The prostate gland, engulfing the urethra, is responsible for producing the fluid that carries sperm. The urethra is a tube-shaped organ that flushes the urine out of the body. When the prostate grows bigger in older men (65+ years), it puts additional pressure on the bladder and urethra.
This condition goes by the name benign prostatic hyperplasia or BPH. It’s so common that nearly 50% of men between 51-60 years of age have it. Moreover, almost 90% of men between 81-90 years of age live with this condition.
According to research, at least 50% of men with healthy testicles develop BPH. However, it may cause moderate-to-severe levels of Lower Urinary Tract Symptoms (LUTS) in some cases.
Correlation Between BPH and Age
Benign prostatic hyperplasia manifests in different ways in different people in that it may or may not show any symptoms even during later stages of life. In cases where it does cause symptoms to appear, it may considerably affect the senior’s quality of life.
Especially if the senior has existing comorbidities such as metabolic syndrome, diabetes, hypertension, etc., BPH may complicate management decisions. It is estimated that the U.S. will have 38 million seniors by 2050, thanks to improved life expectancy.
While that is a good thing, old age also brings with it certain age-related diseases like BPH. With timely benign prostatic hyperplasia treatment and management, seniors can live a reasonable quality of life.
Symptoms of BPH. Less than 50% of men with BPH will ever show any symptoms.
Some of these benign prostatic hyperplasia symptoms include:
- Inability to urinate
- Weak urine stream
- Sudden and strong urge to urinate
- Bloody urine or pain with urination (these may be indicative of infection)
- Straining to urinate
- Urinary incontinence
- Dribbling after urinating
- Frequent urination (more than twice) during the night
- Delayed start of urination
In severe cases of BPH, you may lose the ability to pass your urine at all. Such a condition needs emergency treatment. However, with effective benign prostatic hyperplasia management, your situation may not become so severe.
How to Prevent Benign Prostatic Hyperplasia?
Unfortunately, there’s no sure-fire way of preventing benign prostatic hyperplasia. That said, eating a healthy diet and losing weight may help. Your diet should comprise of fruits and vegetables.
There may be some correlation between your body fat and BPH in the sense that a higher fat percentage generally contributes to increased hormone levels. This, in turn, stimulates the production of prostate cells – more than it usually should. Hence, staying active is necessary to regulate your hormone levels and, thereby, your weight.
How is Benign Prostatic Hyperplasia Diagnosed?
Based on the benign prostatic hyperplasia symptoms, you would need to visit a doctor for a medical diagnosis. They may ask some questions about your medical history. On that note, you should know that no significant link has been found between family history and BPH.
Your doctor may recommend a digital rectal exam to determine the condition of your prostate gland.
Other tests to confirm the diagnosis of BPH may include:
- Urine culture used to detect infection
- Prostate-specific antigen (PSA) test to identify prostate cancer
- Creatinine and blood urea nitrogen (BUN) tests
- Urinalysis to screen the blood or injection
- Cystoscopy – an invasive test to see the inside of the urethra and bladder
- Pressure-flow test to evaluate the bladder pressure during urination
- Post-void residual urine test needed to determine the urine volume left in the bladder after urination
- Urinal flow rate
You may also be given a form to explain how BPH symptoms affect your day-to-day life. Keeping tracking of these benign prostatic hyperplasia symptoms is essential to figure out if your condition is getting better or worse over time.
Benign Prostatic Hyperplasia Causes
As of now, no specific benign prostatic hyperplasia risk factors have been identified. Any man with normally functioning testicles can develop it. Those who had their testicles surgically removed due to testicular cancer at a young age do not develop BPH.
Men that live long enough will most likely develop this condition. The only correlation that has been found is that with age. As you move towards later stages of life, your prostate tends to increase in size.
Family history does not necessarily increase your chances of developing BPH. You must remember that there’s no link between BPH and prostate cancer. The former does not lead to the latter.
Also, in severe cases of benign prostatic hyperplasia, testicles may have to be surgically removed, after which the prostate shrinks back to its original size. That said, there are various other treatments for benign prostatic hyperplasia, and this is not the standard procedure.
Let’s cover the treatments and management of BPH in the next section:
Benign Prostatic Hyperplasia Treatment
The treatment for benign prostatic hyperplasia depends on the severity of your symptoms. Whether or not these symptoms adversely affect your day-to-day life is an essential factor that doctors look for.
Some of the treatment options include surgery, medicines, lifestyle changes, and “watchful waiting.” Those with minor symptoms may feel better with self-care steps and may not need any medication for benign prostatic hyperplasia.
Any changes in the treatment are determined through regular monitoring of symptoms and conducting yearly exams.
Self-care Tips for BPH
For men with a mild form of BPH, specific self-care tips may improve their quality of life.
These are listed below:
- Avoid caffeine and alcohol after dinner.
- Reduce stress. Tension and nervousness may cause frequent urination.
- Exercise regularly. Inactivity may worsen your symptoms.
- Try to keep yourself warm. Cold weather tends to worsen BPH symptoms.
- Before going to bed, try not to drink too much water – at least not for two hours before sleeping. Else, it would lead to frequent urges throughout the night.
- Certain medications such as sinus medicines and over-the-counter cold medicines increase BPH symptoms because they contain antihistamines or decongestants. Take them only if it’s essential and recommended by a doctor.
- Make a proper schedule for bathroom visits and follow it even if you don’t feel the urge to urinate. And when you do feel the urge, don’t delay it.
In most cases, benign prostatic hyperplasia management needs only active surveillance. If your doctor advises it, your symptoms would be closely watched under active surveillance but not actively treated.
You would need to visit your urologist regularly, who would keep you updated on the condition. Even if you don’t have BPH, it’s best to go for yearly exams as you age. Before suggesting any treatment, a urologist would look for new or worsening symptoms.
As part of managing benign prostatic hyperplasia symptoms, your doctor would surely recommend a good diet and exercise. Active surveillance is appropriate for men who have moderate or mild symptoms of BPH.
Active treatment begins if doctors detect new or worsening symptoms.
Medication for Benign Prostatic Hyperplasia
- Alpha-1 blockers: These reduce BPH symptoms, improve urine flow, and relax bladder and prostate muscles. They don’t impact the prostate size in any way. Doctors prescribe them for men with severe or moderate BPH. Side effects are trouble ejaculating, fatigue, lightheadedness, and dizziness. They must not be taken if you’re scheduled to have cataract surgery.
- Dutasteride and finasteride: These medications are used to lower the hormone levels produced by the prostate gland. Dutasteride and finasteride do shrink the gland’s size. They decrease BPH symptoms and increase the urine flow rate. However, impotence is one of the possible side effects.
- Antibiotics: The inflammation of the prostate, also known as chronic prostatitis, needs to be treated with antibiotics. The symptoms tend to improve after antibiotics treatment.
Doctors may also prescribe combined therapy. That may, however, cause more side effects.
Important Note: You must never self-medicate. Only your doctor is qualified to prescribe any of these medicines based on your condition.
Less Invasive Surgery
If the medication for benign prostatic hyperplasia doesn’t seem to work for a patient, doctors may advise less invasive surgery.
Men with the following symptoms may need minimally invasive surgery:
- Bleeding from the prostate
- Incomplete emptying
- Urinary tract obstruction
- Blood in your urine or bladder stones
- Straining to pass urine
- Weak stream of urine
Listed below are the types of minimally invasive surgeries to treat BPH:
- Prostatic Urethral Lift (PUL)
- Water Vapor Thermal Therapy
- Transurethral Microwave Therapy (TUMT)
You can learn more about these surgeries here. Like other treatment options, each type of surgery has its benefits and side effects. Discuss with a urologist for a more detailed and accurate opinion.
More Invasive Surgery
When everything else fails, doctors may recommend more invasive surgery.
Symptoms (or conditions) that would need an invasive surgery include:
- Bladder stones
- Urinary bleeding (that’s untreatable by medication)
- Kidney damage
- Inability to pass urine. There are several surgical options available for you:
- Transurethral incision of the prostate (TUIP)
- Photoselective Vaporization (PVP)
- Transurethral Resection of the Prostate (TURP)
- Holmium Laser Enucleation of Prostate (HoLEP)
- Thulium Laser Enucleation of the Prostate (ThuLEP)
- Transurethral Vaporation of the Prostate (TUVP)
- Transurethral Water-Jet Ablation (TWJA)
Learn more about invasive surgeries for enlarged prostate here.
Benign prostatic hyperplasia is a pervasive condition in men over 50 years of age. Symptoms may or may not resurface in individuals. Depending on the severity, you may consider any of the treatment mentioned above alternatives, however, as advised by your doctor.
In most cases, it will only require active surveillance, an active lifestyle, and an excellent diet to manage the condition.