Benign Prostatic Hyperplasia: Symptoms, Causes, and Treatment

Published : Jun 18, 2024

Benign prostatic hyperplasia (BPH) is a disorder in which the prostate gland grows larger. The enlarged prostate might further block or slow down the passage of urine from the urethra. This medical condition affects men after the age of 40 years. Men facing conditions like BPH deal with many lower urinary tract symptoms and cause urinary tract infections in men.

What is Benign Prostatic Hyperplasia?

Benign prostatic hyperplasia, or BPH, is a condition in men where the prostate gland enlarges but is not cancerous. Other terms for this condition include benign prostatic hypertrophy and benign prostatic obstruction.

The prostate gland surrounds the urethra, the tube responsible for carrying urine and semen out of the body. When the prostate gland enlarges, it can compress the urethra, leading to difficulty passing urine and semen through it.

This enlargement can cause symptoms such as difficulty starting urination, reduced urine flow, dribbling at the end of urination, frequent urge to urinate, and urinary tract infections.

As per the studies, it is suggested that the average prostate gland weighs:

25-30g for men between the age group of 40 to 49 years
30-40g for men in 50 to 59 years of age
35-45g for men 60 years and above

Although BPH is a non-cancerous condition, if not treated on time, it can cause bladder infections and other problems.

Symptoms of benign prostatic hyperplasia

Benign prostatic hyperplasia can make you suffer from several symptoms which affect the flow of urine. You can experience more than one symptom at a time. Some of the common symptoms of benign prostatic hyperplasia include:

Sensation of incomplete bladder emptying
Reduced flow of urine
The problem in starting urination or straining to pass urine
Weak urine flow
Acute urinary retention
Recurrent urinary tract infections
Need to start and stop urine several times
Urine that looks or feels different
Dribbling at the end of urine flow
Pain while ejaculation or urination
Need to urinate frequently
Increased urge to get up at night and urinate

If your condition worsens with time, or you do not get the proper treatment, the following symptoms can be experienced:

Blood in urine
Development of bladder stones
Infection in the bladder
Chills or fever while urinating
Damage to kidneys due to backpressure because of urine retention in the bladder
Pus in urine
Suffering from pain in the lower part of your abdomen or genitals while urinating

Causes of benign prostatic hyperplasia

Ageing and hormonal factors can be the primary cause of benign prostatic hyperplasia. Some common causes of benign prostatic hyperplasia include:

Testosterone and estrogen balance:

Males produce testosterone throughout life, along with a small amount of estrogen. Females also produce these hormones, but their bodies make less testosterone and more estrogen.

With age, males start producing less testosterone in comparison to estrogen. It might be the estrogen that triggers growth in the prostate.

Dihydrotestosterone (DHT):

DHT, or Dihydrotestosterone, is another male hormone that develops and grows the prostate. Studies have found that when testosterone levels in men fall, DHT tends to remain high. However, not all men produce DHT and those who do not make it are not at risk of developing BPH. This means men with high DHT levels are at risk of suffering from benign prostatic hyperplasia.

Risk factors for benign prostatic hyperplasia

As a man, you have more risk of developing benign prostatic hyperplasia if you:

Have a family history of BPH
Are 40 years or above
Suffer from erectile dysfunction
Lack of physical exercise and a sedentary lifestyle
Suffer from medical disorders such as obesity, heart problems, and type 2 diabetes

How is benign prostatic hyperplasia diagnosed?

After considering your symptoms, the doctor will conduct some tests to know whether you have benign prostatic hyperplasia. Some common tests include:

Digital rectal exam
Ultrasound
Cystoscopy
Urine tests
Intravenous pyelogram
Prostate-specific antigen test
Urinary flow test
Postvoid residual volume test
Prostate biopsy
Urodynamic and pressure flow studies

Treatment of benign prostate hyperplasia

Nowadays, there are several treatment options for benign prostate hyperplasia. The doctor will first determine the patient's age, underlying cause, overall well-being, and disorder severity.

Some treatment options for benign prostatic hyperplasia include:

Lifestyle changes

For men whose BPH symptoms are mild or slightly bothersome, a doctor might suggest lifestyle changes. Some lifestyle changes include:

Exercising pelvic floor muscles
Decreasing liquid consumption mainly when stepping out in public or before sleeping
Treating or preventing constipation
Training the bladder to hold more urine for a long time
Avoiding the usage of certain medicines such as antidepressants, decongestants, diuretics, and antihistamines

Medicines

To stop the growth, reduce the prostate size, or decrease symptoms of BPH, the doctor might prescribe some medicines. Some common bladder prostate medications recommended include:

Alpha-blockers

Alpha-blockers are a class of medications primarily used to treat high blood pressure problems. These blood pressure medicines help with circulatory system issues, symptoms of an enlarged prostate, and certain tumours. By relaxing the smooth muscle cells in the bladder, neck, and prostate, Alpha-blockers make urination easier and reduce urinary discomfort.

Some commonly used Alpha-blockers are:

Terazosin
Alfuzosin(Uroxatral)
Tamsulosin(Flomax)
Doxazosin (Cardura)
Silodosin (Rapaflo)

5-alpha reductase inhibitors

This class of medications helps to treat an enlarged prostate gland by preventing hormone that leads to prostate cancer growth. 5-alpha reductase inhibitors work by blocking the enzyme known as 5-alpha reductase. This enzyme is responsible for converting testosterone into dihydrotestosterone (DHT), and it induces prostate growth. Thus, by blocking 5-alpha reductase, these drugs shrink the prostate and ease urinary symptoms. Medications that this class includes are:

Finasteride(Proscar)
Dutasteride(Avodart)

Phosphodiesterase-5 inhibitors

PDE5 inhibitors like Tadalafil are among the best choice for the treatment of BPH. Tadalafil is primarily used as an ED medicine, but it is also effective in easing symptoms of an enlarged prostate. As a PDE-5 inhibitor, it acts on the smooth muscle cells of the bladder and prostate. Thus, it helps reduce the flow of urination and effectively prevents symptoms of BPH.

The effects of Tadalafil last for up to 36 hours, and it can be an ideal choice for your Bph symptoms if the doctor suggests it in your case.

Combination medicines

Depending on your medical condition and symptoms, your doctor can suggest combining therapy with the above-listed medicines. It would be best if you take your prescription drugs exactly as prescribed for the treatment to avail maximum benefits.

Minimally invasive procedures

When medicines do not provide relief from benign prostatic hyperplasia symptoms, some minimally invasive procedures can help. These include:

High-intensity focused ultrasound
Transurethral needle ablation
Transurethral resection
Transurethral microwave thermotherapy
Water-induced thermotherapy
Prostatic stent insertion

Surgery

For long-term treatment of benign prostatic hyperplasia, a urologist might suggest removing enlarged prostate tissue or making cuts in your prostate to widen the urethra. Doctors may suggest "transurethral resection", which typically refers to "transurethral resection of the prostate" (TURP), which is a surgical procedure. In some cases, doctors also suggest laser surgery in which a high-energy laser helps to destroy prostate tissue and treat the condition. There are some conditions when a urologist suggests prostate surgery like surgical treatment:

Complications arise
Medicines and minimally invasive procedures are not effective
Symptoms are bothersome or serious

Summary

Therefore, you can prevent benign prostatic hyperplasia by monitoring your fluids, eating a healthy and balanced diet, and avoiding certain medicines. Since BPH is not cancerous, the right treatment can help you control symptoms and prevent severe complications.

FaQs related to BPH:

Can an enlarged prostate go back to normal?

The condition of BPH is not curable, but its treatment may help ease symptoms and provide relief. Mild symptoms can be well treated with common medical treatments like medications and other treatments. At the same time, severe cases may require surgery.

What is the fastest way to shrink an enlarged prostate naturally?

For enlarged prostate treatment, you may try natural therapies, which are based on your behavioural modifications. It includes two voiding exercises and limiting liquid intake before waking. However, severe cases and symptoms that cause instant pain might need to be addressed.

Will BPH lead to prostate cancer?

Benign prostatic hyperplasia(BPH) is a non-cancerous condition of the prostate. Non-cancerous conditions do not spread(metastasize) to other parts of your body, so usually, it's not life-threatening, and BPH does not increase the risk of prostate cancer.