As a younger man, you may not have given your prostate much thought. But as you get older, you may discover that this little gland in your reproductive system starts to cause problems. One condition you might face is benign prostatic hyperplasia (BPH). With BPH, which is not cancerous, the prostate gets larger — while a normal-sized prostate is about the size of a walnut, an enlarged prostate could be the size of a kiwi. The enlargement could lead to urinary tract, bladder or kidney problems.
David Ritsema, MD, a urologist at Banner Health Clinic in Greeley, CO, filled us in on what causes BPH, what symptoms you might notice, and how it can be diagnosed and treated.
What causes BPH?
“BPH happens to almost all prostates as they age. The number of cells in the prostate increases, and the number of cells that die decreases. Genetic factors, hormones and inflammation can all contribute to how quickly and how large a prostate will grow,” Dr. Ritsema said. “While physical activity may help protect against BPH.”
What are the symptoms?
The prostate surrounds the first part of the urethra, the duct that carries urine out of the bladder. So, if you have BPH, you might notice symptoms such as:
- A weak urine stream
- Difficulty starting to urinate
- Intermittent urine flow, dribbling or an urgent need to urinate
- Frequent urination
- Incomplete emptying of the bladder
While the age that BPH becomes noticeable varies, many men see their doctors for symptoms of BPH beginning in their 50s.
How can you prevent BPH?
It might help to stay physically active and to avoid obesity and diabetes. Medications called 5-alpha reductase inhibitors, such as finasteride and dutasteride, can also help keep the prostate from growing. But these medications have side effects, so although they may be used in men with bothersome symptoms, Dr. Ritsema said they aren’t recommended for prevention in men without symptoms.
How is BPH diagnosed?
Your health care provider will ask you about your symptoms and perform a physical exam of the prostate. You may also need one or more of these tools or tests:
- Voiding diary (a record of all fluid intake and output over time)
- Prostate symptom score questionnaire
- Urine flow test
- Measurement of residual bladder volume after you urinate
- PSA (Prostate Specific Antigen) blood test
It’s crucial to have your symptoms evaluated since they could also be caused by several other conditions such as urethral stricture, prostate cancer, overactive or underactive bladder, bladder or prostate infection, or urinary stones.
How can you treat BPH?
Treating the condition depends on how bothersome your symptoms are. “Mild symptoms are OK to watch without treatment,” Dr. Ritsema said. But if your symptoms get worse, talk to your doctor. You may need treatment to help avoid an inability to urinate, bladder stones, blood in the urine, urine infections, urine leakage or kidney failure.
For mild symptoms, you can try lifestyle modifications such as:
- Urinating when you need to, without holding urine
- Avoiding constipation
- Not drinking fluids before bed
- Limiting caffeine and alcohol
Dr. Ritsema said that there are a lot of different supplements on the market that claim to treat BPH, but there is limited data showing they help — for many men, they do not.
For more severe symptoms, you can try medications that can either shrink the prostate or relax the prostate's muscle to widen the channel. “We usually try medication before considering surgical treatment,” Dr. Ritsema said.
Depending on your overall health, prostate size and symptoms, you may want to consider surgery. Less-invasive procedures can be performed in short, outpatient surgeries under light anesthesia. And if needed, your doctor can perform laparoscopic, robotic or open surgery to remove some or all of the prostate.
The bottom line
Many men notice symptoms of BPH as they get older. If you’re having urinary problems, it’s essential to see your doctor to determine whether BPH or another condition is causing your symptoms. If you’re diagnosed with BPH, lifestyle changes, medication or surgery could help. To connect with a men’s health expert who can evaluate your symptoms, reach out to Banner Health.