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Table of Contents > Conditions > Benign Prostatic Hyperplasia
Benign Prostatic Hyperplasia
Also Listed As:  BPH; Prostate Enlargement
 
Signs and Symptoms
Causes
Diagnosis
Treatment Approach
Lifestyle
Medications
Surgery and Other Procedures
Nutrition and Dietary Supplements
Herbs
Supporting Research

Benign prostatic hyperplasia (BPH), a noncancerous growth of the prostate gland, makes urination difficult and uncomfortable. The expanding prostate squeezes the urethra, the channel that carries urine from the bladder. Symptoms usually develop in men around age 50. At age 60, most men have some degree of BPH. At age 80, men have an 80 percent chance of experiencing urination problems caused by BPH. BPH is NOT cancer and it does NOT put you at increased risk for developing prostate cancer.


Signs and Symptoms
  • The need to urinate frequently
  • Inability to sleep through the night without getting up to urinate
  • Difficulty starting urine stream or complete inability to urinate
  • Decreased strength and force of the urine stream
  • Dribbling after urination ends
  • Blood in the urine (BPH can cause small blood vessels to burst)

Causes

Nobody knows the basic cause of BPH. Research shows that testosterone, the male hormone, or dihydrotestosterone, a chemical produced when testosterone breaks down in a man's body, may cause the prostate to keep growing. Since it surrounds the urethra, the prostate gland squeezes the urethra as it expands.

Some over-the-counter medications for colds or allergies can drastically worsen BPH.


Diagnosis

Your health care provider may feel your prostate gland directly by putting a gloved finger in your rectum. He or she will also order blood tests and possibly a urine sample. Your health care provider may also ask you to urinate into a device that measures the flow of urine. In intravenous pyelography, your health care provider injects a dye into a vein to make the flow of urine visible on an X ray. In cystoscopy, your provider uses a small probe, passed through your urethra, to directly view the inside of your urethra and bladder. Your penis will be numbed before this procedure.

In addition, you may be asked to complete a self-screening form to evaluate the severity of your symptoms and the impact on your daily life. Your score on the screening tool may be compared to past records to evaluate progression or improvement of the disease.


Treatment Approach

Treatment will depend on your age, overall health, and the severity of the disease. BPH clears up by itself in one-third of mild cases. It is important to receive regular check-ups to monitor the progression of symptoms. Treatment will begin as soon as your symptoms become bothersome, interfering with your lifestyle. There are lots of ways to successfully treat BPH, including some simple lifestyle changes if your symptoms are mild and some very good herbal remedies and medications. IF no other therapies work and the symptoms are severe enough, there are also several types of surgery to correct the condition.


Lifestyle

Many men with BPH have only minor symptoms. Some simple habitual changes may be all that you need to feel better:

  • Urinate when you first get the urge.
  • Go to the bathroom when you have the chance, even if you don't feel a need to urinate.
  • Avoid alcohol and caffeine, especially after dinner. Try not to drink within 2 hours before you go to bed.
  • Spread out your fluid intake throughout the day - avoid drinking large amounts of fluid at one time.
  • Avoid cold and sinus medications. Decongestants and antihistamines can worsen BPH symptoms.
  • Exercise regularly.
  • Learn and perform Kegel exercises to strengthen your pelvic floor.
  • Reduce stress.

Medications
  • Finasteride lowers levels of hormones produced by the prostate, reduces the size of the prostate gland, increases urine flow rate, and decreases symptoms of BPH. It may take 3 to 6 months before you notice a significant improvement in your symptoms. Potential side effects related to use of finasteride include decreased sex drive and impotence.
  • Alpha 1-Blockers (like doxazosin, prazosin, tamsulosin, and terazosin) are a class of medications also used to treat high blood pressure. These medications relax the muscles of the bladder neck, allowing easier urination. Two thirds of the people treated with alpha 1-blocker medications report an improvement in symptoms.
  • Antibiotics may be prescribed to treat chronic prostatitis (inflammation of the prostate), which may accompany BPH. Some men note relief of their BPH symptoms after a course of antibiotics.

Surgery and Other Procedures

Prostate surgery may be recommended if you have:

  • Incontinence
  • Recurrent blood in the urine
  • Urinary retention
  • Recurrent urinary tract infections

The choice of a specific surgical procedure is usually based on the severity of your symptoms and the size and shape of your prostate gland.

  • TURP: Transurethral resection of the prostate (TURP) is the most common surgical treatment for BPH. The TURP is performed by inserting a scope through the penis and removing the prostate piece by piece.
  • TUIP: Transurethral incision of the prostate (TUIP) is similar to TURP, but is usually performed in men who have a relatively small prostate. This procedure is usually performed as an outpatient without need for a hospital stay. Like the TURP, a scope is inserted through the penis until the prostate is reached. Then, rather than removal of the prostate, a small incision is made in the prostatic tissue to enlarge the opening of the urethra and bladder outlet.
  • Open Prostatectomy: An open prostatectomy is usually performed using general or spinal anesthesia. An incision is made through the abdomen or perineal area (i.e., through the pelvic floor, including the region from the scrotum to the anus). Then, the prostate is removed. This is a lengthy procedure, and it usually requires a hospital stay of 5 to 10 days.

The majority of men who have prostate surgery have improvement in urine flow rates and symptoms. Possible complications include impotence, urinary incontinence, retrograde ejaculation (semen flowing back into the bladder rather than out the penis), infertility, and urethral stricture (narrowing). Rates of these complications vary, depending on the surgical procedure that you and your doctor decide is best.

Various studies are underway to evaluate the effectiveness of other treatments, such as hyperthermia, laser therapy, and prostatic stents.


Nutrition and Dietary Supplements

Plant based estrogens (called isoflavones or flavonoids) found in soy and other foods like legumes, tea, apples and onions may help prevent or treat the symptoms of BPH. Research is needed to fully test this idea. In the meantime, talk to your doctor about the safety of adding these food items to your diet.

Eating too much fat (especially in the form of butter or margarine) and not enough fruit may increase your chances of developing BPH.


Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, contain active substances that can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care and only under the supervision of a practitioner knowledgeable in the field of herbal medicine.

Reports claim that as many as 80% of European men with BPH are given the option of herbal remedies for their symptoms, including saw palmetto and stinging nettle roots, rather than medication or surgery. According to research, these herbs may be comparable to finasteride (see Medications) for relieving symptoms of BPH. However, unlike this prescription drug, these herbs do not shrink the prostate gland.

Saw palmetto (Serenoa repens)—Some men have had success taking extracts of saw palmetto berries, an herb that has been used to ease prostate symptoms. Look for fat-soluble saw palmetto extract that has been standardized to contain 85% to 95% fatty acids and sterols.

Stinging nettle root (Urtica dioica) — Studies suggest that the root of the stinging nettle, in combination with saw palmetto, may be an effective treatment for BPH, relieving urinary symptoms such as reduced urinary flow, incomplete emptying of the bladder, post urination dripping, and the constant urge to urinate.

Pumpkin seed extract (Curcurbita pepo)- especially in combination with saw palmetto extract may improve urinary flow and decrease frequency of urination.

African plum extract (Pygeum africanum)- may help diminish nighttime urination; more research is needed.

Red clover (Trifolium pretense)- reduces enlargement of non-cancerous prostate cells in mice. Research in people is needed.

Prognosis and Complications

While the majority of men get better with treatment of BPH, men who have had long-standing BPH may develop:

  • Sudden inability to urinate
  • Urinary tract infections
  • Urinary stones
  • Damage to the kidneys
  • Blood in the urine

Even after surgical treatment, a recurrence of BPH may develop over time.


Supporting Research

Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, Mass: Integrative Medicine Communications; 1998:201.

Bondarenko B, Walther C, Funk P, Schlafke S, Engelmann U. Long-term efficacy and safety of PRO 160/120 (a combination of sabal and urtica extract) in patients with lower urinary tract symptoms (LUTS). Phytomedicine. 2003:10 Suppl 4:53-55.

Braeckman J. The extract of Serenoa repens in the treatment of benign prostatic hyperplasia: A multicenter open study. Curr Therapeut Res. 1994;55:776-785.

Chapple CR. Clinical study of benign prostatic disease, current concepts and future prospects randomized controlled trials versus real life practice. Curr Opin Urol. 2003;13(1):1-5.

Denis L, Morton MS, Griffiths K. Diet and its preventive role in prostatic disease. Eur Urol. 1999;35(5-6):377-387.

Di Silverio F, D'Eramo G, Lubrano C, et al. Evidence that Serenoa repens extract displays an antiestrogenic activity in prostatic tissue of benign prostatic hypertrophy patients. Eur Uro.1992;21:309-314.

Ernst E. Herbal medications for common ailments in the elderly. Drugs Aging. 1999;15(6):423-428.

Ernst E. The risk-benefit profile of commonly used herbal therapies: Ginkgo, St. John's Wort, Ginseng, Echinacea, Saw Palmetto, and Kava. Ann Intern Med. 2002;136(1):42-53.

Gerber GS. Saw palmetto for the treatment of men with lower urinary tract symptoms. J Urol. 2000;163(5):1408-1412.

Gerber GS, Kuznetsov D, Johnson BC, Burstein JD. Randomized, double-blind, placebo-controlled trial of saw palmetto in men with lower urinary tract symptoms. Urology. 2001;58(6):960-965.

Goepel M, Hecker U, Krege S. Saw palmetto extracts potently and noncompetitively inhibit human a1-adrenoceptors in vitro. Prostate. 1998;38(3):208-215.

Gordon AE, Shaughnessy AF. Saw palmetto for prostate disorders. Am Fam Physician. 2003;67(6):1281-1283.

Jarred RA, McPherson S, Jones ME, Simpson ER, Risbridger GP. Anti-androgenic activity by red clover-derived dietary isoflavones reduces non-malignant prostate enlargement in aromatase knockout (ArKo) mice. Prostate. 2003;56(1):54-64.

Johnstone PA, Bloom TL, Niemtzow RC, Crain D, Riffenburgh RH, Amling CL. A prospective, randomized pilot trial of acupuncture of the kidney-bladder distinct meridian for lower urinary tract symptoms. J Urol. 2003;169(3):1037-1039.

Katz AE. Flavonoid and botanical approaches to prostate health. J Altern Complemet Med. 2002;8(6):813-821.

Klingler HC. New innovative therapies for benign prostatic hyperplasia: any advance? Curr OpinUrol. 2003;13(1):11-15.

Koch E. Extracts from fruits of saw palmetto (Sabal serrulata) and roots of stinging nettle (Urtica dioica): viable alternatives in the medical treatment of benign prostatic hyperplasia and associated lower urinary tracts symptoms. Planta Med. 2001;67(6):489-500.

Krzeski T, Kazon M, Borkowski A, Witeska A, Kuczera J. Combined extracts of Urtica dioica and Pygeum africanum in the treatment of benign prostatic hyperplasia: double-blind comparison of two doses. Clin Ther. 1993;15:1011-1020.

Lagiou P, Wuu J, Trichopoulou A, Hsieh CC, Adami HO, Trichopoulos D. Diet and benign prostatic hyperplasia: a study in Greece. Urology. 1999;54(2):284-290.

Managing lower urinary tract symptoms in men. Drug Ther Bull. 2003;41(3):18-21.

Marks LS, Partin AW, Epstein JI, et al. Effects of saw palmetto herbal blend in men with symptomatic benign prostatic hyperplasia. J Urol. 2000;163(5):1451-1456.

Moyad MA. Zinc for prostate disease and other conditions: a little evidence, lot of hype, and a significant potential problem. Urol Nurs. 2004;24(1):49-52.

Pittler MH. Complementary therapies for treating benign prostatic hyperplasia. FACT. 2000;5(4):255-257.

Rotblatt M, Ziment I. Evidence-Based Herbal Medicine. Philadelphia, Penn: Hanley & Belfus, Inc.; 2002:327-331.

Suzuki S, Platz EA, Kawachi I, Willett WC, Giovannucci E. Intakes of energy and macronutrients and the risk of benign prostatic hyperplasia. Am J Clin Nutr. 2002;75(4):689-697.

Willets KE, Clements MS, Champion S, Ehsman S, Eden JA. Serenoa repens extract for benign prostate hyperplasia: a randomized controlled trial. BJU Int. 2003;92(3):267-270.

Wilt TJ, Ishani A, Rutks I, MacDonald R. Phytotherapy for benign prostatic hyperplasia.
Public Health Nutr. 2000;3(4A):459-472.

Wilt TJ, Ishani A, Stark G, MacDonald R, Lau J, Mulrow C. Saw palmetto extracts for treatment of benign prostatic hyperplasia: a systemic review. JAMA. 1998;280(18):1604-1609.


Review Date: April 2004
Reviewed By: Participants in the review process include: Jacqueline A. Hart, MD, Department of Internal Medicine, Newton-Wellesley Hospital, Boston, Ma., and Senior Medical Editor, A.D.A.M., Inc. R. Lynn Shumake, PD, Director, Alternative Medicine Apothecary, Blue Mountain Apothecary & Healing Arts, University of Maryland Medical Center, Glenwood, MD; Tom Wolfe, P.AHG, Smile Herb Shop, College Park, MD.

Copyright © 2004 A.D.A.M., Inc

The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application, use, or misuse of any of the information contained herein, including any injury and/or damage to any person or property as a matter of product liability, negligence, or otherwise. No warranty, expressed or implied, is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor, pharmacist, nurse, or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage, precautions, warnings, interactions, and contraindications before administering any drug, herb, or supplement discussed herein.

 
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