Benign Prostatic Hyperplasia
Benign Prostatic Hyperplasia, also known as BPH, is a noncancerous enlargement of the prostate that places pressure on urethra potentially causing
urinary obstruction.
The prostate undergoes two growth time periods in a man’s life. The first begins at puberty until the prostate reaches the adult size between ages 25 to 30 and stays this size until roughly the age 40. At this time the prostate begins a second phase of growth and continues for the rest of the man's lifetime. The second growth phase is when BPH is likely to develop because the prostate can become enlarged to the point that it places pressure on the urethra causing a urinary obstruction. This obstruction can cause issues with
urination.
BPH doesn’t always require treatment but can be treated when symptoms become problematic or an inconvenience in day to day life. According to Johns Hopkins, symptoms related to BPH occur in one in four men by age 55 and in half of men by the age 75.
What are risk factors for BPH?
• Aging: As you continue to age, your prostate continues to grow and becomes more likely to result in BPH the older you become.
• Family History of BPH: If you have a family member who has BPH before 65, you are four times more likely to experience issues with BPH.
• Family History of bladder cancer
• Obesity
• Diabetes and heart disease
What are the symptoms of BPH?
Common symptoms of BPH are:
• Increased need to urinate
• Urgent need to urinate
• Difficulty urinating (stopping/starting, straining)
• Weak urine stream
• Inability to completely empty the bladder
When should you see a doctor?
If you are experiencing any symptoms of BPH that persist, then you should check with your primary care provider or family doctor. This will allow your doctor to accurately diagnose you and rule out other possible causes such as bladder infection, kidney stones, overactive bladder, bladder cancer or prostate cancer.
BPH can be diagnosed through a symptom score, physical exam involving a digital rectal exam, and other tests. The most common tests performed are a urinalysis to examine your urine for infection and a blood test to check your prostate-specific antigen (PSA) level.
What are treatment options for BPH?
Prescription Options:
• Alpha blockers work to relax the bladder and muscles of the prostate to make urination easier. Common alpha blockers used for BPH are tamsulosin (Flomax), doxazosin (Cardura), and alfuzosin (Uroxatral). A fun fact about these medications is that they share the common ending of -sin or -zosin making them easy to identify, but remember some can be used for more than just BPH! Common side effects include dizziness and low blood pressure, to minimize these they are
often taken at bedtime.
• 5-alpha reductase inhibitors work by stopping the prostate from growing further and even possibly causing the prostate to shrink. Finasteride (Proscar) and dutasteride (Avodart) are the two most commonly used 5-alpha reductase inhibitors for BPH. Common side effects include decreased sex drive and sexual dysfunction including problems maintaining erection and ejaculation.
• Tadalafil is commonly known as Cialis which is used for erectile dysfunction, but can also be used to treat BPH at low doses. It works by increasing the blood flow to the penis and, in the case of BPH, relaxing the muscles of the bladder and prostate. Common side effects include headache, flushing, and nausea.
Over-the-counter Options:
There are also some over-the-counter medications that can be used to help support prostate function both before and after a diagnosis of BPH. For each of these options the most common side effect is stomach upset.
• Saw Palmetto has several different functions that help to support prostate health. One function of note is to possibly inhibit 5-alpha reductase, much like finasteride and dutasteride as mentioned above.
• Prostate Health Support with Saw Palmetto and Nettle is a blend of different supplements to help support a healthy prostate. It is a blend of zinc, saw palmetto, pygeum, pumpkin seed oil, nettle root extract, and lycopene. Each of these active ingredients have studies showing that they help the prostate to function ranging from benefiting urine flow to maintaining healthy cells of the prostate. Blending these together allows them to work together to support your overall prostate health.
Can I manage the symptoms of BPH without medication?
For mild cases of BPH many of the symptoms can be avoided with lifestyle changes. These are very similar to techniques used when dealing with incontinence such as double voiding, scheduled bathroom visits, fluid management and diet management.
• Double voiding is when you urinate, wait a few moments after you’re finished and try again to get rid of any remaining urine. This helps when you struggle with feeling as if you aren’t able to completely empty your bladder.
• Scheduling your bathroom visits can help to train your bladder to go longer in between visits and is helpful if you’re experiencing an increased frequency or urgency to urinate.
• Fluid management can be beneficial if you are struggling with urinary frequency in the middle of the night or overall urinary urgency. By restricting your fluid intake a few hours before bed, you can decrease the likelihood of a nighttime trip to the bathroom. You can also manage what types of beverages you are
drinking, caffeine and alcohol increase urine production thereby increasing frequency. Avoiding these types of beverages can help to decrease your trips to the bathroom.
• Diet management is considered beneficial due to obesity being a risk factor for BPH.
Sources:
https://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/diagnosis-treatment/drc-20370093
https://www.urologyhealth.org/urology-a-z/b/benign-prostatic-hyperplasia-(bph)
https://www.hopkinsmedicine.org/health/conditions-and-diseases/benign-prostatic-hyperplasia-bph