The Independent Pharmacy

A Guide To Benign Prostatic Hyperplasia

Scott McDougall
Scott McDougallMPharmDirector & Registered Manager

Reviewed on 1 Oct 2023

Benign prostatic hyperplasia (BPH) is a common condition that many ageing men experience. It's a natural part of ageing, and you're not alone if you're going through it. As the prostate enlarges, it can put pressure on the urethra (the tube that lets urine leave your body) and bladder, causing problematic urinary symptoms.

If BPH goes untreated, it can affect your daily life. So, it's important to seek help and know that support is available to manage its impact.

In this guide, we'll help you to understand all you need to know about BPH.

What Is Benign Prostatic Hyperplasia?

Benign prostatic hyperplasia (BPH) is a condition where the prostate gland grows larger as men age. The prostate is a walnut-sized gland located below the bladder that produces fluid that transports and nourishes sperm.

As part of normal ageing, the prostate can gradually get bigger. As it enlarges, the prostate presses on the urethra, which is the tube carrying urine from the bladder out of the body. This squeezing of the tube (urethra) that carries urine out leads to frustrating urinary symptoms associated with BPH.

It’s important to understand benign means the enlargement is non-cancerous. The prostate cells are growing bigger in size but are not malignant, meaning they are not cancer cells spreading out of control. However, the enlarged prostate can still cause problematic urinary symptoms that may require treatment.

Monitoring prostate health and getting regular medical check-ups is recommended to identify any changes requiring evaluation. Early detection of BPH allows more options to manage symptoms before complications develop.

Causes of BPH

There are several contributing factors that lead to prostate enlargement in BPH:

Age-Related Changes

BPH becomes more common as men age, especially over 50 years old. By age 80, over 80% of men develop some prostate enlargement. As part of the natural ageing process, prostate cells may multiply and increase prostate size over time. Natural processes that control cell growth become less effective at preventing prostate enlargement later in life.

Hormonal Changes

The prostate relies heavily on hormones like testosterone and dihydrotestosterone (DHT) for growth and functioning. Testosterone is converted to DHT, which stimulates prostate growth. As men age, testosterone levels decrease but DHT levels stay constant or rise. This altered balance between testosterone and DHT may promote growth of prostate cells.

Genetic Predispositions

Studies suggest that inherited genes can make certain men more susceptible to BPH. Men with close relatives who developed prostate enlargement are at increased risk. Specific genetic variations like changes in RNAses, vitamin D receptors, and hormones may contribute.

Lifestyle and Dietary Factors

Obesity, lack of exercise, excessive alcohol intake, and diabetes have been associated with higher incidence of BPH. Inflammation also appears connected to prostate enlargement. Some research indicates diets high in saturated fat and red meat may increase risk. More study is needed, but healthy lifestyle choices may help prevent BPH.

Symptoms and Impact on Quality of Life

There are several lower urinary tract symptoms associated with BPH that can disrupt daily living:

  • Weak urine stream – The urine stream may dribble or spray instead of flowing strongly. Men have to push or strain to urinate.
  • Straining to urinate – Men have to push or bear down with abdominal muscles to get urine flow started. This straining is needed to overcome the obstruction.
  • Increased urinary frequency – Men may need to urinate every 1-2 hours during the day because the bladder does not empty fully. Frequency disrupts work and other activities.
  • Urgency of urination – Men get sudden, intense urges to urinate and may fear leakage. It’s challenging to postpone urination when out in public.
  • Nighttime urination – Multiple awakenings for urination prevent sound sleep and leave men tired. BPH severely impacts sleep quality and next-day function.
  • Incomplete bladder emptying – Urine flow stops before the bladder empties fully, leading to leaking a bit of urine after you think you're done. Men may need to urinate again shortly after.

Living with these urinary symptoms can be challenging, and it's okay to seek help and support to improve your quality of life. Simple activities like shopping, exercising, or attending events become logistical challenges. The constant fear of urgency and incontinence causes anxiety and embarrassment. Work productivity and concentration suffer greatly.

BPH may also affect intimacy and relationships but remember that open communication with your partner and seeking professional guidance can make a difference. The psychological effects like depression and isolation further reduce overall well-being. Seeking treatment is important to improve quality of life and regain control.

Diagnosing BPH

Doctors use a variety of tools to evaluate and diagnose BPH. Initial appointments usually involve:

  • Medical History - The doctor asks about your urinary symptoms, any problems with flow, and how long you've had issues. Family history and current medications are also reviewed.
  • Physical Exam - The doctor examines the abdomen for any enlarged bladder or other abnormalities. A digital rectal exam is done by inserting a gloved, lubricated finger into the rectum to feel if the prostate is enlarged or irregular.

Additional tests may include:

  • Bloodwork - A PSA blood test helps screen for prostate cancer risk if BPH is suspected. An elevated PSA level can indicate prostate enlargement.
  • Imaging Tests - An ultrasound, CT scan or MRI provides images that help measure prostate size and look for blockages.
  • Urine Flow Testing - Measuring the urine flow rate and checking post-void residual urine (urine left in the bladder after urinating) assesses how blocked the urethra is.
  • Cystoscopy - A thin tube with a camera called a cystoscope is inserted into the urethra to visualise the prostate and bladder.
  • Biopsy - Collecting prostate tissue samples can help rule out prostate cancer if the PSA is elevated. However, it's typically not the first line of the investigation unless there's a strong suspicion of cancer based on other findings (like a significantly elevated PSA level). Biopsies are invasive and come with risks, so they're reserved for when they're deemed necessary.

Having regular doctor visits for prostate exams supports early detection of BPH. Reporting any worsening urinary symptoms promptly also allows for timely diagnosis and treatment.

Treating BPH

If you're experiencing mild symptoms, doctors may recommend trying medication first to relax the muscles around the enlarged prostate and improve urine flow. Common options are tamsulosin (also known as Flomax), alfuzosin, and terazosin. At The Independent Pharmacy, we provide generic tamsulosin to treat the enlarged prostate common in older men.

Other medications called 5-alpha reductase inhibitors can actually shrink the size of an enlarged prostate over weeks or months. They work by blocking hormones that cause prostate growth. Examples are finasteride and dutasteride.

Some minimally invasive procedures can remove excess prostate tissue through the urethra:

  • Transurethral needle ablation uses heat to destroy prostate overgrowth pressing on the urethra.
  • Transurethral microwave therapy applies microwaves to reduce the size of the enlarged prostate.
  • Laser surgery uses high-energy lasers to vaporise prostate tissue blocking urine flow.
  • Stenting places small tube-like devices in the urethra to prop it open and improve flow of urine.

If medications and minimally invasive treatments aren’t effective, surgical treatments include:

  • Transurethral resection to trim away excess prostate tissue through the urethra, it removes the portion of the prostate that's causing obstruction.
  • Open prostatectomy to remove the entire enlarged prostate gland through an incision in the abdomen.

Preventing and Managing Enlarged Prostate

While some enlarged prostate risk factors can't be changed, lifestyle measures may help:

  • Diet - Eating more vegetables, fruits, whole grains, beans, fish, and healthy plant oils may help inhibit prostate growth. Limiting fatty red meats, processed foods, and high-fat dairy could also be beneficial.
  • Exercise - Being active most days, even with moderate exercise like brisk walking for 30-60 minutes, supports prostate health. Staying active helps maintain proper weight and reduce inflammation.
  • Medical Care - Having regular doctor visits gives a chance for prostate exams, PSA blood tests if applicable, and discussing any urinary changes. Getting potential problems checked early allows timely treatment.
  • Supplements - Some research indicates natural supplements like pygeum africanum bark and saw palmetto extracts may help inhibit prostate cell growth. More evidence is still needed on their effectiveness and safety.

Making positive lifestyle modifications and getting preventive prostate care empowers men to take control of their prostate health. While not always preventable, being proactive helps reduce enlarged prostate risk and progression.

Long-term Implications and Prognosis

If an enlarged prostate is left untreated, some possible problems over time include:

  • Having repeat urinary tract infections
  • Being unable to fully empty the bladder, leading to infections and bladder stones
  • Kidney damage from urine backflow (urine flowing back towards the kidneys)
  • Needing to use a catheter because the bladder fully stops emptying
  • Losing bladder control from weakening muscles

BPH itself is not directly linked to conditions like erectile dysfunction, diabetes, heart disease, and metabolic disorders. However, some treatments for BPH might have side effects or interactions that could influence these conditions. Caring for prostate health may also help control these related conditions.

While there isn't a cure for an enlarged prostate, there are effective treatments available that can help manage the symptoms and improve your well-being. Lifestyle changes, medications, or procedures often greatly relieve symptoms. But the prostate usually keeps growing gradually. This means needing ongoing treatment adjustments.

With the right care and support, many men find they can manage their symptoms effectively and lead fulfilling lives. Tracking changes and staying in touch with your doctor allows you to adjust care when needed. This provides the best quality of life.

Take the Next Step With The Independent Pharmacy

Being proactive about prostate health is important, whether for prevention or existing BPH concerns. The Independent Pharmacy can help.

The Independent Pharmacy is an award-winning online pharmacy and clinic providing high quality medications and support services. We supply generic tamsulosin for benign prostate hyperplasia.

Contact The Independent Pharmacy at:

Our experienced pharmacists and physicians evaluate your BPH symptoms and medical history to recommend appropriate treatment plans. We provide ongoing care, advice on managing side effects, and treatment adjustments as needed.

We're ready to help you on the path to better prostate health.

FAQs About Enlarged Prostate (BPH)

What are the 5 warning signs of BPH?

The 5 main symptoms of an enlarged prostate are:

  1. Weak urine stream
  2. Straining or pushing to urinate
  3. Frequent and urgent urination
  4. Waking at night to urinate
  5. Incomplete bladder emptying

What is the main cause of benign prostatic hyperplasia?

The main cause is age-related prostate enlargement as hormone balances shift with ageing. The prostate gland grows bigger and presses on the urethra.

Is benign prostatic hyperplasia serious?

It can greatly impact quality of life but is not life-threatening on its own. However, leaving BPH untreated can lead to serious complications like infections.

What can be done for a benign enlarged prostate?

Treatment options include medications, minimally invasive procedures, and surgery based on symptom severity. Lifestyle changes like diet and exercise may also help.

Can benign prostate enlargement be cured?

BPH can have a significant impact on quality of life, but it's not life-threatening on its own. With proper care and support, many men manage their symptoms successfully. It's essential to reach out for help and remember that you're not alone in this journey.

Can a benign enlarged prostate become cancerous?

BPH does not turn into prostate cancer, but it's still important to monitor prostate health over time. Some testing helps detect any concerning changes requiring evaluation. While BPH and prostate cancer can coexist, one does not cause the other.

Sources:

Benign Prostatic Hyperplasia (BPH) - Prostate Matters

Modern best practice in the management of benign prostatic hyperplasia in the elderly - PMC (nih.gov)

Androgens and estrogens in benign prostatic hyperplasia: past, present and future - PMC (nih.gov)

Shared Inherited Genetics of Benign Prostatic Hyperplasia and Prostate Cancer - PMC (nih.gov)

Metabolic syndrome and benign prostatic hyperplasia: An update - PMC (nih.gov)

Burden of male lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) - focus on the UK - PubMed (nih.gov)

Reaching a Tipping Point: A Qualitative Exploration of Quality of Life and Treatment Decision-Making in People Living With Benign Prostatic Hyperplasia - PMC (nih.gov)

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