As men age, their risk of prostate enlargement becomes dramatically more likely. In fact, statistics tell us that while only 10 percent of men suffer from Benign Prostatic Hyperplasia (BPH) in their 30s, that number skyrockets to 60 percent for men in their 60s and 80-90 percent for men above 70. Researchers have also predicted that the prevalence of BPH will increase in the next several decades due to the growing elderly population and extended life expectancy rate, so it is becoming more and more important to understand the facts of this widespread condition now.
What is BPH?
Benign Prostatic Hyperplasia is the enlargement of the prostate gland. This enlargement can cause issues when the prostate begins to interfere with the urethra. The urethra, the tube that exports urine out of the bladder, passes directly through the prostate gland in men. Therefore, when the prostate becomes enlarged, it can hinder urine from passing through. While doctors are still unsure what causes the prostate to expand, it is strongly suspected that changes in male sex hormones are responsible. The term “benign” indicates that the enlargement of the prostate is non-cancerous. It is important to note that BPH is not a form of prostate cancer, nor does it increase one’s risk of cancer.
Risk Factors for BPH
BPH is most common is men over 50, and its exact origin is still an enigma. However, it occurs when the cells in the prostate begin to multiply, causing the prostate to swell. Because of the location of the urethra, a swollen prostate can block urine from passing out of the bladder, which can cause a variety of issues in men. Even though the exact cause is unknown, there are many risk factors that can directly influence the prostate. As a man, you are at a higher risk of BPH if you:
- Have a poor diet
- Have a sedentary lifestyle
- Are over 40 years of age
- Have a family history of BPH
- Have diabetes
- Are overweight
- Use beta-blockers
- Are of European or African descent (men of Asian descent are at a decreased risk)
There are also many pre-existing medical conditions that may increase your chance of developing BPH. These include:
- Multiple sclerosis
- Parkinson’s disease
- Alzheimer’s disease
- Diabetic neuropathy
- Bladder infection
- Pelvic surgery
- Metabolic syndrome
Symptoms of Benign Prostatic Hyperplasia
Not all men with enlarged prostates will struggle with symptoms, in fact, some men can live with enlarged prostates for years without ever experiencing any issues. However, when they do occur, most symptoms of BPH are side-effects of a pinched urethra. This condition can cause multiple issues to your urine flow, including:
- Difficulty urinating
- A weak urine stream
- Involuntary stopping and starting during urination
- Dribbling when finishing
If the urethra remains blocked over time, it can have an effect on the bladder’s muscles. The bladder will have to work harder to push urine through the urethra, which can lead to weakened muscles, making it harder to empty the bladder. If the bladder’s muscles become weak, it can lead to symptoms including:
- Sudden urges to urinate
- Needing to urinate more than eight times per day
- Feeling the urge to urinate after just visiting the restroom
- Waking up throughout the night with the urge to urinate
How Do I Know if it’s BPH or OAB?
If you are struggling with frequent and sudden urges to urinate, constant trips to the bathroom at night, or the inability to empty your bladder, you may wonder if the cause is BPH or Overactive Bladder (OAB.) Both share the same symptoms but are very different conditions that require separate treatments. Of course, if you are a woman, you can instantly eliminate BPH as an option. However, if you are a man experiencing symptoms, speaking with a urologist and having a urinalysis / further testing is typically required to properly decipher between OAB and BPH.
Testing the Severity of Your BPH
Initial testing for BPH is as easy as answering a few questions. The American Urological Association has created a list of screening questions for BPH called the “BPH Symptom Score Index.” These seven questions can help patients and doctors better understand the symptoms the patient has been having over the past month.
- How often have you felt like you weren’t able to fully empty your bladder when you finished peeing?
- How often have you had to go again less than two hours after you last finished?
- How often have you stopped and started while peeing?
- How often have you found it hard to wait to go?
- How often have you had a weak stream?
- How often have you had to push or strain to start urinating?
- How many times do you have to get up and use the bathroom during the night?
Each question can be answered on a scale of 0-5 (not at all to all of the time.) This survey is helpful in understanding if a man is suffering from BPH and how severe the condition is. Other questions may include inquiries about your family history, your health and what medications you may be taking. If BPH is suspected, more tests will need to be done, such as a Digital Rectal Exam, blood tests and urine tests.
What is the Best Medication for BPH?
Since BPH often affects men who are above the age of 50, medication for the condition must be given with caution. Most men in this age range are already taking medications for other conditions, so the risk of negative drug interactions is high.
There are also a variety of supplements available to treat BPH. However, because they are less regulated than prescription drugs, their safety standards and side effects are not quite as well-known. The effectiveness of supplements varies from patient to patient, so the results can be problematic in some instances. Prescription medication has proven to be more effective for most patients. The two primary medications for BPH include:
- Alpha Blockers
Alpha Blockers are a type of medication that can help to heal the muscles in the prostate and bladder. Improving these muscles will allow the urine to flow through the body more easily. While alpha blockers do not impact the size of the prostate, they can limit the effects of BPH and eliminate many of its unpleasant symptoms. Three of the most popular alpha blockers include terazosin (Hytrin), doxazosin (Cardura) and tamsulosin (Flomax).
- Alpha-Reductase Inhibitors
Alpha-Reductase Inhibitors, such as finasteride (Proscar) and dutasteride (Avodart), work to combat BPH by preventing the production of testosterone that is causing the prostate to become enlarged. While alpha reductase takes longer to make an impact, this medication can help prevent other side effects of BPH, including bladder damage.
Treating BPH with Surgery
Most surgeries for BPH are minimally invasive. These surgeries are often highly regarded in the medical community because they can solve the urinary symptoms of BPH without causing any permanent damage to the prostate. Additionally, these procedures work as a way to solve the issues that occur with BPH instead of simply easing pain or creating a temporary fix. Some of the surgery options for BPH are:
- Transurethral Needle Therapy (TUMT)
TUMT is a very popular option for treating BPH due to its low medical risk and lack of lasting side effects. This minimally-invasive surgery involves inserting a microwave antenna with a flexible tube into the bladder to rid the bladder of excess cells. This procedure also works to eliminate unwanted hormones that may be causing the prostate to become enlarged.
- Transurethral Needle Ablation (TUNA)
TUNA is another surgery that has proven to be just as effective as TUMT. However, this procedure is not used nearly as often because it is considered to be a more painful option. This treatment involves entering a heated needle into the prostate via the urethra. The tube will then eliminate any excess cells in the prostate gland to reduce the enlargement and relieve any pain caused by BPH.
- Water Vapor Energy Ablation (WaVE)
WaVE therapy, also known as Rezum Therapy, is a relatively new treatment that has reaped promising results in recent studies. Many specialists believe this may become the primary way to treat BPH in the future. This treatment involves inserting a specially-designed catheter into the urethra through a tube. The tube is then connected to a radiofrequency generator that produces water vapors to eliminate the excess tissues in the prostate that can lead to BPH.
The first step to treating your BPH is to rule out any similar conditions such as OAB or incontinence. From there, seeing an experienced urologist for annual check-ups or medication refills is the best way to manage your symptoms and live an overall happier life.