Enlarged Prostate (Benign Prostatic Hyperplasia)
BPH (benign prostatic hyperplasia) is an enlargement of the prostate that is common in men over 40—not just in the United States, but throughout the world. The prostate is a walnut-size gland in men located just below the bladder. It wraps around the urethra, the tube that carries urine from the bladder out through the penis. Normally, the prostate produces the seminal fluid that carries sperm outward during an ejaculation. If the gland enlarges, however, it can interfere with urination.
Many people fear that an enlarged prostate is a prelude to prostate cancer, or is cancer, but this is not the case. Hyperplasia simply means an overgrowth of cells. Although BPH can cause unpleasant symptoms, such as the need to urinate frequently, it is not harmful in itself—hence the term “benign.” After age 60 more than half of all men have some degree of BPH.
BPH does not affect sexual function.
Symptoms of BPH
In some cases, there are no symptoms.
- More urgent and frequent need to urinate
- Feeling as though you still have to urinate, even after the flow has stopped (sensation that the bladder is not completely empty)
- Awakening at night with the need to urinate
- Straining during urination
- A stop-and-start flow of urine, difficulty starting urination (urinary hesitancy) or urinary dribbling after urination
- Decreased volume and force of urine stream
- Bloody urine (hematuria)
What Causes BPH?
No one knows what causes BPH. Diet has no known connection with this condition, but heredity may be a factor in its development. Another theory is that BPH is caused by normal changes in hormone levels, especially a drop in testosterone. (Testosterone therapy, however, is not a safe or recognized treatment for BPH.) Still another theory is that a substance called dihydrotestosterone (DHT), produced by aging men, promotes cell growth.
What If You Do Nothing?
Because urinary discomfort is largely subjective, how aggressively to deal with BPH is largely up to the patient. For men with mild symptoms, “watchful waiting” is usually the best course, since mild symptoms sometimes clear up or remain stable without treatment. Studies show that about 40 percent of men with mild symptoms improve without treatment, 45 percent continue with no change, and only 15 percent deteriorate. You should nonetheless get regular checkups to monitor the condition.
BPH requires treatment only if the symptoms are truly bothersome and begin to limit a man’s activities, or if the urinary tract is threatened. Sometimes urinary flow stops altogether, which is a life-threatening medical emergency.
Home Remedies for BPH
The following lifestyle changes can help manage mild BPH. Keep in mind that you should have regular checkups if you have BPH.
- Avoid certain medications. Avoid tranquilizers, as well as over-the-counter cold remedies containing decongestants and antihistamines. These can worsen urinary symptoms.
- Cut down on fluids—especially alcoholic beverages—in the evening. This will decrease the need to urinate during the night.
- Go easy on caffeinated drinks. These are diuretics, which don’t help and can be harmful.
There are no measures known to prevent BPH.
Beyond Home Remedies: When To Call Your Doctor
If you have any urinary difficulties, it’s wise to discuss them with your doctor. They may be caused by something more serious that needs immediate treatment.
Herbs and the Prostate
Plant-derived substances used as drugs are in wide use for treating BPH in Europe, and indeed are preferred by German urologists. Not classified as drugs in this country or regulated as such, these are sold over the counter in health-food stores.
Probably the best-known such therapy is saw palmetto, derived from berries of the saw palm tree (Serenoa repens, Serenoa serrulata, and other species). Saw palmetto appears to have a similar action to that of finasteride—that is, it may shrink the prostate. Some studies tend to support its effectiveness, though the evidence is fairly sparse.
Unfortunately, there is still a lack of real scientific information based on well-designed clinical trials of saw palmetto and other herbal remedies. Meanwhile, supplement manufacturers can market saw palmetto without any further proof of efficacy. And since their products are not regulated, you may or may not be getting what the label says.
If you want to try saw palmetto, do so only after seeing a doctor; don't dose yourself if you have prostate symptoms, since your condition could be cancer. Get a diagnosis. Also, if you are having a PSA test, tell your doctor if you are taking any over-the-counter remedies, since they may alter the results and thus make prostate cancer hard to diagnose.
What Your Doctor Will Do
If you have BPH, your doctor should be able to diagnose it. The digital rectal exam is one method, plus tests to measure the rate of urine flow and lab tests of urine and blood. You may also be referred to a urologist for diagnosis and treatment. Most urologists also have a device in their offices that can measure the size of your prostate gland using ultrasound.
If your symptoms worsen, the first line of treatment is usually drugs. Finasteride (Proscar) can shrink the prostate. Studies have shown that finasteride works best if the prostate is greatly enlarged, but not in cases of mild enlargement. It may take six months to produce any improvement and may cause side effects, including reduced sexual function and desire.
Certain alpha blocker medications (Cardura, Flomax, Hytrin), which are also used to treat hypertension, act to relax the sphincter at the bladder outlet, facilitating urination. While the alpha blockers may reduce symptoms, they can produce such side effects as reduced sexual function, low blood pressure, and dizziness.
In cases of severe BPH, surgery may be the best option. One of two forms of surgery is usually undertaken, one involving removal of some prostate tissue (TURP, or transurethral resection of the prostate), and the other an incision in the tissue to relieve pressure (TUIP, transurethral incision of the prostate). Several other approaches are available, including laser, radiowave, and microwave reduction of the prostate. But surgery is not necessary in most cases.
The Complete Home Wellness Handbook
John Edward Swartzberg, M.D., F.A.C.P., Sheldon Margen, M.D., and the editors of the UC Berkeley Wellness Letter
Updated by Remedy Health Media