve problems, bladder or prostate infection, kidney or bladder stones and some medications.

Treating BPH

Treatment of BPH is important. Untreated, BPH can lead to an inability to urinate, bladder stones or bladder damage, urinary tract infections, urine leakage or kidney damage or failure. 

Your health care provider may recommend lifestyle changes, medication or surgery to treat BPH.

Lifestyle changes

Many men can manage their BPH symptoms with active monitoring and lifestyle changes such as:

• Moderating fluid intake, especially before bedtime, so you don’t wake up so often because you need to urinate.
• Bladder training, gradually increasing the length of time between bathroom breaks.
• Performing pelvic floor exercises like Kegel exercises to improve urinary control.
• Choosing a healthy diet rich in fruits, vegetables, whole grains, omega-3 fatty acids and foods high in antioxidants, and limiting caffeine and alcohol intake, to help keep your prostate healthy. 
• Getting regular physical exercise to support your prostate health.
• Maintaining a healthy weight, controlling blood sugar and managing heart disease risk factors, since obesity, diabetes and circulatory problems are linked to BPH.
• Reducing stress, since feeling stressed may make you urinate more often.

Medications

Most providers recommend trying medications before surgery. Your provider may recommend:

• Alpha-blockers to relax the muscles around the prostate and bladder neck, which may improve urine flow. Some options include alfuzosin (Uroxatral), doxazosin (Cardura), silodosin (Rapaflo), tamsulosin (Flomax), and terazosin.
• 5-Alpha reductase inhibitors to reduce the size of the prostate by slowing the production of hormones that make it grow. They include dutasteride (Avodart) and finasteride (Proscar).
• Tadalafil (Cialis) is often prescribed for erectile dysfunction (ED). It is also approved by the FDA to help with BPH.

In some cases, your provider may prescribe both alpha-blockers and 5-alpha reductase inhibitors. 

Some medications may cause side effects such as dizziness, decreased sex drive or retrograde ejaculation, which is where semen enters the bladder instead of exiting the penis. Talk to your provider about any possible side effects. 

There are a lot of different supplements on the market that claim to treat BPH, including saw palmetto, but there is limited data showing they help. For many men, they do not.

Surgical treatment and other procedures 

In some cases, you may need surgery to treat BPH. Treatment options include:

• Prostatic artery embolization (PAE): PAE is a non-surgical, minimally invasive procedure where tiny beads are placed in the prostate arteries to reduce blood flow and make the prostate shrink. PAE is an outpatient procedure that takes between 1.5 and three hours, with 45 minutes to three hours of recovery time. Most people see improvement within two weeks.
• Transurethral resection of the prostate (TURP): TURP removes excess prostate tissue to improve urine flow. 
• Transurethral incision of the prostate (TUIP): TUIP alleviates symptoms by making small incisions in the prostate.
• Transurethral microwave thermotherapy (TUMT): TUMT uses microwave energy to destroy part of the prostate gland. 
• Laser therapy: Lasers can be used to relax, shrink or remove prostate tissue. 
• Prostate urethral lift (PUL): PUL compresses the sides of the prostate with implants.
• Water vapor thermal therapy (WVTT): WVTT uses steam to remove extra prostate tissue.
• Robotic waterjet treatment: This method uses jets of water to remove extra prostate tissue.
• Simple prostatectomy: A surgeon removes prostate tissue with either open or minimally invasive techniques.

Risks of these procedures may include bleeding, infection and changes in sexual function. Your health care provider will discuss these risks and benefits before any procedure. 

Managing symptoms 

These strategies can help you manage the symptoms of BPH: 

• Educate yourself about BPH so you understand how to manage and treat it.
• Schedule bathroom breaks so you have better bladder control and don’t have to urinate as urgently.
• Try double voiding. After you urinate, wait a minute and try again without straining. That way, your bladder is as empty as possible.
• Avoid or limit caffeine, alcohol and spicy foods since they can irritate your bladder.
• Avoid becoming constipated, since constipation puts pressure on your bladder. Choose a diet rich in fiber and fluids to help keep your digestive and urinary tracts healthy. 
• Get regular physical activity, which can promote your overall well-being - including your urinary function. 

Be sure to see your health care provider to review how well your treatment plan is working and talk about any changes that you might need.