Prostate enlargement, commonly referred to as Benign Prostatic Hyperplasia (BPH), is a common condition experienced by over 14 million men in the United States. Although BPH is non-cancerous, it is important to properly treat it in order to limit symptoms and prevent damage to surrounding structures.
What is the prostate?
The prostate is a small gland in men that is responsible for making most of the fluid in semen which supports the sperm and improves fertility.
The prostate surrounds the urethra and is located between the bladder, and penis and just in front of the rectum. As men age, the prostate tends to grow larger and starts putting pressure on the urethra.
What causes BPH?
Benign Prostatic Hyperplasia (BPH), an enlarged prostate gland is a common condition found in men as they get older. BPH is different from prostate cancer as it is benign (non-cancerous).
The exact cause is still unclear but we know that the enlargement of the prostate from BPH occurs when prostate cells begin to grow and multiply. As prostate cells continue to multiply, the prostate gland swells and creates pressure on the urethra. The urethra then begins to narrow and the bladder must work harder to expel urine from the body, causing the bladder walls to thicken. Subsequently, the bladder may weaken and lose the ability to fully empty the bladder.
Who is most likely to develop BPH?
While it isn’t completely clear what causes prostate enlargement, various factors can increase your risk of developing BPH, with age being the most significant.
Risk factors for BPH:
— Age: The chances of developing BPH increase with age. Over 40% of men over 40 have BPH, with that number significantly increasing to 90% for men over 85.
— Genetics: If you have a family history of BPH, prostate, or testicular problems, you’re more likely to develop BPH.
— Type-2 Diabetes: studies suggest that prostate growth can be triggered by high insulin levels found in Type 2 Diabetes.
— Heart disease: factors such as high blood pressure, diabetes, and obesity that contribute to heart disease also increase the risk of BPH.
— Obesity: more body fat increases the amount of estrogen in the body, causing increased prostate growth.
What is BPH symptoms?
There are many urinary problems associated with BPH, although not all men with BPH experience symptoms. Additionally, the size of the prostate does not always correlate to the number or severity of the symptoms you experience. Having a larger prostate does not necessarily mean that you will have more severe symptoms.
Common lower urinary tract symptoms of BPH include:
— A slow or weak urinary stream
— A urinary stream that starts and stops
— Straining to urinate
— Inability to urinate
— Pain when urinating
— Blood in the urine
— Frequent urination
— Constant urge to urinate
— Dribbling at the end of urination
— Urinary incontinence
— Inability to empty the bladder completely
— Nocturia (the frequent need to urinate at night)
How is BPH diagnosed?
Your doctor can determine if you have BPH using your personal and family medical history, a physical examination, and medical tests. Here is what you can expect and how you can best prepare for your doctor’s visit.
1. Personal and family medical history
In addition to going through your personal and family medical, your doctor will also ask you questions about the symptoms you’re experiencing as well as lifestyle habits that may contribute.
The American Urological Association (AUA) also has a BPH Symptom Score Index that gives you a score, rating your BPH from mild to severe. You can take this test before seeing your doctor and bring the results to your appointment.
2. Physical examination
A physical examination includes a digital rectal exam (DRE) where your doctor will insert a lubricated finger into the rectum to feel the prostate. During this examination your doctor will feel for prostate enlargement and any other abnormalities.
3. Medical tests
In addition to looking through your medical history and conducting a physical examination, there are a variety of medical tests that can be done to determine whether or not you have BPH.
4. Medical test may include:
— Prostate-specific antigen (PSA) test: a blood test that checks your levels of PSA, which is a protein produced in your prostate. Elevated levels of PSA occur when the prostate is enlarged, but also with other instances such as prostate cancer, infections, or recent procedures and surgeries.
— Urinalysis: tests a urine sample for infection.
— Urinary flow test: measures the strength of your urine stream as you urinate into a receptor. This can be used to determine whether your condition is getting better or worse.
— Postvoid residual volume test: conducted using an ultrasound or catheter, this test measures if you can empty your bladder completely
— Transrectal ultrasound: measures and evaluates your prostate using an ultrasound that is inserted into your rectum.
— Prostate biopsy: takes a tissue sample from your prostate to determine whether or not your prostate enlarged is due to prostate cancer.
— Urodynamic and pressure-flow studies: saline (salt water) is used to fill your bladder through a catheter and measures how well your bladder muscles are working. This test is most often used with known or suspected neurological problems, but can also be done for men who continue to have problems after many treatments
— Cystoscopy: an instrument called a cystoscope is inserted into the urethra to see any abnormalities in the urethra and bladder.
Are there any possible complications of BPH?
Prostate enlargement can cause a number of complications, although most men with BPH do not develop any.
Complications of BPH:
— Urinary retention: the inability to fully empty the bladder or urinate at all.
— Urinary tract infections (UTIs): the risk of UTIs increases when urine is not fully emptied from the bladder.
— Kidney damage: increased pressure on the bladder from urinary retention can cause urine to flow into the kidneys causing damage and infection.
— Bladder stones: when urine is not fully emptied from the bladder, bladder stones may form and cause pain, infection, and irritation.
— Bladder damage: bladder obstruction from an enlarged prostate causes the bladder to need to contract more to expel urine. This can cause the bladder walls to thicken and the bladder may weaken and even stop contracting. Complications can also occur when the bladder is not emptied completely, causing the bladder to stretch and weaken.
What is the best treatment for BPH?
There are a variety of treatment options available for dealing with BPH or its symptoms on your own, using medication, or through surgical procedures. Although, it’s important to note that with all forms of treatment, prostate tissue can continue to grow if you stop medication or can grow back after minimally invasive treatment or surgery. While you should always talk to your doctor to see what they recommend for you, here are some remedies you could look into.
For those with mild symptoms, “watchful waiting” might be the best course of action. “Watchful waiting” is the practice of self-monitoring your symptoms, checking in with your doctor periodically, before adopting a more serious course of treatment. While you wait, there are a number of lifestyle changes that could help alleviate the effects of BPH.
Recommended lifestyle changes:
— Urinate as soon as you feel the urge
— Use the bathroom on a planned schedule, even if you don’t feel the need to go
— Empty the bladder as thoroughly as possible each time you urinate
— Avoid caffeine and alcohol
— Space out your fluid intake evenly throughout the day, avoid drinking a lot all at once or right before going to bed
— Reduce liquid consumption before going to sleep
— Reduce your stress levels
— Keep warm
— Maintain a healthy diet
— Exercise regularly
— Perform Kegel exercises to strengthen your pelvic muscles
— Avoid over-the-counter antihistamines and decongestants, which can worsen the symptoms of BPH
— Prevent or treat constipation, which can worsen the symptoms of BPH
For mild to moderate symptoms of an enlarged prostate, medication is the most common treatment.
Medication can include:
— Alpha-blockers: relax the bladder and prostate muscles, making it easier to urinate. Side effects may include dizziness, decreased sexual drive, and problems with ejaculation.
— 5-alpha reductase inhibitors: prevent the hormonal changes responsible for prostate growth, and may even shrink the prostate. Side effects may include retrograde ejaculation, a harmless condition where semen goes backwards into the bladder instead of out of the penis.
— Phosphodiesterase-5 (PDE5) inhibitors: mainly prescribed to treat erectile dysfunction, this medication is also used to treat BPH because it relaxes muscles in the urinary tract. Since it’s not uncommon to have erectile dysfunction and BPH, many men will use this medication for both concerns.
Minimally invasive procedures
If you are unable to treat your symptoms with lifestyle changes and medications, there are a range of different procedures that might help. All of these procedures are done endoscopically (or through the urethra). They include:
— Transurethral needle ablation (TUNA): small needles are inserted in the prostate, which are used to pass radio waves that heat and destroy parts of the prostate tissue that block the flow of urine.
— Transurethral microwave thermotherapy (TUMT): an electrode is inserted through the urethra and into the prostate area. Microwave energy is then released from the electrode, destroying the prostate tissue and making it easier to pass urine.
—High-intensity focused ultrasound: an ultrasound probe is inserted into the rectum, near the prostate. Ultrasound waves are emitted from the probe that heat and destroy enlarged prostate tissue.
— Transurethral electrovaporization: a resectoscope, a tube like device, is inserted through the urethra to the prostate. An electrode on the resectoscope moves along the surface of the prostate and transmits an electric current that destroys prostate tissue.
— Water-induced thermotherapy (WIT): Heated water is inserted through a catheter and into a treatment balloon that sits in the middle of the prostate. This heats and destroys the surrounding prostate tissue.
— Prostatic stent insertion: a small, prostatic stent is inserted into the part of the urethra narrowed by the enlarged prostate. Prostatic stents may be temporary or permanent.
— Prostatic urethral lift (PUL): the sides of the prostate are compressed using special tags, increasing urine flow.
For longer term treatment, some men opt for surgery to reduce the symptoms of prostate enlargement that cannot be controlled through lifestyle changes, medication, or minimally invasive procedures.
Surgical options include:
— Transurethral resection of the prostate (TURP): This is also an endoscopic surgery in which all of the prostate, except for the outer capsule, is removed. Most men experience a stronger flow of urine and fewer symptoms after this procedure.
— Open or robot-assisted prostatectomy: prostate tissue is removed through an incision in the lower abdomen.
— Transurethral incision of the prostate (TUIP): This is similar to the TURP, except instead of removing tissue, two small incisions are made in the prostate gland and bladder neck to widen the urethra, allowing the stream of urine to pass more easily. Some urologists claim that TUIP provides the same results as TURP, but with less side effects.
— Laser therapy: high-energy lasers are used to destroy prostate tissue.
What products might be helpful for those with an enlarged prostate?
Many products can help manage the symptoms of an enlarged prostate.
Product options include:
— Supplements: saw palmetto, beta-sitosterol, pygeum, rye grass, and stinging nettle are common supplements that have been used to manage the symptoms of BPH. While some people have found supplements effective, results vary and more studies are needed to confirm the effects of these supplements. If you’re interested in learning more, speak to your doctor to see what they recommend.
— Incontinence pads: for those experiencing minor urinary incontinence as a symptom of BPH, incontinence pads can be used in your to your boxers or underwear to catch small amounts of urine.
— Intermittent catheters: it is important to empty the bladder fully to prevent infection, the formation of stones, and the backflow of urine into the kidneys. If you’re experiencing urinary retention caused by BPH and you’re unable to fully empty your bladder on your own, intermittent catheters may be a good option to help drain the bladder completely. Intermittent catheters are inserted into the bladder several times per day by the user or his caretaker to expel urine from the body. Although, if you are able to urinate but don’t empty your bladder completely, you may be able to urinate as normal and use an intermittent catheter once or twice per day to make sure all urine has been drained.
If you would like to learn more about your product options, Better Health carries male incontinence pads as well as an extensive selection of both intermittent catheters to suit a wide variety of needs. Take a look at our catheter offerings or take our product selection quiz to get personalized recommendations just for you.