Benign prostatic hyperplasia (BPH) is a condition in which the prostate becomes enlarged, which is why the condition is often referred to as an enlarged prostate. Men who have this condition can have a prostate gland that grows from its normal walnut-size of 20 to 30 grams to as much as 50 to 100 grams.
A common question asked is “What does BPH stand for?” “Benign” refers to the fact that the condition is not cancerous or malignant. “Prostatic” refers to the prostate gland. “Hyperplasia” is the growth of tissue through an increase in the number of cells. Men develop an enlarged prostate either because they experience an increase in the number of cells growing in the prostate, or there is a decrease in the number of cells that die.
You may also see the term “benign prostatic hypertrophy,” which some doctors and laypeople use when referring to the same condition, but technically it is a misnomer. “Hypertrophy” means the growth of tissue through enlargement of existing cells.
All of the symptomsare associated with the transitional zone (the prostate gland has three zones—peripheral, central, and transitional). The signs and symptoms can range from mild to severe and are different for every man. Symptoms of BPH include dribbling after urinating, feeling that the bladder has not emptied completely after urination, frequent urination, an interrupted or weakened urinary stream, the need to push or strain to begin urination, an urgent need to urinate, and blood in the urine. These symptoms occur because the prostate grows either around the urethra (the tube that transports the urine) and squeezes it, or into the urethra. In both cases, urinary flow is affected.
Some men experience other complications as a result of an enlarged prostate. These may include urinary tract infections, bladder stones, and bladder infections. In some men, the bladder itself becomes stretched out, and small veins in the bladder and urethra burst because you need to strain so hard to start the urinary flow. That’s when blood can appear in your urine.
BPH Symptoms Test
To help you determine if you have an enlarged prostate which is affecting your health, you can take the International Prostate Symptoms Test, a seven-question test available online that you can complete in about one minute. It is not an accurate diagnosis but it does give an indication as to whether you should see a specialist about your symptoms.
Diagnosis and Tests
Doctors typically make a diagnosis as part of a general physical examination (which usually includes a digital rectal examination an analysis of any symptoms, and discussion arising from answers to the International Prostate Symptoms Test. Other factors that are part of a diagnosis include questions about medical and social history, problems with mobility, and dietary habits that could have a role in irritating the prostate.
Your doctor may also conduct or order a number of tests to help make a diagnosis, including a PSA test, urinalysis, blood tests, the “long and strong” test, filling cystometry, pressure-flow urodynamic studies, cystoscopy, and ultrasound and imaging tests.
Newly Diagnosed with BPH?
If you are newly diagnosed with an enlarged prostate, you probably have many questions about your enlarged prostate, including signs and symptoms, how doctors are treating the condition, if there is a relationship between an enlarged prostate and erectile dysfunction or prostate cancer, what types of medications are available, and if you can expect complications from any of the current treatment options. To alleviate your concerns, there are steps you can take to reduce your symptoms and put you back on the path to recovery.
Causes and Risk Factors
The cause of BPH is unknown, yet experts widely believe hormonal changes play a major role. One theory is that the prostate glands of older men respond to testosterone in a way that prompts development of an enlarged prostate. Another is that the testosterone produced by the testes is converted to dihydrotestosterone (DHT) and estradiol (estrogen) in some prostate tissues. High levels of DHT are involved in the growth of the prostate.
Although the cause of BPH is still uncertain, experts have composed a list of risk factors. They include age, family history, excessive DHT, elevated estradiol levels, overweight, diabetes, high cholesterol, high blood pressure, metabolic syndrome, atherosclerosis, ethnicity, lifestyle, poor diet, alcohol consumption, and a weakened immune system.
A quick review of the risk factors above reveals that several of them are things men cannot change. However, most of the factors are things over which men have control, and that means active steps can be taken to prevent an enlarged prostate including making adjustments to diet, lifestyle and other matters that do not contribute to men’s health.
Erectile Dysfunction and BPH
The relationship between erectile dysfunction (ED) and BPH is one of great interest to researchers as well as to men who suffer with either or both conditions. Studies indicate that BPH and ED share more than a relationship based on age; there also appears to be an association between ED, an enlarged prostate and the lower urinary tract symptoms that accompany it.
There is also evidence that medications and/or certain treatments for BPH could be among erectile dysfunction causes. On the flip side, the erectile dysfunction drug tadalafil (Cialis) has been approved for treatment of BPH symptoms, opening the door for use of ED drugs as a treatment for BPH.
Treatment depends on the severity of the condition, a man’s treatment preferences, and which other treatment options have already been tried.
- Watchful Waiting. The most basic step is watchful waiting, which is a time when men can take the steps involved in preventing BPH, including diet and lifestyle changes, to help manage an enlarged prostate.
- Drugs. The use of medications is one approach to treatment. Among the options are alpha blockers, which relax the bladder and prostate to improve urinary flow; 5-alpha-reductase inhibitors, which prevent the conversion of testosterone to DHT; and anticholinergics, which manage symptoms of overactive bladder. Read more on drugs for BPH
- Invasive, Non-Surgical Treatment. Treatment may also include the possibility of invasive, non-surgical procedures, including transurethral balloon dilation (TUBD), transurethral needle ablation (TUNA), transurethral microwave thermotherapy (TUMT), insertion of a stent, or a variety of laser procedures such as the photo-selective vaporization of the prostate (PVP), holmium laser treatment (HoLAP), or interstitial laser therapy.
- Surgery. For some men, surgery is the best choice. Among the options are transurethral resection of the prostate (TURP), transurethral incision of the prostate (TUIP), transurethral vaporization of the prostate (TVP), holmium laser enucleation of the prostate (HoLEP), and removal of the prostate, or prostatectomy (radical prostatectomy), which is considered the last resort. The decision to undergo surgery should be made after considering all other possible treatments options.
- Natural and Alternative Treatments. The number of natural BPH treatment options are considerable, and include following a non-inflammatory diet, such as The Prostate Diet, as well as weight loss and exercise, stress reduction, hormone management, and the use of a number of natural supplements for BPH (e.g., saw palmetto, stinging nettle) that can relieve symptoms.
- Can Botox Help with BPH? Although use of Botox for treatment of BPH is still in the early stages, study results thus far have been promising. Botox is being used in clinical studies and has not yet been approved by the Food and Drug Administration for treating BPH.
Supplements. Supplements are a possible alternative to drugs but discuss any natural treatments with a knowledgeable healthcare provider before you begin taking them. Read more on best supplements for BPH
Side Effects of Treatments for BPH
The side effects of treatments for BPH include those associated with the use of drugs, invasive nonsurgical treatments, and surgery, including radical prostatectomy. Among the more common side effects of BPH treatment are urinary incontinence, erectile dysfunction, and retrograde ejaculation. Men should discuss the potential side effects of treatments with their physician so they can make an informed decision about which treatments are best for them.