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
Difficulty starting urine stream or complete inability to
Decreased strength and force of the urine stream
Dribbling after urination ends
Blood in the urine (BPH can cause small blood vessels to
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
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 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
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.
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.
Learn and perform Kegel exercises to strengthen your pelvic floor.
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:
Recurrent blood in the urine
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
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.
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
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
Damage to the kidneys
Blood in the urine
Even after surgical treatment, a recurrence of BPH may develop over
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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.
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