Enlarged Prostate (BPH)
Benign Prostatic Hyperplasia (BPH), commonly known as an enlarged prostate, is a non-cancerous condition where the prostate gland grows larger with age. The prostate is a walnut-sized gland that surrounds the urethra (the tube that carries urine from the bladder out of the body) in men. As the prostate enlarges, it can squeeze or partially block the urethra, causing urinary symptoms. BPH is extremely common, affecting about 50% of men over age 50 and up to 90% of men over age 80. While it is not life-threatening, it can significantly impact quality of life if symptoms become severe.
Causes
- Age - BPH rarely causes symptoms in men younger than 40. More than half of men in their 60s and up to 90% of men in their 70s and 80s have some symptoms of BPH.
- Hormonal changes - As men age, the amount of active testosterone in the blood decreases, leaving a higher proportion of estrogen. Studies suggest this higher proportion of estrogen may increase prostate cell growth.
- Growth factors - Substances like insulin-like growth factor and fibroblast growth factors may play a role in prostate enlargement.
- Family history - Having a blood relative, such as a father or brother, with prostate problems means you're more likely to have problems yourself.
- Lifestyle factors - Obesity, lack of physical activity, and erectile dysfunction may increase the risk or severity of BPH.
- Metabolic syndrome - A combination of conditions including increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels may increase the risk of BPH.
- Diabetes and heart disease - These conditions may increase the risk of developing BPH or worsen its symptoms.
Signs and Symptoms
- Frequent or urgent need to urinate
- Increased frequency of urination at night (nocturia)
- Difficulty starting urination
- Weak urine stream or a stream that stops and starts
- Dribbling at the end of urination
- Inability to completely empty the bladder
- Straining while urinating
- Strong and sudden urge to urinate
- Urinary tract infections
- Inability to urinate (urinary retention)
- Blood in the urine (hematuria)
Diagnosis
Medical History and Symptom Assessment
Your doctor will ask detailed questions about your urinary symptoms, their severity, when they started, and their impact on your quality of life. The International Prostate Symptom Score (IPSS) questionnaire may be used to quantify symptom severity.
Physical Examination
A digital rectal examination (DRE) allows the doctor to feel the size, firmness, and texture of the prostate through the rectal wall. This helps assess prostate enlargement and check for abnormalities that might suggest prostate cancer.
Urinalysis
A urine test can help rule out infection or other conditions that may cause similar symptoms. It checks for blood, bacteria, and white blood cells in the urine.
Blood Tests
Blood tests include prostate-specific antigen (PSA) testing to help rule out prostate cancer, as well as kidney function tests to assess whether BPH has affected kidney function.
Uroflowmetry
This test measures the strength and amount of urine flow. It involves urinating into a special device that measures how quickly urine flows and how much urine is released.
Post-void Residual Volume Test
This test measures the amount of urine left in the bladder after urination, either through ultrasound or catheterization. A large residual volume may indicate significant blockage or bladder dysfunction.
Transrectal Ultrasound
A probe inserted into the rectum uses sound waves to create images of the prostate, allowing measurement of prostate size and identification of structural abnormalities.
Urodynamic Studies
These tests evaluate how well the bladder, sphincters, and urethra store and release urine. They can help determine if symptoms are due to bladder dysfunction rather than prostatic obstruction.
Cystoscopy
A thin, flexible scope with a light and camera is inserted into the urethra to examine the urethra and bladder. This can help identify strictures, stones, or other problems that might be causing symptoms.
Treatment Options
Watchful Waiting
For men with mild symptoms that aren't bothersome, this approach involves regular monitoring without active treatment. Lifestyle modifications like reducing evening fluid intake, limiting caffeine and alcohol, and scheduled voiding may help manage symptoms.
Medication
Several types of medications can help relieve BPH symptoms. Alpha-blockers relax prostate and bladder neck muscles, making urination easier. 5-alpha reductase inhibitors shrink the prostate over time by blocking hormones that promote prostate growth. Phosphodiesterase-5 inhibitors may improve urinary symptoms and erectile function simultaneously.
Minimally Invasive Therapies
These treatments are less invasive than surgery but more effective than medications for moderate to severe symptoms. Options include prostatic urethral lift (UroLift), water vapor thermal therapy (Rezūm), prostatic artery embolization, and various forms of laser therapy that can reduce prostate tissue.
Home Remedies
Kegel Exercises
These exercises strengthen the pelvic floor muscles, which can help improve bladder control. To perform Kegels, tighten the muscles you would use to stop urinating, hold for a few seconds, then release. Repeat multiple times daily.
Double Voiding
This technique involves urinating, waiting a few moments, and then trying to urinate again. This helps empty the bladder more completely and can reduce frequency and urgency.
Fluid Management
Limit fluid intake in the evening to reduce nighttime urination. Avoid drinking within 2 hours of bedtime. Maintain good overall hydration during the day, but space out fluid consumption evenly.
Bladder Training
Gradually increase the time between bathroom visits to train your bladder to hold urine longer. Start by delaying urination by 15 minutes when you feel the urge, then gradually increase the time.
Dietary Adjustments
Limit consumption of bladder irritants like caffeine, alcohol, artificial sweeteners, spicy foods, and acidic foods, which can worsen BPH symptoms. Some men find that certain supplements like saw palmetto, beta-sitosterol, or pygeum may help with mild symptoms, though scientific evidence is mixed.
Preventive Care
- Maintain a healthy weight through balanced nutrition and regular physical activity.
- Exercise regularly, as physical activity may reduce urinary symptoms and risk of urinary retention.
- Limit alcohol and caffeine consumption, as they can increase urine production and irritate the bladder.
- Avoid medications that can worsen symptoms, such as decongestants and antihistamines.
- Practice timed voiding - urinate on a schedule rather than waiting for the urge.
- Avoid holding urine for long periods, as this can stretch the bladder muscle.
- Manage stress, as anxiety can increase the frequency of urination.
- Stay warm, as cold temperatures can increase urinary urgency and frequency.
- Treat constipation, as straining can put pressure on the prostate.
- Get regular prostate check-ups, especially after age 50, or earlier with family history.
Surgical Options
Transurethral Resection of the Prostate (TURP)
The gold standard surgical treatment for BPH where excess prostate tissue is removed through the urethra using surgical instruments. No external incisions are needed. TURP provides significant long-term symptom relief but requires a brief hospital stay and recovery period.
Learn More About This ProcedureGreenLight Laser Therapy
A minimally invasive alternative to TURP where a high-powered laser vaporizes excess prostate tissue. Benefits include less bleeding, shorter catheterization time, and quicker recovery compared to traditional TURP. It's particularly suitable for men on blood thinners.
Learn More About This ProcedureUroLift System
A minimally invasive approach that uses small implants to lift and hold enlarged prostate tissue out of the way, opening the urethra without cutting, heating, or removing prostate tissue. It preserves sexual function, requires minimal recovery time, and can be performed as an outpatient procedure.
Learn More About This ProcedureSimple Prostatectomy
For very large prostates, this procedure involves removing the inner portion of the prostate through an incision in the lower abdomen or using minimally invasive techniques such as laparoscopy or robotic assistance. While more invasive than other options, it provides excellent long-term results for severe BPH.
Learn More About This ProcedureSchedule a Consultation
If you're experiencing symptoms of enlarged prostate (bph), our expert team is here to help you find the right treatment approach for your specific needs.