Benign prostatic hyperplasia

You may be at greater risk for developing BPH if you:

• Are 40 years old or older
• Have a family history of BPH
• Have conditions like cardiovascular diseases, obesity, or type 2 diabetes
• Lead a sedentary lifestyle with limited physical activity
• Experience erectile dysfunction

Your doctor will evaluate your symptoms and perform various tests to rule out other conditions that may mimic benign prostatic hyperplasia (BPH).

Digital Rectal Exam

• The doctor can feel the prostate through the anus. After applying a numbing gel, they will gently insert a gloved finger into the rectum to assess the size, shape, and consistency of the prostate. This helps determine whether the prostate is enlarged or of normal size.

Cystoscopy

• This test allows the doctor to inspect the inner lining of the bladder and urethra. A thin, flexible tube with a camera (cystoscope) is inserted into the urethra and guided into the bladder. This procedure typically causes minimal discomfort, though you may feel an urge to urinate during the test, which lasts only a few minutes.

Ultrasound

• Ultrasound is commonly used as a first-line investigation after a digital rectal exam. An ultrasound of the kidneys and urinary bladder (USG KUB) helps assess the size and volume of the prostate.

Intravenous Pyelogram (IVP)

• IVP is an X-ray procedure that provides images of the urinary tract. A contrast dye is injected into a vein, traveling through the bloodstream to the urinary tract, highlighting an enlarged prostate. However, due to more effective alternatives, IVP is less commonly used today.

Urine Tests

• A urine test can help rule out infections or other urinary conditions that may present similar symptoms to BPH.

Prostate-Specific Antigen (PSA) Test

• PSA is a substance produced by the prostate. Elevated PSA levels can indicate an enlarged prostate. While this test is helpful for detecting prostate cancer, it is not definitive, as elevated PSA can also result from infections or recent procedures.

Urinary Flow Test

• This test measures the strength and volume of your urine flow. You will urinate into a special receptacle connected to a machine that tracks your flow and helps monitor whether your condition is improving or worsening.

Postvoid Residual Volume Test

• This test checks whether you are fully emptying your bladder when you urinate. Using ultrasound or a catheter, the doctor can measure the amount of urine left in your bladder after urination.

24-Hour Voiding Diary

• Your doctor may ask you to track how frequently you urinate and how much you pass, especially if you urinate more than one-third of your daily output at night. This record helps evaluate your urinary patterns.

Prostate Biopsy

• A transrectal ultrasound probe is inserted into the rectum to evaluate the prostate’s health. If necessary, a biopsy is performed using a needle to collect tissue samples from the prostate. This helps diagnose whether you have prostate cancer.

Urodynamic and Pressure Flow Studies

• This test evaluates bladder muscle function. A catheter is inserted into the bladder, and water or air is introduced to measure how well the bladder muscles work.

Currently, no known method can prevent benign prostatic hyperplasia (BPH). However, men at higher risk, such as those over 40 or with a family history of BPH, should consult their doctor if they notice any symptoms.

Regular prostate exams can help detect early signs of prostate issues, including prostate cancer. Early intervention can minimize the effects of BPH and reduce the chances of prostate enlargement.

Specialists to Visit

If you experience symptoms such as difficulty urinating, blood in the urine, painful urination, straining, dribbling at the end of urination, weak urine flow, or frequent nighttime urination, you should see a doctor. These symptoms may suggest BPH. The following specialists can assist with diagnosis:

• Urologist
• General surgeon
• General physician

Benign prostatic hyperplasia (BPH) can be managed using various treatment options. The best approach depends on factors such as the patient's age, overall health, the underlying cause of the condition, and the severity of the symptoms. If the symptoms are manageable, the doctor may recommend a "watchful waiting" approach, where the condition is monitored over time before deciding on further treatment. Treatment options include:

Alpha-blockers

These medications work by relaxing the muscles of the prostate, making it easier to urinate. They are most effective in men with smaller prostates. Side effects can include low blood pressure, dizziness, and retrograde ejaculation (when semen goes back into the bladder instead of being released from the penis). Alpha-blockers begin to show effects within days to weeks. Common examples include:

• Prazosin
• Terazosin
• Tamsulosin

5-alpha reductase inhibitors

These medications shrink the prostate by blocking the formation of dihydrotestosterone (DHT). Finasteride and dutasteride inhibit the enzyme 5-alpha reductase, which converts testosterone into DHT, leading to a reduction in prostate size. The effects typically take one month to become noticeable and may take up to six months for full results. Side effects include decreased libido, reduced ejaculate volume, and erectile dysfunction. Common drugs in this category are:

• Finasteride
• Dutasteride

Tadalafil

Tadalafil, mainly used to treat erectile dysfunction, has also been shown to help reduce the symptoms of BPH.

Transurethral Resection of the Prostate (TURP)

TURP is a surgical procedure used to quickly relieve BPH symptoms. After the surgery, patients typically experience an improved urine flow. The procedure involves inserting a lighted scope through the urethra to remove most of the prostate tissue, leaving only the outer part. A catheter will be required temporarily post-surgery.

Risks associated with TURP include retrograde ejaculation and urinary incontinence. Common complications include:

• Bleeding
• Urethral stricture
• Bladder neck contracture

Transurethral Incision of the Prostate (TUIP)

A lighted scope is inserted into the urethra, where one or two small cuts are made in the prostate to ease urine flow. This surgery is typically recommended for men with smaller or moderately sized prostates, or those with health issues that make other surgeries too risky. TUIP carries fewer complications and may be a better choice for those with smaller prostates.

Transurethral Microwave Thermotherapy (TUMT)

An electrode is passed through the urethra to the prostate, where it emits microwave energy to destroy the inner tissue of the prostate. This shrinking of the prostate helps improve urine flow. The effects may take some time to be fully noticeable, and the procedure may only partially alleviate symptoms. It is generally recommended for men with small prostates, and re-treatment might be necessary.

Transurethral Needle Ablation (TUNA)

A scope is passed into the urethra, and a needle is used to deliver radio waves that heat and destroy the excess prostate tissue blocking urine flow.

Ablative Laser Therapy

This procedure uses high-energy lasers to vaporize the prostate tissue that is obstructing urine flow. Some patients may experience irritative symptoms after the surgery.

Enucleation Procedure

This approach removes all prostate tissue blocking urine flow and prevents the tissue from regrowing. The removed tissue is analyzed for signs of prostate cancer or other disorders.

Prostatic Urethral Lift

In this procedure, special devices are used to compress the sides of the enlarged prostate, improving urinary flow. It is recommended for men with lower urinary tract symptoms and causes less impact on ejaculation and sexual function than TURP.

If left untreated, benign prostatic hyperplasia (BPH) can lead to several complications that affect the urinary system, including the bladder and kidneys. These complications include:

Urinary Tract Infections (UTIs)

When BPH is untreated, urine may become trapped in the bladder, preventing full emptying. This stagnant urine becomes an ideal breeding ground for bacteria, which can cause urinary tract infections. Some infections may not show symptoms, while others can result in painful or difficult urination, frequent urges to urinate, severe systemic infections, or visible blood in the urine (hematuria).

Blood in Urine (Hematuria)

Hematuria, or blood in the urine, often occurs due to fragile blood vessels in the enlarged prostate that are easily damaged by physical activity. It can also be caused by the formation of blood clots. Typically, this condition presents with blood at the beginning of urination, while the rest of the urine stream remains clear. Finasteride has been shown to be effective in treating hematuria related to BPH by reducing the density of these fragile blood vessels.

Urinary Stones

Urinary stones or calculi account for about 5% of all urinary tract stones. The formation of stones is commonly linked to chronic urinary infections, particularly when bacteria split urea. Recurrent UTIs and a residual volume of urine left in the bladder can lead to the formation of bladder stones. Men with a large residual urine volume are at a higher risk of developing multiple stones. Symptoms may include abdominal pain, visible blood in the urine, recurring UTIs, and severe infections in extreme cases.

Kidney Damage

Untreated BPH can result in chronic urinary retention, which may ultimately lead to kidney damage or chronic kidney disease. This condition impairs the kidney's ability to filter toxins and other substances. Patients with recurring UTIs and chronic urinary retention due to BPH are at a higher risk of developing renal failure.

It is important to consult your doctor before trying any herbal remedies, and you should never stop taking prescribed medications without first discussing it with your healthcare provider.

• Some herbal treatments have shown promise in managing BPH symptoms. Saw palmetto and stinging nettle, when used together, may be effective in alleviating symptoms.
• Other herbal remedies, such as African plum tree extract and lycopene, have also demonstrated some benefits in improving BPH-related symptoms.
• Including pumpkin seeds in your diet may be helpful as well. A study found that men with BPH who took pumpkin seed extract daily for 12 days reported improvements in their quality of life and a reduction in the urgency to urinate.
• Flaxseed has also shown encouraging results. A report indicated that individuals who took flaxseed hull extract for eight weeks experienced improvements in both obstructive and irritable symptoms associated with BPH.

Take Medications as Prescribed

If prescribed BPH medications, it’s essential to follow your doctor’s instructions and take the medications as directed. Some medications may take several months to show results, so consistent use is necessary for effective treatment. To help remember your medication schedule, you can store pills in a labeled box and set reminders to take them.

Regular Follow-Up Visits

Doctors usually recommend active monitoring of BPH, meaning you will track any changes in symptoms without immediate treatment. Regular visits to your urologist are essential. If your symptoms don’t improve, your doctor may adjust your treatment plan or suggest additional tests. If you’ve had surgery, ensure you follow all post-operative instructions from your doctor. Yearly visits are recommended to check for any new or worsening symptoms before deciding on further treatment. Active surveillance is an appropriate approach for those with mild symptoms or those who are not significantly bothered by their condition.

Exercise to Strengthen Pelvic Muscles

Kegel exercises, which strengthen the pelvic floor muscles, are often recommended for men with prostate issues. These exercises involve contracting the pelvic muscles for five seconds and then relaxing them. Aim for 10-20 repetitions, 3-4 times a day. Additionally, regular physical activity like walking, jogging, swimming, or sports is beneficial. Maintaining a healthy weight is also important, as obesity is a risk factor for BPH.

Your doctor may advise limiting heavy lifting or excessive physical activity for a week after laser ablation or transurethral needle ablation. Other surgeries may require restricted activities for up to six weeks.

Manage Stress

Stress can increase the urge to urinate, worsening BPH symptoms. Practicing mindfulness through meditation or yoga can help reduce stress. Meditating both in the morning and before bed can help decrease the frequency of nighttime urination.

Receiving a diagnosis of benign prostate hyperplasia (BPH) can bring stress and anxiety. This condition affects a man's quality of life, often causing frequent urges to urinate at inconvenient times. Some individuals also struggle with incontinence, which can lead to feelings of embarrassment. However, with early diagnosis and appropriate treatment, it is possible to manage the symptoms associated with BPH effectively.

1. Avoid Certain Medications

If you are taking medications like diuretics (water pills) to treat high blood pressure, liver disease, or heart failure, it is essential to consult with your doctor. Diuretics increase urination, which can exacerbate BPH symptoms. Tricyclic antidepressants, an older class of antidepressants, may reduce bladder muscle contractions, increasing the risk of urinary retention.

2. Avoid Antihistamines and Decongestants

Antihistamines, which are used to treat allergies, prevent bladder muscles from contracting, potentially slowing or inhibiting urination. Decongestants, commonly used for cold symptoms, can aggravate BPH by tightening the prostate and bladder muscles, making it more difficult for urine to exit the bladder.

3. Monitor Your Fluid Intake

Being mindful of how much fluid you consume is important. The more fluid you take in, the stronger the urge to urinate. Limiting fluid intake a few hours before bedtime can help reduce nighttime urination. Be cautious with drinks like alcohol, soda, coffee, or other caffeinated beverages, as they increase urine production.

4. Eat a Healthy Diet

It is advisable to avoid red meat and dairy. Studies suggest that eliminating red meat from your diet can significantly benefit prostate health. Consuming red meat regularly may increase the risk of prostate enlargement. Dairy products have also been associated with a higher likelihood of developing BPH. Instead, focus on including tomatoes, berries, salmon, and broccoli in your diet, as these foods have been found to help with BPH symptoms.