Benign Prostatic Hyperplasia (BPH): Causes & Treatment

Benign prostatic hyperplasia (enlarged prostate) is a condition in which your prostate grows in size. It is a problem that becomes more common with aging in men.

If your prostate grows in size, it can prevent pee and ejaculate from passing through the urethra. It can also cause bladder, urinary tract or kidney problems.

Benign prostatic hyperplasia is common condition in male. By the age of 60, just about 50% of people with a prostate tend to have some signs of enlarged prostate. By the age of 85, about 90% will have signs of this condition. Up to half of the people with enlarged prostate will develop symptoms that require treatment.

Study shows that having BPH (Benign prostatic hyperplasia) doesn’t increase the risk of developing prostate cancer. However, enlarged prostate and prostate cancer have similar symptoms. If you have BPH, you may have undetected prostate cancer at same time.

The prostate gland

Prostate gland is located beneath the bladder in men urinary system. The tube that moves urine from the bladder out of the penis is called the urethra. This tube passes through the center of the prostate. When the prostate grows bigger, it starts to block the flow of Urine.

The prostate gland is a gland that typically keeps growing throughout men’s life. This growth often enlarges the prostate enough to cause symptoms or to block the flow of urine.

Symptoms of benign prostatic hyperplasia

The following are the common symptoms of benign prostatic hyperplasia:

• Trouble starting to pee.
• Frequent or urgent need to pee, also called urination.
• Peeing more often at night.
• Weak urine stream, or a stream that stops and starts.
• Not being able to fully empty the bladder.
• Dribbling at the end of urination.

Less common symptoms of benign prostatic hyperplasia include:

• Not being able to pee.
• Urinary tract infection.
• Blood in the urine.

The symptoms of enlarged prostate tend to slowly get worse over time. But sometimes they may stay the same or even improve with time.

Size of the prostate does not always determine how severe the symptoms are. Someone with slightly enlarged prostates can have major symptoms. While others who have very enlarged prostates can even have minor problems. Likewise some other people with benign prostatic hyperplasia don’t notice any symptoms at all.

When to seek a medical attention

You should talk to your doctor about your symptoms, even if they don’t bother you. It’s very important to find out if there are any causes that could be managed. Simply because without treatment, the risk of a dangerous blockage of the urinary tract can occur. If you are finding it difficult to pass any urine, get medical attention immediately.

Causes of benign Prostatic Hyperplasia

It isn’t clear what causes the prostate to get bigger. It might be due to changes in the balance of sex hormones as you grow older. Study suggest as you age, the amount of testosterone in your body decreases (low testosterone). At the same time, your estrogen levels remain the same. These hormone changes may cause your prostate cells to grow. However, people who take supplemental testosterone may develop or worsen BPH.

Older men have higher dihydrotestosterone (DHT) levels. DHT is a more potent form of testosterone that increases the size of the prostate.

Without so much clarity of what causes benign Prostatic Hyperplasia (enlarged prostate), there are factors that can increase the risk of getting it.

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Risk factors of benign Prostatic Hyperplasia

The risk factors of developing benign prostatic hyperplasia include:

• Age. An enlarged prostate gland rarely causes symptoms before the age 40. But after that, the chance of having an enlarged prostate and related symptoms starts to rise.
• Family history of enlarged prostate. Having a family with prostate problems makes you more likely to have problems with your prostate.
• Diabetes and heart disease. Studies show that diabetes might raise the risk of enlarged prostate. So might heart disease.
• Lifestyle (being obese). Obesity can raise the risk of enlarged prostate, and exercise can help lower the risk.

Complications of benign prostatic hyperplasia

Those with long-standing history of benign prostatic hyperplasia tend to develop the following complications over time:

• a sudden inability to urinate
• urinary tract infections
• urinary stones
• kidney damage
• bleeding in the urinary tract

A urinary obstruction from benign prostatic hyperplasia can become severe that no urine can leave the bladder at all. This is known as bladder outlet obstruction. It can be very dangerous because urine trapped in the bladder can cause urinary tract infections and damage your kidneys over time.

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Prevention of benign prostatic hyperplasia

The best things to do to cut down your risk of developing benign prostatic hyperplasia is to make lifestyle changes that improve your prostate and your heart health and also take supplements.

Exercise is also one of the thing that can help you cut down the risk of enlarged prostate. At least 30 minutes each day can help prevent it or slow prostate growth. Maintaining normal cholesterol, blood pressure and blood sugar levels is also very important.

The examples of herbal supplements that can help lower the risk of benign prostatic hyperplasia include:

• Pygeum africanum. Pygeum africanum is an herbal extract from African cherry tree bark that may help shrink your prostate.
• Beta-sitosterol. Beta-sitosterol is a micronutrient in plants that may help keep your heart healthy.
• Pumpkin seed oil. Pumpkin seed oil comes from pumpkin seeds. It may help shrink your prostate.
• Flaxseed. Flax is a good source of dietary fiber and omega-3 fatty acids that may help lower your cholesterol.

Before taking or using any of the above herbal supplements, you should first consult your doctor. He or she can explain more about those herbal supplements, if they are best for you and if they may adversely react to other supplements or medicines you are currently taking.

Diagnosis of benign prostatic hyperplasia

Your healthcare provider or urologist will start the diagnosis of benign prostatic hyperplasia by doing a physical exam and asking you of your medical history. This physical examination includes a rectal exam that allows your provider to estimate the size and shape of your prostate.

During your physical examination and medical history, your healthcare provider may also ask about drugs you’re taking that might be affecting your urinary system, such as:

• diuretics
• antidepressants
• sedatives
• antihistamines

If you are taking any of the above medications, your provider can make any necessary medication adjustments for you. Don’t do the adjustment by yourself.

Other tests to diagnose an enlarged prostate include:

• Urinalysis. Your urine is checked for blood and bacteria.
• Prostate-specific antigen (PSA) test. This blood test checks for cancer of the prostate.
• Urodynamic test. Your bladder is filled with liquid via a catheter to measure your bladder’s pressure during urination.
• Cystoscopy. This is the examination of your urethra and bladder with a tiny lighted scope that’s inserted into your urethra
• Post-void residual. This tests the amount of urine left in your bladder after urination.

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Treatment of benign prostatic hyperplasia

There’re many treatments and management available for enlarged prostate. These can include medicines, surgery and procedures that involve smaller, fewer or no cuts. The best treatment option depends on the following:

• Size of your prostate.
• Age.
• Your overall health.
• How severe the symptoms are.

If the symptoms don’t get in the way of your life, you might decide with your doctor to put off treatment. Instead, your doctor may recommend you to wait and see if your symptoms change or get worse over time. Some people symptoms of benign prostatic hyperplasia can ease with time without any treatment.

Taking medications is the most common treatment for mild to moderate symptoms of an enlarged prostate. These include taking the following medication:

• Alpha blockers. Alpha blockers work by relaxing the smooth muscle of the bladder neck and prostate. This makes peeing easier. Alpha blockers include alfuzosin (Uroxatral), doxazosin (Cardura), tamsulosin (Flomax) silodosin (Rapaflo) and terazosin. They often work quickly in people with somewhat smaller prostates. Side effects might include dizziness. They also may include a harmless issue in which semen goes back into the bladder instead of out the tip of the penis. This is called retrograde ejaculation.
• 5-alpha reductase inhibitors. These medicines shrink the prostate. They do this by preventing hormone changes that cause the prostate to grow. Examples include finasteride (Proscar) and dutasteride (Avodart). They might take up to six months to work well and can cause sexual side effects.
• Tadalafil (Cialis). This medicine is often used to treat erectile dysfunction. Studies suggest it also can treat an enlarged prostate.
• Combination therapy. Your health care provider might suggest that you take an alpha blocker and a 5-alpha reductase inhibitor at the same time if either medicine alone doesn’t help enough.

Surgery or other procedures might help with enlarged prostate symptoms, this is if:

• You prefer not to try medicine.
• You don’t get enough relief from medicines.
• You aren’t able to pee.
• You keep getting bladder stones, blood in the urine or UTIs.
• You have kidney problems.

Surgeries or procedures that are used in the treatment of enlarged prostate include:

• Transurethral resection of the prostate (TURP). A thin tool with a light, called a scope, is inserted into the urethra. The surgeon removes all but the outer part of the prostate. TURP often relieves symptoms quickly. Some people have a stronger urine flow soon after the procedure too. After TURP, you might need a catheter to drain your bladder for a little while.
• Transurethral incision of the prostate (TUIP). A lighted scope is inserted into the urethra. The surgeon makes one or two small cuts in the prostate gland. This makes it easier for urine to pass through the urethra. TUIP might be an option if you have a small or slightly enlarged prostate gland. It also may be an option if you have health problems that make other surgeries too risky.
• Transurethral microwave thermotherapy (TUMT). A special catheter is placed through the urethra into the prostate area. Microwave energy from the catheter destroys the inner portion of the enlarged prostate gland. This shrinks the prostate and eases urine flow. TUMT might relieve only some of your symptoms. It also might take some time before you notice results. In general, this surgery is used only on small prostates in special situations because the treatment might be needed again.
• Laser therapy. A high-energy laser destroys or removes overgrown prostate tissue. Laser therapy has a lower risk of side effects than does nonlaser surgery. It might be used in people who shouldn’t have other prostate procedures because they take blood-thinning medicines.

Options of laser therapy include:

Enucleative procedures. These treatments include holmium laser enucleation of the prostate (HoLEP). In general, they remove all the prostate tissue blocking urine flow and prevent tissue from growing back. The removed tissue can be checked for prostate cancer and other health problems.

Ablative procedures. These destroy prostate tissue that blocks urine flow. Types of these procedures include photoselective vaporization of the prostate (PVP) and holmium laser ablation of the prostate. Ablative procedures can cause irritating symptoms after surgery. In rare cases, another procedure to remove prostate tissue might be needed at some point.

Other surgical procedures for the treatment of enlarged prostate include:

• Prostate lift. Special tags are used to compress the sides of the prostate. This can improve the flow of urine. A prostate lift might be an option if the middle section of the prostate gland doesn’t get in the way of urine flow. It’s less likely to cause sexual side effects than are many other surgical treatments.
• Water vapor thermal therapy. A device is placed in the urethra. It turns water into steam. This wears away extra prostate tissue. WVTT can ease symptoms of an enlarged prostate. It is less likely to cause sexual side effects compared with many other surgical treatments.
• Embolization. In this experimental procedure, the blood supply to or from the prostate is blocked in chosen areas. This causes the prostate to get smaller. Long-term data on how well this procedure works isn’t available.
• Open or robot-assisted prostatectomy. One or more cuts are made in the lower stomach area. This lets the surgeon reach the prostate and remove tissue. In general, this type of surgery is done if you have a large or very large prostate. A short hospital stay is often needed afterward. The surgery is linked with a higher risk of needing donated blood due to bleeding.
• Robotic waterjet treatment. This procedure uses imaging tests and robotic tools to guide a device into the urethra. The device releases tiny, powerful jets of water to remove extra prostate tissue. This can ease symptoms of an enlarged prostate. Robotic waterjet treatment can cause some of the same side effects that TURP can cause.

Side effects form procedures. Depending on the surgical procedure you choose, health issues or problems afterward may include:

• Leaking urine by accident.
• Semen flowing backward into the bladder instead of out through the penis during ejaculation.
• Erectile dysfunction.
• Urinary tract infection.
• Bleeding.

Before you choose the best treatment option for you, make sure you ask your doctor about any possible side effects. Your healthcare provider will work with you to develop a treatment plan that helps you manage your symptoms and also live a healthy life.

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