Benign prostatic hyperplasia

Benign prostatic hyperplasia can cause several symptoms that affect your urine flow. It is possible to experience more than one symptom at the same time. Some of the common symptoms include:

• Decreased flow of urine
• Weak urine flow
• Sensation of incomplete bladder emptying
• Need to start and stop urination several times
• Trouble starting urination or straining to pass urine
• Dribbling at the end of urine flow
• Urge to urinate frequently
• Increased urgency to urinate
• Increased need to get up at night to urinate
• Pain while urinating or during ejaculation
• Urine that appears or feels different

If your condition worsens over time, you might experience:

• Development of bladder stones
• Bladder infection
• Kidney damage due to backpressure from retention of large amounts of urine in the bladder
• Blood in urine
• Pus in urine
• Pain in the lower abdomen or genitals during urination
• Inability to urinate
• Chills or fever while urinating

In severe cases, benign prostatic hyperplasia can lead to bladder damage and infection, which may result in blood in the urine. If left untreated for a long time, it can also cause kidney damage and lead to chronic kidney disease and renal failure. Here are a few common causes of frequent urination and why you should not ignore this symptom.

The prostate gland is located beneath your bladder. The urethra is a tube that passes urine from your bladder to the outside of your penis. The urethral tube passes through the center of the prostate. When the prostate enlarges, urine flow can begin to get blocked. The actual cause of benign prostatic hyperplasia (BPH) is not completely understood. It is postulated that testosterone, a hormone produced by the testicles, is a major contributing factor to BPH.

Men produce testosterone, the primary male sex hormone, throughout their lives, along with a small amount of estrogen. With advancing age, the testosterone produced by the body declines, which increases the proportion of estrogen in the system. Studies suggest that benign prostatic hyperplasia may result from this imbalance between estrogen and testosterone. The elevated level of estrogen within the prostate enhances the activity of substances that promote the growth of prostate cells.

Experts also believe that dihydrotestosterone (DHT), a hormonal byproduct of testosterone, plays a crucial role in the growth of the prostate gland. Research indicates that older adults continue to produce DHT, which accumulates within the prostate despite decreased testosterone levels. This increase in DHT may stimulate the growth of prostate cells. Studies have shown that a reduction in DHT levels can improve BPH.

• Are 40 years of age or above
• Have a family history of BPH
• Have medical conditions such as cardiovascular problems, obesity, and type 2 diabetes
• Lack physical exercise and live a sedentary lifestyle
• Have erectile dysfunction

Your doctor will consider your symptoms and carry out some tests to rule out diseases that mimic the symptoms of benign prostatic hyperplasia.

• Digital rectal exam: Your prostate can be felt through the anus. Your doctor will apply a topical anesthetic (numbing gel) onto your anal passage. Then the doctor will insert a gloved hand into the rectum to assess the prostate's shape, thickness, and size. This will help determine if your prostate is of average size or enlarged.
• Cystoscopy: This procedure allows a healthcare provider to examine the lining of your bladder and urethra. A hollow tube called a cystoscope, equipped with a lens, will be inserted into your urethra. The doctor will slowly advance the cystoscope into your bladder. This procedure usually does not hurt but may cause some discomfort. You may feel the urge to urinate during the process, but it lasts only a few minutes.
• Ultrasound: Ultrasound has become the standard first-line investigation following the urologist's examination. An ultrasound of the kidneys and urinary bladder (USG KUB) is routinely performed to evaluate the size and volume of the prostate gland.
• Intravenous pyelogram (IVP): An intravenous pyelogram (IVP) is a type of X-ray that provides images of the urinary tract. During an IVP, a healthcare provider will inject a contrast dye into one of your veins. The dye travels through your bloodstream and into your urinary tract, aiding in the detection of an enlarged prostate. Due to the availability of better alternatives, IVP is not commonly used today.
• Urine tests: Your doctor may request a urine test to rule out any infections or other urinary conditions that cause similar symptoms.
• Prostate-specific antigen (PSA) test: Prostate-specific antigen is a compound released by your prostate. When you have an enlarged prostate, your PSA levels may increase. This test helps detect prostate cancer, although it is not perfect and does not identify all cases. Elevated PSA levels can also result from recent procedures, surgeries, or infections.
• Urinary flow test: This test measures your urine flow. You will be asked to urinate into a receptacle attached to a machine that measures the strength and volume of your urine flow, helping determine if your condition is improving or worsening over time.
• Postvoid residual volume test: This test evaluates your ability to fully empty your bladder while urinating. It can be performed through ultrasound or by inserting a catheter into your bladder after you finish urinating, allowing a healthcare provider to measure the residual urine.
• 24-hour voiding diary: Your doctor may ask you to keep a record of the frequency and amount of urine you pass. This is especially helpful if more than one-third of your daily urine output occurs at night.
• Prostate biopsy: A transrectal ultrasound involves inserting an ultrasound probe into the rectum to evaluate your prostate health. The probe sends and receives sound waves through the rectal wall into the prostate gland, located just in front of the rectum. Your doctor may suggest a prostate biopsy using a transrectal approach, where a needle is guided into the rectum to obtain tissue samples from the prostate. Examining these samples will help determine if you have prostate cancer.
• Urodynamic and pressure flow studies: This test allows doctors to measure how well your bladder muscles are functioning. Your doctor will insert a catheter into your urethra and bladder, slowly injecting water or air to evaluate muscle function.

Unfortunately, researchers have not found a way to prevent benign prostatic hyperplasia to date. Men who have risk factors for BPH, such as:

• Being over 40 years of age
• Having a family history of BPH

should contact their doctor. You can discuss any symptoms of BPH with your doctor. Moreover, regular prostate exams can help identify early signs of prostate cancer. Early treatment can minimize the effects of prostatic hyperplasia and reduce the chances of an enlarged prostate.

BPH can be managed through several treatment modalities. The best approach is determined by the patient's age, overall wellbeing, underlying cause, and severity of the disorder. If symptoms are tolerable, your doctor may advise postponing treatment and monitoring the condition. The treatments include:

• Alpha-blockers
  These medications work by relaxing the prostate muscles, making it easier to pass urine. Alpha-blockers are effective in men with relatively small prostates. Side effects may include low blood pressure (orthostatic hypotension), dizziness, and retrograde ejaculation (where semen goes back into the bladder). Effects typically start within days to weeks. Common medications include:
  • Prazosin
  • Terazosin
  • Tamsulosin
• 5-alpha reductase inhibitors
  These drugs shrink the prostate size by preventing the formation of dihydrotestosterone (DHT). Medications such as finasteride and dutasteride inhibit the 5-alpha reductase enzyme that converts testosterone into DHT. A decline in DHT levels leads to a decrease in prostate size, typically starting after a month and reaching maximum effect in up to 6 months. Common side effects include low libido, decreased ejaculate volume, and impotence. Common medications include:
  • Finasteride
  • Dutasteride
• Tadalafil
  Tadalafil is primarily used to treat erectile dysfunction but has also been shown to be effective in treating prostate enlargement.
• Transurethral resection of the prostate (TURP)
  TURP is a surgical procedure that quickly relieves the symptoms of BPH. Men usually experience a strong urine flow soon after surgery. This procedure involves inserting a lighted scope into the urethra to remove most of the prostate except the outer part. A catheter will be needed post-surgery to drain the bladder. Risks associated with TURP include retrograde ejaculation and urinary incontinence. Common complications include:
  • Bleeding
  • Urethral stricture
  • Bladder neck contracture
• Transurethral incision of the prostate (TUIP)
  A surgeon inserts a lighted scope into the urethra and makes one or two minor cuts in the prostate gland, facilitating urine passage. TUIP is recommended for men with small or moderate-sized prostates and for those with health issues that make other surgeries risky. This procedure has a lower incidence of complications and may be a better option for patients with smaller gland sizes. Consult your doctor regarding the choice of surgical procedure, as it may vary on a case-by-case basis.
• Transurethral microwave thermotherapy
  An electrode is inserted through the urethra to reach the prostate, releasing microwave energy to destroy the inner part of the enlarged prostate gland. This results in prostate shrinking, allowing easier urine outflow. This surgery may only partially relieve symptoms and may take time before its full effect is seen. It is generally recommended for men with small prostates and may require re-treatment if needed.
• Transurethral needle ablation
  Your doctor will insert a scope into the urethra and use a needle to deliver radio waves that heat and destroy excess prostate tissue blocking urine flow.
• Ablative laser therapy
  This procedure uses a high-energy laser to vaporize prostate tissue obstructing urine flow. These procedures can cause irritative symptoms for some time after surgery.
• Enucleation procedure
  These procedures typically remove all prostate tissue blocking urinary flow and prevent regrowth of the tissue. The removed tissue can be examined for signs of prostate cancer and other disorders.
• Prostatic urethral lift
  Doctors use special tags to compress the sides of the enlarged prostate, increasing urinary flow. This procedure has less impact on ejaculation and sexual function compared to procedures like TURP.

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1. Take medicine as recommended
   If you have been prescribed BPH medications, ensure you take them as directed. Different BPH medications may take time to show their effects, with some requiring up to six months. It is essential to continue your medication as directed by your doctor. To help remember to take your medications on time, consider using labeled medicine boxes and setting alarms for the scheduled times.
2. Follow-up without fail
   Doctors typically recommend that patients actively monitor the progress of BPH. This involves observing any worsening symptoms without actively treating the condition. Regular visits to your urologist are necessary. If symptoms do not improve over time, your doctor may adjust your dosage or recommend further tests. If you have undergone surgery for an enlarged prostate gland, ensure you follow all post-operative instructions from your doctor. The specific follow-up care will depend on the type of surgery performed. Yearly visits are advised, as your doctor will assess any new or worsening symptoms since your last visit before recommending a treatment plan. Active surveillance is the best course of action for men with mild symptoms of BPH or those who are not significantly affected by their symptoms.
3. Exercise to strengthen pelvic muscles
   You may be recommended basic Kegel exercises to strengthen the pelvic floor. These exercises involve holding your pelvic floor muscles for five seconds and then releasing them. Aim for 10 to 20 repetitions of Kegel exercises three to four times a day. Kegel exercises are beneficial for men with prostate problems, as they help strengthen the pelvic floor and improve urine control. Additionally, consider incorporating daily activities such as walking, jogging, swimming, or playing sports. As obesity is a risk factor for developing BPH, maintaining a healthy weight is crucial for managing the condition. Your doctor may advise against heavy lifting and excessive training for a week after procedures like laser ablation or transurethral needle ablation. Other surgeries may necessitate restricted activities for nearly six weeks post-procedure.
4. Manage your stress
   Engaging in meditation or practicing yoga that promotes mindfulness can be beneficial. Stress and anxiety often increase the urge to urinate, potentially worsening BPH symptoms. Practicing meditation in the morning and before bedtime can help manage stress levels and reduce nighttime urges to urinate.

Untreated benign prostatic hyperplasia can cause several complications that affect your urinary bladder and kidney. These include:

• Urinary tract infections: Untreated benign prostate hyperplasia can lead to the accumulation of stagnant urine since patients cannot completely empty their bladder. The stagnant urine acts as a growth medium for bacteria that cause urinary tract infections. Some infections can be asymptomatic, whereas others can cause mild dysuria (painful or difficult urination), increased frequency and urgency to urinate, severe systemic infection, and frank hematuria (presence of blood cells in urine).
• Blood in urine: The presence of blood in urine is called hematuria. It is usually a result of friable hypervascularity, a condition in which superficial vessels of the enlarged prostate easily get damaged by any physical activity. It can also result in the formation of a clot and retention of the clot. Generally, the condition presents as initial hematuria while the rest of the urine stream is clear. Finasteride has proven to be effective in treating BPH-related hematuria since it lowers the density of microvessels.
• Urinary stones: Stones or calculi in the bladder make up 5% of all urinary tract calculi. The formation of stones is a known risk factor in cases with chronic urinary infections due to a microorganism that splits urea. Recurrent urinary tract infections and a residual volume of urine in the bladder usually precede the formation of bladder stones. Patients with a large residual volume in the bladder are at greater risk of developing multiple bladder stones. Symptoms of urinary stones include abdominal pain, visible blood in urine, recurrent urinary tract infections, and signs of sepsis (severe infection) in extreme cases.
• Kidney damage: Untreated BPH can lead to chronic urinary retention, which can further develop into chronic kidney disease in patients. This condition leads to a decline in the rate at which the kidney filters toxins and other substances. Patients suffering from recurrent urinary tract infections who already have chronic urinary retention due to BPH are at increased risk of developing renal failure.

Always consult your doctor before using any herbal remedy, and do not stop taking your regular medications without consulting your healthcare provider.

Saw palmetto and stinging nettle have shown some benefits when used together to manage BPH symptoms in men.

African plum tree and lycopene are other herbal remedies that have demonstrated benefits in improving the signs associated with BPH.

You can include pumpkin seeds in your diet. A study revealed that men with BPH who took pumpkin seed extracts once a day for 12 days experienced a better quality of life and a decrease in the urgency to urinate.

Flaxseed has also shown promising results. A report suggested that people who took flaxseed hull extract for eight weeks saw improvements in obstructive and irritable symptoms associated with BPH.

Here are seven superfoods beneficial for maintaining prostate health.

Being diagnosed with benign prostate hyperplasia can cause stress and anxiety in men. This medical condition directly affects the quality of life, and patients struggle with the urge to urinate in difficult situations. Some men also face incontinence (inability to control the evacuation of urine), leading to embarrassment. However, timely diagnosis and treatment can help you manage the signs and symptoms linked with BPH.

1. Avoid certain medications
   Talk to your doctor if you take medications such as diuretics or water pills, which are used to treat high blood pressure, liver disease, and heart failure. Diuretics remove excess fluid from your body and increase urination, which can worsen your BPH symptoms. Tricyclic antidepressants are an older generation of antidepressant drugs that reduce bladder muscle contractions, increasing your risk of urinary retention.
2. Avoid taking antihistamines and decongestants
   Antihistamines are anti-allergic drugs that prevent the bladder muscles from contracting. This can slow or inhibit urine flow and worsen BPH. Medications used to treat colds, such as decongestants, aggravate BPH since they tighten the prostate and bladder muscles, making it difficult for urine to leave the bladder.
3. Monitor your fluids
   It is essential to be aware of how much fluid you are taking in. The more fluid you drink, the more you will feel the urge to urinate. You can stop or limit drinking water a few hours before you go to bed to reduce your chances of awakening during the night to urinate. Drinks such as alcohol, soda, coffee, or other caffeinated beverages also cause your body to release more urine.
4. Eat a healthy diet
   Avoid eating red meat and dairy. Reports suggest that eliminating red meat can significantly improve your prostate health. Eating meat daily can triple your risk of prostate enlargement. Dairy products have also been linked with an increased risk of developing benign prostatic hyperplasia. Instead, include tomatoes, berries, salmon, and broccoli in your diet. These foods have been shown to improve your signs and symptoms linked with BPH.