The Facts About Benign Prostatic Hyperplasia

Benign prostatic hyperplasia (BPH) is a common condition that often affects men as they age. For men who develop BPH—also known as an enlarged prostate—the prostate gland continues to grow to an abnormal size. It's not the same as prostatitis or prostate cancer and it's not lethal, but BPH can cause quality-of-life issues.

The prostate gland sits just below the bladder and surrounds the initial part of the urethra just where it leaves the bladder. When a man has an enlarged prostate and it gets severe enough, it can restrict the flow of urine out of the bladder and cause issues with ejaculation.

The prostate gland plays a vital role in the male reproductive process. It's a walnut-shaped, muscular gland that only males are born with, and it sits just below the bladder and in front of the rectum.

Part of your urethra passes through the gland, which is what causes much of the discomfort when it comes to BPH. The prostate is responsible for producing seminal fluid when ejaculation takes place, which is deposited into the urethra to mix with sperm, nutrients and other substances.

The seminal fluid is the liquid that carries, nurtures and protects sperm as it makes its journey to fertilize the egg. Along with muscles at the base of the penis, the prostate gland uses powerful contractions to help propel the seminal fluid into the urethra and out of the penis.

The medical community understands that BPH is very common and is much more likely to happen to older men. Still, there's no clear understanding of why it affects some men and not others. Because the prostate gland is so closely tied to male hormones and testosterone in particular, some theorize that BPH is related to the normal reduction in testosterone production that happens to all men as they age.

Everyone produces both testosterone and estrogen. As men age, they produce less testosterone, yet they may continue to produce similar levels of estrogen. This may contribute to the unchecked growth of prostate tissue.

Older men also produce more dihydrotestosterone (DHT), a more powerful form of testosterone that may contribute to developing an enlarged prostate, according to Cleveland Clinic.

Benign prostatic hyperplasia is very common. In fact, if a man lives long enough, he's probably going to develop it.

Half of all men will have BPH by the time they reach 50 years of age, according to Harvard Medical School. That percentage goes up more than 10 points for every subsequent decade. Men lucky enough to reach age 80 and still have an intact prostate gland have a 90 percent chance of experiencing BPH.

Around 50 percent of those who develop an enlarged prostate will have symptoms that require intervention.

Because BPH involves the man's urethra becoming more and more constricted by the growth of the prostate tissue, the symptoms revolve around urinating and ejaculating. The most common symptoms or signs include issues related to the urinary tract, such as the following:

• A change in the color of your urine
• A strange odor to your urine
• Difficulty getting started when urinating
• Dribbling or slowness when urinating
• Having to get out of bed at night to urinate
• Never feeling like you can empty your bladder
• Pain after ejaculating or urinating
• Urgency or a sudden need to urinate
• Urinary incontinence or leaking

If you notice any changes such as urinary retention or ejaculatory discomfort, you should schedule an appointment with a healthcare provider because it could indicate other prostate problems, not just BPH.

When it comes to diagnosing BPH, a doctor will ask you some questions about your age, medical history and urinary frequency, as well as other issues around urination and ejaculation. They'll likely also perform a digital rectal exam (DRE). During this exam, the healthcare provider usually has you lie on your side on the exam table with one knee raised, then inserts a gloved, lubricated finger into your rectum in order to feel the surface of the prostate tissue through the front wall of your rectum.

A DRE can help doctors determine if the gland is oversized or if there are any hard areas that could indicate cancer. You may also be asked to complete a urine flow test to measure how fast your stream comes out, or a urine retention test to determine how much urine remains in your bladder after you've peed.

While there isn't a cure for BPH, there are many treatment options to help alleviate the symptoms.

Mild symptoms, such as a slight sense it is more difficult to get started when you're urinating, might be safely placed in the "watchful waiting" category. If the symptoms become more troublesome, there are a variety of medications to help relax the prostate's muscles and allow urine to flow more freely. Tamsulosin (Flomax) is probably the best-known in this category. 

Another class of medication reduces the production of DHT, which can slow the growth of prostate tissue. Examples include finasteride (Proscar) and dutasteride (Avodart).

Should none of those do the trick, there are several surgical options, including the following:

• Transurethral electrovaporization. An electrode is inserted through the urethra that is then used to heat and vaporize prostate tissue, turning it into steam.
• Transurethral incision of the prostate (TIRP). Small incisions are made in the prostate and urethra where it meets the bladder to open it up more and relieve urinary retention.
• Transurethral resection of the prostate (TURP). An instrument is inserted into your urethra up to your prostate that allows the urologist to remove prostate tissue.

Some newer, less-invasive interventions for BPH are designed to be less damaging to the prostate tissue. In general, these are outpatient procedures, so you can go home the same day. They're also less costly than traditional surgery, allow for faster recovery and have fewer side effects.

These invasive surgeries include a prostatic urethral lift and water vapor therapy.

Prostatic urethral lift

The enlarged prostate lobes are separated using a special instrument that is inserted into the urethra up to the prostate gland. The device then ejects small implants that push the lobes of the prostate apart, opening up space for the urethra in between, allowing for better urine flow.

Water vapor therapy

An instrument is inserted into your urethra up to your prostate gland. The urologist then triggers a needle to enter the prostate gland. The device emits a vapor that turns into water with enough thermal energy to kill some of the prostate tissue. The dead cells are then reabsorbed into the body and the prostate gland shrinks.

Preventing BPH is not all that straightforward since it's not clear what causes it. However, a healthy lifestyle, regular exercise and a healthy body weight all contribute to a healthier prostate gland overall.

It's also helpful to aim for healthy blood glucose levels and eat whole, natural, unprocessed foods. As part of that strategy, watch your carbohydrate intake and avoid some foods, including the following:

• Alcohol
• Caffeine
• Dairy
• Red meat
• Sodium

According to Cleveland Clinic, some herbal supplements may also help to slow the growth of the prostate gland, including:

• Beta-sitosterol. This is a plant-based micronutrient thought to contribute to heart health.
• Flaxseed. This contains omega-3s and may help lower cholesterol.
• Pygeum africanum. This extract from the bark of a cherry tree found in Africa may help shrink prostate tissue.
• Pumpkin seed oil. This may help shrink prostate tissue.

BPH can have profound effects on urination, but it can also affect you in the bedroom. Some specific ways it can affect your sex life include:

• Erections. Prescribed 5-alpha reductase inhibitors such as finasteride and dutasteride may affect erection quality.
• Worse ED. Simply having the stress of these issues surrounding your penis, as well as the discomfort of constantly feeling like you need to pee, may cause some men to develop or experience worse ED.
• Painful ejaculation. The impingement on the urethra by the prostate can become so profound that ejaculation is painful.
• Retrograde ejaculation. Another class of drugs—alpha blockers, such as tamsulosin—work by relaxing the smooth muscle of the prostate and bladder neck to help open the urethra and allow urine to flow more easily. However, one side effect can be retrograde ejaculation, a condition in which the man's ejaculate doesn't go out through the urethra. Instead, it takes the path of least resistance and passes through the open entrance/exit to the bladder. This results in little to no ejaculate coming out of the penis. It is discharged when the man pees, but it is otherwise harmless.

What are the five signs of BPH?

The five most common signs of BPH are:

• An urgent need to urinate
• Difficulty getting your stream started when you urinate
• Dribbling or slowness when you urinate
• Having to get up at night to empty your bladder
• Urinary incontinence or leaking

What is the most common cause of BPH?

There isn't really a known cause of BPH, but some researchers hypothesize that the changing balance of hormones in men's bodies as they age may contribute. Other risk factors may include:

• Aging. Enlarged prostate glands are rare prior to age 40 but affect about 50 percent of men by age 50.
• Diabetes and heart disease. Both conditions are believed to increase the risk of BPH, according to Mayo Clinic.
• Family history. Prostate problems run in the family, so your odds increase if you have a close relative with BPH.
• Lifestyle choices. A sedentary lifestyle and obesity are both thought to be linked to an increased risk of developing an enlarged prostate.

What is the best treatment for BPH?

It depends. Every person is different with different medical histories, symptoms and goals. Work closely with your medical team and discuss all the options available, factoring in how troublesome your symptoms are and what you are willing to undergo to alleviate them.

In the meantime, you can help by eating a healthy diet, getting plenty of exercise, and working to maintain good blood sugar levels and weight.