Benign prostatic hyperplasia (BPH) — also called prostate gland enlargement — is a common condition as men get older. An enlarged prostate gland can cause uncomfortable urinary symptoms, such as blocking the flow of urine out of the bladder. It can also cause bladder, urinary tract or kidney problems.
The severity of symptoms in people who have prostate gland enlargement varies, but symptoms tend to gradually worsen over time. Common signs and symptoms of BPH include:
- Frequent or urgent need to urinate
- Increased frequency of urination at night (nocturia)
- Difficulty starting urination
- Weak urine stream or a stream that stops and starts
- Dribbling at the end of urination
- Inability to completely empty the bladder
Less common signs and symptoms include:
- Urinary tract infection
- Inability to urinate
- Blood in the urine
The size of your prostate doesn’t necessarily determine the severity of your symptoms. Some men with only slightly enlarged prostates can have significant symptoms, while other men with very enlarged prostates can have only minor urinary symptoms. In some men, symptoms eventually stabilize and might even improve over time.
Causes and Risk Factors
The prostate gland is located beneath your bladder. The tube that transports urine from the bladder out of your penis (urethra) passes through the center of the prostate. When the prostate enlarges, it begins to block urine flow. It isn’t entirely clear what causes the prostate to enlarge. However, it might be due to changes in the balance of sex hormones as men grow older.
Risk factors for prostate gland enlargement include:
- Aging : Prostate gland enlargement rarely causes signs and symptoms in men younger than age 40. About one-third of men experience moderate to severe symptoms by age 60, and about half do so by age 80.
- Family history : Having a blood relative, such as a father or a brother, with prostate problems means you’re more likely to have problems.
- Diabetes and heart disease : Studies show that diabetes, as well as heart disease and use of beta blockers, might increase the risk of BPH.
- Lifestyle : Obesity increases the risk of BPH, while exercise can lower the risk.
Complications of an enlarged prostate can include:
- Sudden inability to urinate (urinary retention) : The need to have a tube (catheter) inserted into the bladder to drain the urine. Some men with an enlarged prostate need surgery to relieve urinary retention.
- Urinary tract infections (UTIs) : Inability to fully empty the bladder can increase the risk of infection in the urinary tract. If UTIs occur frequently, surgery will be needed to remove part of the prostate.
- Bladder stones : These are generally caused by an inability to completely empty the bladder. Bladder stones can cause infection, bladder irritation, blood in the urine and obstruction of urine flow.
- Bladder damage : A bladder that hasn’t emptied completely can stretch and weaken over time. As a result, the muscular wall of the bladder no longer contracts properly, making it harder to fully empty the bladder.
- Kidney damage : Pressure in the bladder from urinary retention can directly damage the kidneys or allow bladder infections to reach the kidneys.
Most men with an enlarged prostate don’t develop these complications. However, acute urinary retention and kidney damage can be serious health threats. Having an enlarged prostate is not believed to increase the risk of developing prostate cancer.
What You Can do When Diagnosed With Prostate Enlargement
A wide variety of treatments are available for enlarged prostate, including medication, minimally invasive therapies and surgery. The best treatment choice depends on several factors, including:
- The size of the prostate
- Overall health
- The amount of discomfort or bother you are experiencing.
If the symptoms are tolerable, you might decide to postpone treatment and simply monitor your symptoms. For some men, symptoms can ease without treatment.
Medication is the most common treatment for mild to moderate symptoms of prostate enlargement. The options include:
- Alpha blockers – These medications relax bladder neck muscles and muscle fibers in the prostate, making urination easier. Alpha blockers — which include alfuzosin (Uroxatral), doxazosin (Cardura), tamsulosin (Flomax) and silodosin (Rapaflo) — usually work quickly in men with relatively small prostates. Side effects might include dizziness and a harmless condition in which semen goes back into the bladder instead of out the tip of the penis (retrograde ejaculation).
- 5-alpha reductase inhibitors – These medications shrink your prostate by preventing hormonal changes that cause prostate growth. These medications — which include finasteride (Proscar) and dutasteride (Avodart) — might take up to six months to be effective. Side effects include retrograde ejaculation.
- Combination drug therapy – Your doctor might recommend taking an alpha blocker and a 5-alpha reductase inhibitor at the same time if either medication alone isn’t effective.
- Tadalafil (Cialis) – Studies suggest this medication, which is often used to treat erectile dysfunction, can also treat prostate enlargement.
Minimally invasive or surgical therapy might be recommended if:
- The symptoms are moderate to severe.
- Medication has not relieved the symptoms.
- Urinary tract obstruction, bladder stones, blood in the urine or kidney problems.
- You prefer definitive treatment.
Minimally invasive or surgical therapy might not be an option if you have:
- An untreated urinary tract infection.
- Urethral stricture disease.
- A history of prostate radiation therapy or urinary tract surgery.
- A neurological disorder, such as Parkinson’s disease or multiple sclerosis.
There are several types of minimally invasive or surgical therapies which include;
Transurethral resection of the prostate (TURP) : A lighted scope is inserted into the urethra, and the surgeon removes all but the outer part of the prostate. TURP generally relieves symptoms quickly, and most men have a stronger urine flow soon after the procedure. After TURP you might temporarily need a catheter to drain your bladder.
Transurethral incision of the prostate (TUIP) : A lighted scope is inserted into your urethra, and the surgeon makes one or two small cuts in the prostate gland — making it easier for urine to pass through the urethra. This surgery might be an option if their is a small or moderately enlarged prostate gland, especially if problems that make other surgeries too risky.
Transurethral microwave thermotherapy (TUMT) : The doctor inserts a special electrode through the urethra into the prostate area. Microwave energy from the electrode destroys the inner portion of the enlarged prostate gland, shrinking it and easing urine flow. TUMT might only partially relieve symptoms, and it might take some time before notice results. This surgery is generally used only on small prostates in special circumstances because re-treatment might be necessary.
Transurethral needle ablation (TUNA) : In this outpatient procedure, a scope is passed into the urethra, allowing doctor to place needles into the prostate gland. Radio waves pass through the needles, heating and destroying excess prostate tissue that’s blocking urine flow. This procedure might be a good choice if you bleed easily or have certain other health problems. However, like TUMT, TUNA might only provide partial relief and results might take some time.
Laser therapy : A high-energy laser destroys or removes overgrown prostate tissue. Laser therapy generally relieves symptoms right away and has a lower risk of side effects than does nonlaser surgery. Laser therapy might be used in men who shouldn’t have other prostate procedures because they take blood-thinning medications.
The options for laser therapy include:
- Ablative procedures. These procedures vaporize obstructive prostate tissue to increase urine flow. Examples include photoselective vaporization of the prostate (PVP) and holmium laser ablation of the prostate (HoLAP). Ablative procedures can cause irritating urinary symptoms after surgery, so in rare situations another resection procedure might be needed at some point.
- Enucleative procedures. Enucleative procedures, such as holmium laser enucleation of the prostate (HoLEP), generally remove all the prostate tissue blocking urine flow and prevent regrowth of tissue. The removed tissue can be examined for prostate cancer and other conditions. These procedures are similar to open prostatectomy.
Prostate lift : In this experimental transurethral procedure, special tags are used to compress the sides of the prostate to increase the flow of urine. Long-term data on the effectiveness of this procedure aren’t available.
Embolization : In this experimental procedure, the blood supply to or from the prostate is selectively blocked, causing the prostate to decrease in size. Long-term data on the effectiveness of this procedure aren’t available.
Open or robot-assisted prostatectomy :
The surgeon makes an incision in your lower abdomen to reach the prostate and remove tissue. Open prostatectomy is generally done if you have a very large prostate, bladder damage or other complicating factors. The surgery usually requires a short hospital stay and is associated with a higher risk of needing a blood transfusion.
Any type of prostate procedure can cause side effects. Depending on the procedure you choose, complications might include:
- Semen flowing backward into the bladder instead of out through the penis during ejaculation (retrograde ejaculation).
- Temporary difficulty with urination.
- Urinary tract infection.
- Erectile dysfunction.
- Very rarely, loss of bladder control (incontinence).
Lifestyle and Home Remedies You Can Adopt
To help control the symptoms of an enlarged prostate, try to:
- Limit beverages in the evening. Don’t drink anything for an hour or two before bedtime to avoid middle-of-the-night trips to the toilet.
- Limit caffeine and alcohol. They can increase urine production, irritate the bladder and worsen symptoms.
- Limit decongestants or antihistamines. These drugs tighten the band of muscles around the urethra that control urine flow, making it harder to urinate.
- Go when you first feel the urge. Waiting too long might overstretch the bladder muscle and cause damage.
- Schedule bathroom visits. Try to urinate at regular times — such as every four to six hours during the day — to “retrain” the bladder. This can be especially useful if you have severe frequency and urgency.
- Follow a healthy diet. Obesity is associated with enlarged prostate.
- Stay active. Inactivity contributes to urine retention. Even a small amount of exercise can help reduce urinary problems caused by an enlarged prostate.
- Urinate — and then urinate again a few moments later. This practice is known as double voiding.
- Keep warm. Colder temperatures can cause urine retention and increase the urgency to urinate.