Benign prostatic hyperplasia: Signs and treatments

 

If you’re a man in your 50s or older there’s a reasonably good chance you’re experiencing a condition called benign prostatic hyperplasia (BPH) to some degree or other. The medical term for an enlarged prostate, BPH causes difficulties with urination, but it’s not the same as prostate cancer nor does it increase your risk of developing cancer (i). And while it can be quite troublesome, in most cases BPH is not a serious threat to health. 
 

 

What is benign prostatic hyperplasia?

 
A walnut-sized gland found in the pelvis, the prostate lies between the penis and the bladder and is wrapped around the urethra (the tube that carries urine from the bladder down through the penis). It’s important for a man’s sex life as it produces prostatic fluid, which is a fluid found in semen. However when the number of cells in the prostate start to increase (hyperplasia) – a process that usually begins when a man reaches 25 years old (ii) – it gradually makes the gland bigger. In time this can affect how you pass urine because it puts pressure on your bladder and urethra.
 
BPH is the most common of three main health conditions that involve the prostate (the other two being prostatitis and prostate cancer). Indeed, according to the charity Prostate Cancer UK, around one in three men over the age of 50 has urinary symptoms, the most common cause of which is an enlarged prostate (iii).
 
Meanwhile The Urology Foundation estimates 50 percent of men in their 50s and 60s have an enlarged prostate, with the incidence rising to 90 percent in men older than 80 years of age (iv). Up to three million men in the UK have lower urinary tract symptoms associated with prostate enlargement, the charity adds. BPH can affect younger men too, though this isn’t common.
 

Who is at risk of benign prostatic hyperplasia?

 
Age, then, is a major risk factor for an enlarged prostate. But while more studies are needed to confirm it, the condition may also be more prevalent in men who have:
 

• A family history of BPH

• An inactive lifestyle

• A medical condition such as cardiovascular disease, type 2 diabetes, high blood pressure, erectile dysfunction or obesity

 
Some of these medical conditions, however, are associated with the natural ageing process, so they may not be directly linked with prostate enlargement.
 

What causes prostate enlargement?

 
Nobody really understands exactly what causes BPH, but experts believe it’s connected to hormonal changes that happen in men as they get older. Two hormones are thought to be involved:
 

Testosterone

 
Testosterone is a male hormone that decreases in level as men get older. Men also produce small amounts of the female hormone oestrogen. But when their testosterone levels drop with age, the balance of testosterone to oestrogen in men changes. According to the US National Institutes of Health, scientific studies have suggested this higher proportion of oestrogen within the prostate may trigger the increased production of cells (ii)
 

Dihydrotesterone

 
Dihydrotesterone (DHT) is another male hormone that plays a role in prostate development and growth. Some experts believe DHT continues to be produced in men, even when their testosterone levels decrease, and this may lead to an increase in the number of prostate cells. This idea is reinforced by the discovery by some scientists that men who do not produce any DHT don’t develop BPH (ii) (indeed men who have had their testicles removed also don’t develop it).
 
BPH can also be caused by other prostate-related conditions such as prostate cancer and prostatitis.
 

Symptoms of enlarged prostate

 
In some men the symptoms of an enlarged prostate are so mild, they don’t need any treatment – some even have no symptoms at all. In others, however, the symptoms – called lower urinary tract symptoms – can be more problematic and can have a significant effect on your day-to-day life.
 
Interestingly the size of your prostate doesn’t necessarily determine how bad your symptoms will be, since some men with much enlarged prostates have few symptoms while others with only slightly enlarged prostates can experience more and more severe symptoms.
 
The most common symptoms include:
 

• A weak urine stream that usually means you take longer to empty your bladder than normal (often the flow will stop and start)

• Having an urgent need to pass urine (this can lead to urinary incontinence if you can’t get to a toilet quickly)

• Straining while passing urine

• Leaking urine when you cough, sneeze, or lift something heavy (stress incontinence)

• Having to wait for a while before the urine starts to flow (this is sometimes called hesitancy)

• Incomplete emptying of your bladder

• Dribbling at the end of passing urine

• Passing more urine more often than normal (more than eight times a day), including at night (you may even have to get up several times during the night to urinate – this is called nocturia)

 
Blood in your urine – or haematuria – is also a symptom of an enlarged prostate, but it isn’t very common and is usually caused by another condition (see your GP if this happens).
 
Symptoms tend to be mild to begin with, but in time they can become more severe and therefore have a bigger impact on your everyday life.
 

Is an enlarged prostate serious?    

 
If left untreated for months or years, enlarged prostate symptoms can cause complications such as:
 

• Acute urinary retention – this is when your bladder becomes suddenly and totally blocked, which means you cannot urinate at all. Acute urinary retention can be very painful, and you may need emergency treatment to drain the bladder (call 999 for an ambulance if this happens to you or someone you know). It can develop in men who haven’t previously had any prostate-related symptoms, but it’s more common if you already have moderate or severe urinary symptoms as a result of having an enlarged prostate. According to the NHS acute urinary retention happens in fewer than one in 100 men with an enlarged prostate each year (v)

•  Chronic urinary retention – unlike acute urinary retention this doesn’t cause a total blockage of the bladder, but it does mean that you can only pass some of the urine in your bladder when you try to empty it. This leaves some urine constantly in the bladder, which can cause frequent urinary tract infections or incontinence caused by dribbling.

• Sexual problems can happen in a small number of men with prostate enlargement, including erection difficulties, pain on ejaculation and releasing smaller amounts of semen during ejaculation

• Problems with kidney function can also happen as a complication of prostate enlargement, but they aren’t very common these days

 

Should you see your GP?

 
It’s a good idea to seek medical advice if you notice any changes or problems with urination if you’re a man of any age. Even if you’re having very mild urinary symptoms, it’s important to see a doctor, since those symptoms could be caused by another condition that needs to be investigated. Always consult your GP if you have blood in your urine.
 

What are the benign prostatic hyperplasia treatments?

 
If you’ve had tests and the results show you have an enlarged prostate, you may or may not need treatment, depending on how bad your symptoms are and how much they’re affecting your quality of life. If your symptoms are mild you may be advised to just wait and see if they develop. Indeed, the symptoms of BPH don’t always worsen, and they may even improve.
 
If your symptoms are more troublesome, there are several treatment options available. However, having treatment for prostate enlargement isn’t likely to clear all your symptoms completely, though it often improves them.
 
In the first instance, you’re likely to be offered medication. There are two main types of medicines used to treat prostate enlargement:
 

• Alpha-blockers are drugs that relax the muscle in your prostate and at the base of your bladder, which can help you urinate more easily

• 5-alpha reductase inhibitors block an enzyme called 5-alpha reductase, which stops your prostate converting testosterone to dihydrotestosterone (this helps shrink an enlarged prostate)

 
Other medicines that are sometimes used to treat the symptoms of an enlarged prostate include diuretics and desmopressins, which both help with nighttime urination, anticholinergics to relax an overactive bladder muscle and a drug called mirabegron, which relaxes the muscles around your bladder.
 

Surgical options for an enlarged prostate

 
According to Patient UK, around one in four men with prostate enlargement has an operation as part of their treatment (vi). There are several different types of surgery used to treat prostate enlargement in men who have severe symptoms or when medication hasn’t helped. These include:
 

• Transurethral resection of the prostate (TURP) is the most common operation for prostate enlargement (vi), where an instrument called a cystoscope is inserted through the urethra into the bladder under anaesthetic

• Transurethral incision of the prostate (TUIP) is often used in men who have a slightly enlarged prostate

• Open prostatectomy involves cutting the skin to get to the prostate. It’s only performed when the prostate is very large, and it isn’t often performed these days.

• Laser prostatectomy achieves the same as an open prostatectomy, but as the procedure is performed with a laser it has fewer side-effects and often only needs a one-night stay in hospital

 
In each of the above, the procedure works by removing part of the prostate to improve the flow of urine. Other procedures include one that places a device through the urethra to lift and hold the enlarged prostate tissue out of the way, and another that injects water vapour into the prostate to shrink it.
 
In cases where surgery isn’t a suitable option, catheters can be used to drain the bladder (these can be removable, or they may remain in your bladder for longer periods).
 

What is the lifestyle advice for BPH?    

 
Lifestyle changes are part of the overall treatment for prostate enlargement. Indeed, the NHS says you may be able to relieve your symptoms by making some simple changes to your lifestyle (vii) – here are some of the things you may be advised to do:
 

1. Cut back on alcohol, caffeine, artificial sweeteners, and fizzy drinks as these can all irritate your bladder and make your symptoms worse.

2. Eat plenty of fibre to reduce your risk of constipation (this can put pressure on your bladder). Foods that are rich in fibre include fruit, vegetables, and whole grains.

3. Keep your weight at a healthy level, as there’s some evidence being overweight is linked with the risk of developing an enlarged prostate (viii). If you think you may need to lose weight, speak to your GP about support that may be available to you.

4. Drink less before bedtime to help prevent getting up at night to urinate. You should still drink plenty of fluids during the daytime, just try to stop two hours before going to sleep.

5. Stay moderately active, as regular exercise may help improve your symptoms.

6. Make sure any medicines you’re taking aren’t making your symptoms worse (check the patient information leaflet for possible side effects – for instance, some prescription and over-the-counter medicines such as antihistamines and decongestants can make urinary symptoms worse). If any of your medicines is a problem, talk to your GP about possible alternatives or changing the dosage or the time when you take them.

7. If leaking is a problem try using absorbent pads or underwear – or if you’re having trouble with dribbling you may want to try urinary sheaths (these look like condoms that have tubes at the end that connect to bags). All of these are available online.

 
There are also some techniques you can try that might be helpful. For instance, double voiding is where you wait a few moments after you’ve finished urinating, then trying to go again (however don’t strain when you do this). Another technique is called bladder training, which can help you to urinate less frequently. Your GP can tell you more about bladder training, including the exercises you can do to distract your mind when you feel you need to urinate.
 

Supplements for prostate support

 
Nutritional supplements for prostate enlargement are another option, though as of yet there hasn’t been a huge amount of good-quality human research carried out that might prove their effectiveness. However, some may be worth a try if your symptoms are mild and your doctor agrees they’re suitable, including:
 

Zinc  

This key nutrient is often considered important for prostate health, since studies suggest prostate enlargement may be linked with low levels of zinc in the blood and tissues (ix). However, results of studies that look at whether taking zinc supplements might reduce BPH risk are mixed, with some saying they probably do and others suggesting they probably don’t. If you’re not sure, ask your GP if taking zinc might be suitable for you. You can also get more zinc in your diet by eating whole grains, nuts, pumpkin seeds, lentils, beans, poultry, eggs, red meat and seafood (oysters are thought to be the best source).
 

Saw palmetto  

A native plant of North America, saw palmetto contains a wide range of biologically active chemicals. It’s one of the most commonly used ingredients in prostate health supplements, and there is some evidence it may be helpful for prostate enlargement. One older study suggests a commercial saw palmetto supplement, at a level of 320mg, is at least as effective as conventional BPH treatments but without their side effects (x). A more recent study involving 165 men found saw palmetto capsules, when taken for six and 12 weeks, may improve urinary symptoms, leading the researchers to conclude they are safe and effective for the treatment of BPH (xi).
 
Nutrition experts advise taking saw palmetto for at least three months before assessing if it’s suitable for you.
 

Beta sitosterol  

A mixture of cholesterol-like plant compounds called sitosterols and sitosterolins, beta-sitosterol is principally used for the treatment of BPH. Studies suggest taking beta-sitosterol may help reduce some prostate enlargement symptoms, including urine flow problems (xii) – and while it’s not exactly clear how beta-sitosterol works, it may have something to do with the compound’s antioxidant and anti-inflammatory properties (xiii).
 

Vitamin D 

In addition to zinc, low levels of vitamin D have been associated with BPH (xiv). A review of studies concludes vitamin D shows promise in reducing prostate cells, claiming increased intake of vitamin D through diet and supplements is linked with fewer cases of prostate enlargement (xv).
 
Sunlight is our main source of vitamin D, but it’s also found in a small number of foods including oily fish, egg yolks, red meat and fortified foods. The recommended form of vitamin D for supplements is vitamin D3 or cholecalciferol, as it’s the natural form of vitamin D that the body makes when it’s exposed to sunlight. Vegetarian vitamin D supplements – including easy-to-take drops – are widely available, but some aren’t suitable for vegans (look for vegan vitamin D3 supplements sourced from lichen).
 
Meanwhile an older study involving 45 men with BPH has found a combination of amino acid supplements – namely glutamic acid, alanine, and glycine – may be effective in reducing urinary symptoms, though the author of the report didn’t clarify how the supplements might work (xvi).
 

Can prostate enlargement be prevented?

 
Since BPH appears to be a natural part of ageing for most men – as natural as greying hair, for instance – at the moment there’s no likely way to prevent it. Being aware of the symptoms, however, could help you manage an enlarged prostate early, which may in turn help reduce any negative effect it might have on your quality of life.
 

Need more information?

 
There’s more information about BPH and other prostate-related conditions in our guide to prostate health. Meanwhile you can stay informed by visiting the men’s health section of our pharmacy health library. 

 

References:

1. Available online: https://www.nhs.uk/conditions/prostate-enlargement/

2. Available online: https://www.niddk.nih.gov/health-information/urologic-diseases/prostate-problems/prostate-enlargement-benign-prostatic-hyperplasia

3. Available online: https://prostatecanceruk.org/prostate-information-and-support/just-diagnosed/other-prostate-problems/enlarged-prostate

4. Available online: https://www.theurologyfoundation.org/professionals/healthcare-resources-and-reports/urology-resources/facts-and-figures/prostate-related-statistics

5. Available online: https://www.esht.nhs.uk/wp-content/uploads/2017/06/0392.pdf

6. Available online: https://patient.info/mens-health/prostate-and-urethra-problems/prostate-gland-enlargement

7. Available online: https://www.nhs.uk/conditions/prostate-enlargement/treatment/

8. Wang S et al., Body mass index and risk of BPH: a meta-analysis. Prostate Cancer Prostatic Dis. 2021 Sep;15(3):265-72. Available online: https://www.nature.com/articles/pcan201165

9. Christudoss P et al., Zinc status of patients with benign prostatic hyperplasia and prostate carcinoma. Indian J Urol. 2011 Jan-Mar;27(1):14-18. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3114577/

10. Carraro JC et al., Comparison of phytotherapy (Permixon) with finasteride in the treatment of benign prostate hyperplasia: a randomized international study of 1,098 patients. Prostate. 1996;29:231-240. Available online: https://onlinelibrary.wiley.com/doi/10.1002/(SICI)1097-0045(199610)29:4<231::AID-PROS4>3.0.CO;2-E

11. Xiao-bing Ju et al., Efficacy and safety of Saw Palmetto Extract Capsules in the treatment of benign prostatic hyperplasia (article in Chinese). Zhonghua Nan Ke xue. 2015 Dec;21(12):1098-101. Available online: https://pubmed.ncbi.nlm.nih.gov/26817302/

12. Berges RR et al., Randomised, placebo-controlled, double-blind clinical trial of beta-sitosterol in patients with benign prostatic hyperplasia. Lancet. 1995;345:1529-1532. Available online: https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(95)91085-9.pdf
    
    Klippel KF, Hiltl DM, Schipp B. (1997). A multicentric, placebo-controlled, double-blind clinical trial of beta-sitosterol (phytosterol) for the treatment of benign prostatic hyperplasia. Br J Urol, 80, 427-432. Available online: https://pubmed.ncbi.nlm.nih.gov/9313662/

13. Bin Sayeed MS et al., Critical Analysis on Characterization, Systemic Effect, and Therapeutic Potential of Beta-Sitosterol: A Plant-Derived Orphan Phytosterol. Medicines. 2016 Dec;3(4):29. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5456237/

14. Yalcinkaya S et al., Deficiency of vitamin D and elevated aldosterone in prostate hyperplasia. Adv Clin Exp Med. 2014 May-Jun;23(3):441-6. Available online: http://www.advances.umed.wroc.pl/en/article/2014/23/3/441/
    
    Zhang W et al., Vitamin D Deficiency as a Potential Marker of Benign Prostatic Hyperplasia. Urology. 2016 Nov;97:212-218. Available online: https://www.goldjournal.net/article/S0090-4295(16)30308-9/fulltext

15. Espinosa G et al., Vitamin D and benign prostatic hyperplasia — a review. Can J Urol. 2013 Aug;20(4):6820-5. Available online: https://www.canjurol.com/abstract.php?ArticleID=&version=1.0&PMID=23930605

16. Damrau, F. (1962). Benign Prostatic Hypertrophy: Amino Acid Therapy for Symptomatic Relief. Am J Feriatr, 10, 426-430. Available online: https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.1962.tb00317.x

 

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Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.

 

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