The prostate is a small, muscular gland in the male reproductive system. Your prostate surrounds your urethra and makes most of the fluid in your semen. The muscular action of the prostate helps propel the fluid and semen through your penis during sexual climax.
In many men, the prostate can become enlarged. Sometimes it leads to symptoms and, over time, other complications. However, there are treatments.
Enlargement of the prostate is called benign prostatic hyperplasia (BPH). It occurs when the cells of the prostate gland begin to multiply. These additional cells cause your prostate gland to swell, which squeezes the urethra and limits the flow of urine.
BPH isn’t the same as prostate cancer and doesn’t increase your risk for cancer. However, it can cause symptoms that can affect your quality of life.
BPH is common in men over 50.
BPH is considered a normal condition of aging. Although the exact cause is unknown, changes in male sex hormones that come with aging may be a factor.
Any family history of prostate problems or any abnormalities with your testicles may raise your risk for BPH. Men who’ve had their testicles removed at a young age don’t develop BPH.
The symptoms of BPH are often very mild at first, but they become more serious if they aren’t treated. Common symptoms include:
- incomplete bladder emptying
- nocturia, which is the need to urinate two or more times per night
- dribbling at the end of your urinary stream
- incontinence, or leakage of urine
- straining when urinating
- a weak urinary stream
- a sudden urge to urinate
- a slowed or delayed urinary stream
- painful urination
- blood in the urine
Talk with your doctor if you have any of these symptoms. They’re treatable, and treating them often can help prevent complications.
When checking you for BPH, your doctor will usually begin by doing a physical exam and asking you about your medical history. The physical exam includes a rectal examination that allows the doctor to estimate the size and shape of your prostate. Other tests can include:
- Urinalysis. Your urine is checked for blood and bacteria.
- Urodynamic test. Your bladder is filled with liquid via a catheter to measure your bladder’s pressure during urination.
- Prostate-specific antigen (PSA) test. This blood test checks for cancer of the prostate.
- Post-void residual. This tests the amount of urine left in your bladder after urination.
- Cystoscopy. This is the examination of your urethra and bladder with a tiny lighted scope that’s inserted into your urethra
Your doctor may also ask about medications you’re taking that might be affecting your urinary system, such as:
Your doctor can make any necessary medication adjustments. Don’t attempt to adjust your medications or doses yourself.
Let your doctor know if you’ve taken self-care measures for your symptoms for at least 2 months without noticing any improvement.
Treatment of BPH can begin with self-care and lifestyle adjustments. If symptoms don’t subside, medication or surgery may be recommended. Your age and general health will also influence the prescribed treatment.
Natural treatment can include specific actions or lifestyle changes that you can make to help relieve your symptoms of BPH. These include:
- urinating as soon as you feel the urge
- going to the bathroom to urinate, even when you don’t feel the urge
- avoiding over-the-counter decongestants or antihistamine medications, which can make it harder for the bladder to empty
- avoiding alcohol and caffeine, especially in the hours after dinner
- reducing your stress level, as nervousness can increase the frequency of urination
- exercising regularly, as a lack of exercise can aggravate your symptoms
- learning and practicing Kegel exercises to strengthen your pelvic muscles
- keeping warm, since being cold can make symptoms worse
Some people also include natural remedies in their treatment of BPH. However, there isn’t evidence that they’re effective.
When lifestyle changes aren’t enough to relieve your symptoms, your doctor may recommend medication.
There are several medications that can help to both treat the symptoms of BPH and BPH itself. These medications include:
- alpha-1 blockers
- hormone reduction medications
Alpha-1 blockers are medications that relax the muscles of the bladder and prostate. Alpha-1 blockers relax the neck of the bladder and make it easier for urine to flow. Examples of alpha-1 blockers include:
Hormone reduction medications
These two medications lower the levels of dihydrotestosterone (DHT), a more potent variation of testosterone that affects hair and prostate growth, among other functions.
Sometimes, lowering the hormone levels will make the prostate get smaller and improve urine flow. However, in rare cases, these medications may also lead to side effects such as impotence and a decreased sex drive.
Antibiotics may be used if your prostate becomes chronically inflamed from bacterial prostatitis related to BPH.
Treating bacterial prostatitis with antibiotics may improve your symptoms of BPH by reducing the inflammation. However, antibiotics won’t help prostatitis or inflammation that is not caused by bacteria.
There are different types of surgical procedures that can help treat BPH when medications aren’t effective. Some procedures are either noninvasive or minimally invasive and can often be done in your doctor’s office or clinic (outpatient procedures).
Others are more invasive and need to be done in a hospital (inpatient procedures).
Outpatient procedures involve inserting an instrument into your urethra and into the prostate gland. They include:
- Transurethral needle ablation (TUNA). Radio waves are used to scar and shrink prostate tissue.
- Transurethral microwave therapy (TUMT). Microwave energy is used to eliminate prostate tissue.
- Transurethral water vapor therapy (Rezūm). Water vapor is used to destroy excess prostate tissue.
- Water-induced thermotherapy (WIT). Heated water is used to destroy excess prostate tissue.
- High-intensity focused ultrasonography (HIFU). Sonic energy is used to eliminate excess prostate tissue.
- Urolift. The enlarged prostate is surgically lifted with the help of implants so that it doesn’t block the urethra.
Urolift and Rezūm
Inpatient procedures might be recommended if you have any of the following symptoms:
- kidney failure
- bladder stones
- recurrent urinary tract infections
- a complete inability to empty the bladder
- recurrent episodes of blood in the urine
Inpatient procedures include:
- Transurethral resection of the prostate (TURP). This is the most commonly used surgical treatment for BPH and remains the gold standard surgical treatment. Your doctor inserts a small instrument through your urethra into the prostate. The prostate is then removed piece by piece.
- Simple prostatectomy. Your doctor makes an incision in your abdomen or perineum, which is the area behind your scrotum. The inner part of your prostate is removed, leaving the outer part. After this procedure, you may have to stay in the hospital for up to 10 days.
- Transurethral incision of the prostate (TUIP). This is similar to TURP, but your prostate isn’t removed. Instead, a small incision is made in your prostate that will enlarge your bladder outlet and urethra. The incision allows urine to flow more freely. You aren’t always required to stay in a hospital with this procedure.
The symptoms of BPH can be easy to ignore. However, early treatment can help you avoid potentially dangerous complications. Call your doctor if you’re noticing symptoms of BPH.
People with a long-standing history of BPH may develop the following complications:
- urinary tract infections
- urinary stones
- kidney damage
- bleeding in the urinary tract
- a sudden inability to urinate
Sometimes, urinary obstruction from BPH is so severe that no urine can leave the bladder at all. This is called bladder outlet obstruction. It can be dangerous because urine trapped in the bladder can cause urinary tract infections and damage your kidneys.
BPH and prostate cancer don’t share symptoms. Prostate cancer is almost always asymptomatic and identified by either an elevated PSA or prostate nodule. It’s also a more serious condition than BPH.
Your doctor can test to make sure that your symptoms aren’t related to prostate cancer.
BPH doesn’t always require medical treatment. Sometimes, your doctor will want you to have regular checkups to monitor your symptoms and the size of your prostate.
Lifestyle changes, medication, and surgery are all treatment options for symptoms that are affecting your quality of life.
Your doctor will work with you to develop a treatment plan that helps you manage your symptoms and live a healthy life. That’s why it’s important to discuss your symptoms of BPH with your doctor, no matter how minor you feel they may be.