almost all informations of postate enlargement ( courtecy; webMD&others internate sources )without adv.
Enlarged
Prostate
Medical Author:
Khaled Fareed, MD
Medical Editor:
·
A
man's prostate
gland usually starts to enlarge after he reaches 40 years of
age. This condition is called benign prostatic hyperplasia (BPH). This is
considered a natural process of aging, and attempts
to stop or reverse it so far have been unsuccessful.
The
prostate gland serves a fertility function as it secretes the seminal
fluid that helps to nourish and transport the sperm that comes from the
testicles. The fluid is then stored in the seminal vesicles. The gland itself
surrounds the urethra, which is the tube that carries urine from the bladder
out through the tip of the penis (see multimedia file 1). As the prostate grows
larger, it may press on the urethra. This narrowing of the urethra can cause
some men with prostate enlargement to have trouble with urination. Prostate
enlargement may be the most common health problem in men older than 60 years of
age.
·
The
prostate gland, which is normally about the size and shape of a walnut, wraps
around the urethra between the pubic bone and the rectum, below the bladder. In
the early stage of prostate enlargement, the bladder muscle becomes thicker and
forces urine through the narrowed urethra by contracting more powerfully. As a
result, the bladder muscle may become more sensitive, causing a need to urinate
more often and more suddenly.
The
prostate grows larger due to an increase in the number of cells (hyperplasia).
However, the precise reason for this increase is unknown. A variety of factors
may be involved, including androgens (male hormones), estrogens, and growth
factors and other cell signaling pathways (cell-to-cell communication).
As
the prostate grows larger and the urethra is squeezed more tightly, the bladder
might not be able to fully compensate for the problem and completely empty. In
some cases, blockage from prostate enlargement may result in stagnation and
backing up of urine, which in turn may cause repeated urinary tract infections,
bladder stones, bladder diverticulae (outpouchings or pockets inside the
bladder), and gradually result in bladder or kidney damage. It may also cause a
sudden inability to urinate (acute
urinary retention) -- a painful medical emergency that requires urgent
drainage.
·
Many men with
an enlarged prostate have no symptoms or signs. If
symptoms are present, they commonly include- a
weak stream of urine;
- difficulty
starting urination;
- dribbling
of urine, especially after urinating;
- a
sense of not fully emptying the bladder;
- leaking
of urine;
- more frequent urination and
a strong and sudden desire to urinate, especially at night; and
- blood in the urine.
Urinary
symptoms related to enlarging prostate initially affect the quality of life,
and if no complications exist, as mentioned above (urinary infections, bladder
stones, bleeding), the
decision to treat is optional and is left to the patient. This means that if
you don't feel bothered enough to take a medicine or undergo a procedure for
it, you'll need to follow up with your doctor to ensure the symptoms are
stable, and the bladder empties well. This can be assessed by prostate symptom
questionnaires and a measure of the strength of the urinary stream (flow test)
and residual urine in the bladder. If complications develop, however, or if the
bladder starts holding increasing amounts of residual urine after urination,
treatment should be started.
If
you experience bladder pain or burning with urination, blood in the urine
associated with fever/chills
or nausea/vomiting, or if the
prostate enlargement condition worsens and symptoms such as blood in the urine
or lower back pain are
present, consult a doctor immediately. If you cannot reach your doctor when
these symptoms are present, seek evaluation at a hospital's emergency
department.
For
acute symptoms such as acute urinary retention (you feel uncomfortably full but
cannot urinate), you should immediately go to the closest emergency medical
facility for bladder drainage, usually with a catheter, which is a tube
inserted into the bladder.
Men
over 50 years of age should have their prostate checked annually by their
physician even if they have no symptoms.
Enlarged
Prostate Symptom
Inability
to Urinate
The two essential
causes of urinary retention are (1) blockage of the urethra and (2) disruption
of the delicate and complex system of nerves that connects the urinary tract
with the brain and the nervous system (as described earlier).
Common causes
- Blockage
(obstruction): The most common cause of blockage of the urethra in men is
enlargement of the prostate. In males, the prostate gland partially
surrounds the urethra. If the prostate becomes enlarged, which is common
in older men, it presses on the urethra and can block it. The most common
cause of prostate enlargement is benign prostatic hypertrophy (often
called BPH). Other causes of prostate enlargement include prostate cancer
and prostate infection (prostatitis). Causes of blockage of the urethra
that can occur in both sexes include scar tissue, injury (as in a car
wreck or bad fall), blood clots, infection, tumors in the pelvic region,
and stones (rare).
·
- A
physical exam is required to see if other medical problems may be causing
your symptoms. The doctor will conduct a digital rectal exam to examine
the prostate gland. He or she can feel the prostate by inserting a gloved,
lubricated finger into the rectum. This procedure allows your doctor to
roughly estimate the size and consistency of the prostate. Most
importantly, it allows the doctor to feel for lumps or hard areas that
could indicate the presence of prostate cancer.
- Your
doctor may check your urine (urinalysis) for
blood or signs of infection. Your blood may be tested for kidney problems
(a serum creatinine level) or sent for a prostate-specific antigen (PSA)
level, a screening test for prostate cancer.
- Some
men are referred to a specialist (urologist) for further tests. Urologists
specialize in diseases of the male and female urinary tracts and of the
male genital tract. Before you are treated for benign prostate enlargement, it is
important to rule out other possible causes of an enlarged
prostate, such as cancer.
Once
the diagnosis of prostate enlargement is made, your doctor may not recommend
immediate treatment if symptoms are mild. Likely, one or more exams will be
conducted per year to be sure that you are not developing any complications
from prostate enlargement. Should your symptoms become more severe, both
medical and surgical treatments are available.
Some
precautions can help to avoid worsening of symptoms of prostate enlargement and
complications.
Do
not delay urination once you experience an urge. Urinate as soon as you feel
the urge, and empty the bladder completely.
·
·
Watchful
waiting: This conservative and often wise program of care is used because, for
many men, symptoms can lessen without treatment. On the other hand, medications
should be started early for moderate symptoms. Also, if there are complications
or if symptoms are severe, your doctor may recommend surgery. For most men, the
decision to treat the symptoms of an enlarged prostate is based on the patient's
desire to improve his quality of life.
Several
types of medications have been approved for treatment of urinary symptoms
secondary to prostate enlargement. Men with severe symptoms may require
treatment with a combination of these medications. Your doctor will determine
the optimal combination for your condition:
- Alpha-blockers,
such as terazosin (Hytrin), prazosin (Minipress),
or doxazosin (Cardura), relax
the muscles in the prostate and thus may relieve symptoms. Newer
alpha-blockers, such as tamsulosin (Flomax), alfuzosin (Uroxatral),
and silodosin(Rapaflo), are
more commonly prescribed because they may have fewer side effects.
- Finasteride (Proscar)
or dutasteride (Avodart) can
cause the prostate to shrink. As a result, the urinary symptoms may
improve. These drugs are most helpful in men who have at least moderate
enlargement of the prostate.
- Tadalafil (Cialis for
daily use) has recently been approved for the treatment of BPH.
- There
are bladder calming medications that help with the symptoms related to
bladder irritability from prostate blockage: oxybutynin (Ditropan-pills, Oxytrol skin
patch, Gelnique-topical
gel), solifenacin (Vesicare), darifenacin (Enablex), trospium(Sanctura),
and mirabegron (Myrbetriq).
- A
common operation for treatment of prostate enlargement is transurethral
resection of the prostate (TURP) and is considered the gold standard. In
this procedure, the doctor scrapes away the innermost core of the prostate
through a small instrument inserted through the urethra. The surgery
reduces pressure on the urethra and generally gives relief from symptoms.
- A
more limited operation called transurethral incision of the prostate
(TUIP) may be an option for some men. In this operation, instead of
removing prostate tissue, the doctor passes an instrument through the
urethra to make one or two small cuts in the prostate. These cuts reduce
the prostate's pressure on the urethra, making urination easier.
- Several
newer treatments that may be performed in the office with local anesthetic
alone or supplemented by sedation have been introduced and may be
effective for men with an enlarged prostate. These include a treatment
known as Rezum therapy, which consists of injecting a water steam into the
prostate under local anesthetic; the Urolift procedure, which consists of
placing small suture implants to hold the prostate tissue apart from
around the urethra; transurethral microwave thermotherapy (TUMT),
transurethral radiofrequency needle ablation of the prostate (TUNA), and
interstitial laser coagulation (ILC). The general principle of all these
treatments is similar. In each case, the prostate tissue is heated to a
level that will lead to death of portions of the prostate tissue, thus
shrinking away and removing some of the obstruction.
- The
Rezum and Urolift procedures have the advantage of preserving ejaculatory
function, which can be affected by almost all other prostate procedures.
These can also be done in the office without the need for anesthesia.
- Another
popular new treatment is photovaporization of the prostate (PVP) or laser
ablation of the prostate, in which a laser is used to directly remove or
vaporize prostate tissue in a similar fashion to what is accomplished with
a TURP (see above) with much less bleeding. The advantage of this
technique compared with TUMT, TUNA, or ILC is that it offers immediate
removal of tissue with rapid improvement in symptoms. Conversely, these
other three treatments lead to delayed tissue loss and are not associated
with immediate improvement of urinary symptoms in most cases.
- Other
new surgical alternatives are being evaluated by the FDA for approval in
the U.S. (like the AquaBeam ablation procedure, which also preserves
ejaculatory function). Ask your doctor about the potential risks and
benefits of medication and surgery. An operation for
an enlarged prostate does not eliminate the risk of developing
prostate cancer.
- Holmium
laser enucleation of the prostate (HoLEP) is a procedure that is offered
in specialized centers and allows larger prostates to be enucleated
(shelled out).
- Sometimes
for very large prostates, a procedure called simple prostatectomy is indicated, which is
traditionally done by open surgery. A minimally invasive procedure can be
done in specialized centers where the enlarged part of the prostate
(referred to as the adenoma) is removed laparoscopically or with a
surgical robot through keyhole incisions instead of the open surgical
incision.
Once your doctor has given you a medical plan, you should stick
to it and follow up as recommended. Sometimes men need follow-up with a
urologist.
There is no known way to prevent prostate enlargement. It is a
common part of aging.
- Men
can reduce the need to urinate frequently during the night by not drinking
liquids after 6 p.m.
- Caffeinated beverages, alcohol,
and spicy foods can be bladder irritants and make urinary symptoms worse.
- Drinking
more fluid, up to eight glasses of water per day, may help prevent
infection. However, for men already suffering with increased urinary frequency,
this may only exacerbate the problem. In most cases, drinking a normal
amount of fluid based on thirst is all that is necessary.
- There
is evidence that cranberry juice
may be helpful in the prevention of urinary tract infections in those who are
prone to developing these.
- Finasteride
or dutasteride (see above) are prescription medications that
can slow down the process of prostatic enlargement and reduce the risk of
urinary retention, complications, and the future need for surgery related
to benign prostatic enlargement.
Your condition may improve, remain the same, or become worse.
Serious urinary problems from prostate enlargement affect one in 10 older men.
If the bladder is permanently damaged from prostate enlargement, treatment may
not be as effective.
Prostate enlargement is not cancer,
nor does it seem to increase your chances of developing prostate cancer. You
can, however, have both prostate enlargement and prostate cancer at the same
time.
Male urinary system and prostate: The prostate makes some of the
milky fluid (semen) that carries sperm. The gland is the size of a walnut and
is found just below the bladder, which stores urine. The prostate wraps around
a tube (the urethra) that carries urine from the bladder out through the tip of
the penis. During a man's orgasm(sexual climax), muscles squeeze the prostate's
fluid into the urethra. Sperm, which are made in the testicles, also go into
the urethra during orgasm. The milky fluid carries the sperm through the penis
during orgasm.
![Normal prostate and enlarged prostate (prostate with benign prostatic hyperplasia [BPH]](file:///C:\Users\CnE\AppData\Local\Temp\msohtmlclip1\01\clip_image014.jpg)
Normal prostate and enlarged prostate (prostate with benign
prostatic hyperplasia [BPH]
Reviewed on 9/11/2017
Diagnosis
Your doctor will start by
asking detailed questions about your symptoms and doing a physical exam. This
initial exam is likely to include:
· Digital rectal exam. The doctor inserts
a finger into the rectum to check your prostate for enlargement.
· Urine test. Analyzing a sample of your urine can
help rule out an infection or other conditions that can cause similar symptoms.
· Blood test. The results can indicate kidney
problems.
· Prostate-specific antigen (PSA) blood test. PSA
is a substance produced in your prostate. PSA levels increase when you have an
enlarged prostate. However, elevated PSA levels can also be due to recent
procedures, infection, surgery or prostate cancer.
After that, your doctor
might recommend additional tests to help confirm an enlarged prostate and to
rule out other conditions. These tests include:
· Urinary flow test. You urinate into a
receptacle attached to a machine that measures the strength and amount of your
urine flow. Test results help determine over time if your condition is getting
better or worse.
· Postvoid residual volume test. This test measures
whether you can empty your bladder completely. The test can be done using
ultrasound or by inserting a catheter into your bladder after you urinate to
measure how much urine is left in your bladder.
· 24-hour voiding diary. Recording the
frequency and amount of urine might be especially helpful if more than
one-third of your daily urinary output occurs at night.
If your condition is more
complex, your doctor may recommend:
· Transrectal ultrasound. An ultrasound probe
is inserted into your rectum to measure and evaluate your prostate.
· Prostate biopsy. Transrectal ultrasound
guides needles used to take tissue samples (biopsies) of the prostate.
Examining the tissue can help your doctor diagnose or rule out prostate cancer.
· Urodynamic and pressure flow studies. A
catheter is threaded through your urethra into your bladder. Water — or, less
commonly, air — is slowly injected into your bladder. Your doctor can then
measure bladder pressure and determine how well your bladder muscles are
working. These studies are usually used only in men with suspected neurological
problems and in men who have had a previous prostate procedure and still have
symptoms.
· Cystoscopy. A lighted, flexible instrument
(cystoscope) is inserted into your urethra, allowing your doctor to see inside
your urethra and bladder. You will be given a local anesthetic before this
test.
Tests and diagnosis at Mayo Clinic
Mayo Clinic specialists
have experience diagnosing complex conditions involving enlarged prostate. You
have access to the latest diagnostic testing, including urodynamic and pressure
flow studies.
Treatment
A wide variety of
treatments are available for enlarged prostate, including medication, minimally
invasive therapies and surgery. The best treatment choice for you depends on
several factors, including:
· The
size of your prostate
· Your
age
· Your
overall health
· The
amount of discomfort or bother you are experiencing
If your symptoms are
tolerable, you might decide to postpone treatment and simply monitor your
symptoms. For some men, symptoms can ease without treatment.
Medication
Medication is the most
common treatment for mild to moderate symptoms of prostate enlargement. The
options include:
· Alpha blockers. These medications
relax bladder neck muscles and muscle fibers in the prostate, making urination
easier. Alpha blockers — which include alfuzosin (Uroxatral), doxazosin
(Cardura), tamsulosin (Flomax) and silodosin (Rapaflo) — usually work quickly
in men with relatively small prostates. Side effects might include dizziness
and a harmless condition in which semen goes back into the bladder instead of
out the tip of the penis (retrograde ejaculation).
· 5-alpha reductase inhibitors. These medications
shrink your prostate by preventing hormonal changes that cause prostate growth.
These medications — which include finasteride (Proscar) and dutasteride
(Avodart) — might take up to six months to be effective. Side effects include
retrograde ejaculation.
· Combination drug therapy. Your doctor might
recommend taking an alpha blocker and a 5-alpha reductase inhibitor at the same
time if either medication alone isn't effective.
· Tadalafil (Cialis). Studies suggest
this medication, which is often used to treat erectile dysfunction, can also
treat prostate enlargement.
Minimally invasive or surgical therapy
Minimally invasive or
surgical therapy might be recommended if:
· Your
symptoms are moderate to severe
· Medication
hasn't relieved your symptoms
· You
have a urinary tract obstruction, bladder stones, blood in your urine or kidney
problems
· You
prefer definitive treatment
Minimally invasive or
surgical therapy might not be an option if you have:
· An
untreated urinary tract infection
· Urethral
stricture disease
· A
history of prostate radiation therapy or urinary tract surgery
· A
neurological disorder, such as Parkinson's disease or multiple sclerosis
Any type of prostate
procedure can cause side effects. Depending on the procedure you choose,
complications might include:
· Semen
flowing backward into the bladder instead of out through the penis during
ejaculation (retrograde ejaculation)
· Temporary
difficulty with urination
· Urinary
tract infection
· Bleeding
· Erectile
dysfunction
· Very
rarely, loss of bladder control (incontinence)
There are several types
of minimally invasive or surgical therapies.
Transurethral resection of the prostate (TURP)
A lighted scope is
inserted into your urethra, and the surgeon removes all but the outer part of
the prostate. TURP generally relieves symptoms quickly, and most men have a
stronger urine flow soon after the procedure. After TURP you might temporarily
need a catheter to drain your bladder.
Transurethral incision of the prostate (TUIP)
A lighted scope is
inserted into your urethra, and the surgeon makes one or two small cuts in the
prostate gland — making it easier for urine to pass through the urethra. This
surgery might be an option if you have a small or moderately enlarged prostate
gland, especially if you have health problems that make other surgeries too
risky.
Transurethral microwave thermotherapy (TUMT)
Your doctor inserts a
special electrode through your urethra into your prostate area. Microwave
energy from the electrode destroys the inner portion of the enlarged prostate
gland, shrinking it and easing urine flow. TUMT might only partially relieve
your symptoms, and it might take some time before you notice results. This
surgery is generally used only on small prostates in special circumstances
because re-treatment might be necessary.
Transurethral needle ablation (TUNA)
In this outpatient
procedure, a scope is passed into your urethra, allowing your doctor to place
needles into your prostate gland. Radio waves pass through the needles, heating
and destroying excess prostate tissue that's blocking urine flow.
This procedure might be a
good choice if you bleed easily or have certain other health problems. However,
like TUMT, TUNA might only provide partial relief and results might take some
time.
Laser therapy
A high-energy laser
destroys or removes overgrown prostate tissue. Laser therapy generally relieves
symptoms right away and has a lower risk of side effects than does nonlaser
surgery. Laser therapy might be used in men who shouldn't have other prostate
procedures because they take blood-thinning medications.
The options for laser
therapy include:
· Ablative procedures. These procedures
vaporize obstructive prostate tissue to increase urine flow. Examples include
photoselective vaporization of the prostate (PVP) and holmium laser ablation of
the prostate (HoLAP). Ablative procedures can cause irritating urinary symptoms
after surgery, so in rare situations another resection procedure might be
needed at some point.
· Enucleative procedures. Enucleative
procedures, such as holmium laser enucleation of the prostate (HoLEP),
generally remove all the prostate tissue blocking urine flow and prevent
regrowth of tissue. The removed tissue can be examined for prostate cancer and
other conditions. These procedures are similar to open prostatectomy.
Prostate lift
In this experimental
transurethral procedure, special tags are used to compress the sides of the
prostate to increase the flow of urine. Long-term data on the effectiveness of
this procedure aren't available.
Embolization
In this experimental
procedure, the blood supply to or from the prostate is selectively blocked,
causing the prostate to decrease in size. Long-term data on the effectiveness
of this procedure aren't available.
Open or robot-assisted prostatectomy
The surgeon makes an
incision in your lower abdomen to reach the prostate and remove tissue. Open
prostatectomy is generally done if you have a very large prostate, bladder
damage or other complicating factors. The surgery usually requires a short
hospital stay and is associated with a higher risk of needing a blood
transfusion.
Follow-up care
Your follow-up care will
depend on the specific technique used to treat your enlarged prostate.
Your doctor might
recommend limiting heavy lifting and excessive exercise for seven days if you
have laser ablation, transurethral needle ablation or transurethral microwave
therapy. If you have open or robot-assisted prostatectomy, you might need to
restrict activity for six weeks.
Treatment at Mayo Clinic
Mayo Clinic specialists
have training in a wide range of state-of-the-art technology to treat enlarged
prostates. You have access to the latest noninvasive laser treatments,
including HoLEP and PVP lasers. Your Mayo Clinic specialist will explain the
range of treatments available and help you choose the best approach based on
your symptoms.
Clinical
trials
Explore Mayo Clinic studies testing
new treatments, interventions and tests as a means to prevent, detect, treat or
manage this disease.
Lifestyle
and home remedies
To help control the
symptoms of an enlarged prostate, try to:
· Limit beverages in the evening. Don't
drink anything for an hour or two before bedtime to avoid middle-of-the-night
trips to the toilet.
· Limit caffeine and alcohol. They can increase
urine production, irritate the bladder and worsen symptoms.
· Limit decongestants or antihistamines. These
drugs tighten the band of muscles around the urethra that control urine flow,
making it harder to urinate.
· Go when you first feel the urge. Waiting
too long might overstretch the bladder muscle and cause damage.
· Schedule bathroom visits. Try to urinate at
regular times — such as every four to six hours during the day — to
"retrain" the bladder. This can be especially useful if you have
severe frequency and urgency.
· Follow a healthy diet. Obesity is
associated with enlarged prostate.
· Stay active. Inactivity contributes to urine
retention. Even a small amount of exercise can help reduce urinary problems
caused by an enlarged prostate.
· Urinate — and then urinate again a few moments later. This
practice is known as double voiding.
· Keep warm. Colder temperatures can cause urine
retention and increase the urgency to urinate.
Alternative
medicine
The Food and Drug
Administration hasn't approved any herbal medications for treatment of an
enlarged prostate.
Studies on herbal
therapies as a treatment for enlarged prostate have had mixed results. One
study found that saw palmetto extract was as effective as finasteride in
relieving symptoms of BPH, although prostate volumes weren't reduced. But a
subsequent placebo-controlled trial found no evidence that saw palmetto is
better than a placebo.
Other herbal treatments —
including beta-sitosterol extracts, pygeum and rye grass — have been suggested
as helpful for reducing enlarged prostate symptoms. But the safety and
long-term efficacy of these treatments hasn't been proved.
If you take any herbal
remedies, tell your doctor. Certain herbal products might increase the risk of
bleeding or interfere with other medications you're taking.
Preparing
for your appointment
You might be referred
directly to a doctor who specializes in urinary issues (urologist).
What you can do
· Make a list of your symptoms, including any that
may seem unrelated to the reason for which you scheduled the appointment.
· Keep track of how often and when you urinate,
whether you feel you're completely emptying your bladder, and how much liquid
you drink.
· Make a list of your key medical information, including
other conditions you might have.
· Make a list of all medications, vitamins
or supplements that you're currently taking.
· Write down questions to ask your doctor.
Questions to ask your doctor
· Is an
enlarged prostate or something else likely causing my symptoms?
· What
kinds of tests do I need?
· What
are my treatment options?
· How can
I manage other health conditions along with an enlarged prostate?
· Are
there any restrictions on sexual activity?
Don't hesitate to ask
other questions during your appointment.
What to expect from your doctor
Your doctor is likely to
ask you a number of questions. Being ready to answer them might give you more
time to address any concerns. You might be asked:
· When
did you first begin experiencing urinary symptoms? Have they been continuous or
occasional? Have they gradually worsened over time, or did they come on
suddenly?
· How
often do you urinate during the day, and how often do you need to get up at
night to urinate?
· Have
you ever leaked urine? Do you have a frequent or urgent need to urinate?
· Is it
difficult for you to begin urinating? Do you start and stop when urinating, or
feel like you have to strain to urinate? Does it ever feel like you haven't
completely emptied your bladder?
· Is
there any burning when you urinate, pain in your bladder area or blood in your
urine? Have you had urinary tract infections?
· Do you
have a family history of enlarged prostate, prostate cancer or kidney stones?
· Have
you ever had any trouble getting and maintaining an erection (erectile
dysfunction), or other sexual problems?
· Have
you ever had surgery or another procedure that involved insertion of an
instrument through the tip of your penis into your urethra?
· Are you
taking any blood thinners, such as aspirin, warfarin (Coumadin, Jantoven) or
clopidogrel (Plavix)?
· How
much caffeine do you consume? What is your fluid intake?
ters, L. A., et al. "Benign Prostatic Hypertrophy."
Medscape.com. Oct. 12, 2015.
How is an enlarged prostate diagnosed?
ON THIS PAGE
You might
have several different tests to find out if you have an enlarged prostate. Some
of the tests can be done at your GP surgery. Your GP might also arrange for you
to see a doctor who specialises in urinary problems (a urologist) or a
specialist nurse at the hospital.
You may
not need all of the tests described below. Ask your GP to explain which tests
you will have, where you will have them, and what they will involve.
What tests might I have at the GP surgery?
Symptom check
Your GP will ask about your symptoms,
how long you’ve had them, whether they are getting worse over time, and how
they are affecting your life.
Before
you visit your GP, you might want to think about how often you’ve had symptoms
over the last month. This may help you explain your symptoms to your GP. You
might also want to keep a diary of how much you drink and how often you
urinate.
Your GP
will check whether your symptoms might be caused by another health problem,
such as diabetes, or by any medicines you are taking, such as blood pressure
medicines, anti-depressants or herbal medicines.
They
will also check whether your symptoms could be caused by your lifestyle – for
example, if you often drink large amounts of fluid, alcohol, or drinks
containing caffeine (such as tea, coffee or cola).
Bladder diary
Your GP
may ask you to keep a diary for a few days to check how much you are drinking,
what type of drinks you have, how much urine you pass, and how often and at
what times you urinate. A diary can help your doctor to work out what may be
causing your symptoms and how to treat them.
Urine test
Your GP
may ask you for a urine sample to check for blood or any infection that could
be causing your symptoms. You may need to give more than one sample. If you
have an infection your GP will give you a course of antibiotics.
Blood tests
You may be offered a blood test to check your kidneys are
working properly. You may also be offered a prostate specific antigen (PSA) blood test.
PSA is a protein produced by cells in your prostate. If the PSA level is
raised, there may be a problem with your prostate. An enlarged prostate can
cause the amount of PSA in your blood to rise. A urine infection, inflammation
and prostate cancer can also make your PSA level rise.
Physical examination
Your GP may examine your abdomen (stomach area) and penis. They
may also feel your prostate through the wall of the back passage (rectum). This
is called a digital rectal examination
(DRE).
During
a DRE, the doctor or nurse will ask you to lie on your side on an examination
table, with your knees brought up towards your chest. The doctor or nurse will
slide a finger gently into your back passage. They’ll wear gloves and put some
gel on their finger to make it more comfortable.
The
doctor or nurse will feel your prostate for any hard or lumpy areas and to get
an idea of its size. If your prostate is larger than expected for your age,
this could be a sign of an enlarged prostate. You may find the DRE slightly
uncomfortable or embarrassing, but the test isn’t usually painful and it
doesn’t take long.
Enlarged
prostate: A guide to diagnosis and treatment
This booklet is for men who want to know more
about a non-cancerous condition called an enlarged prostate.
Still
have questions?
Ask all the questions you need answers to, or
just talk. Our nurses have time for you.
What tests might I have at the hospital?
If
you’re given an appointment with a hospital specialist, they may do some of the
tests you had at the GP surgery again. You may also have other tests, including
the tests described below.
Symptom
questionnaire
You
might be asked to fill in a short questionnaire about your symptoms. This is
called the International Prostate Symptom Score (IPSS) and is used to see how
bad your symptoms are and how much they are bothering you.
Urine
flow test
You’ll
be asked to urinate into a machine that measures the speed of your urine flow.
Men with an enlarged prostate usually have a slower flow than other men. You'll
need a full bladder for the test. The doctor or nurse will tell you how much to
drink before you have the test. They may also ask you not to urinate for two to
three hours before the test.
Ultrasound
scan
This
shows how much urine your bladder can hold, and if it is emptying properly. You
may have the scan straight after the urine flow test to see how much urine is
left in your bladder after you urinate. You may also have an ultrasound scan to
look at your kidneys.
Further tests
Depending
on your test results, you may have further tests to find out what is causing
your symptoms.
Bladder
pressure (urodynamic) test
This
shows how well your bladder is working. The doctor passes thin tubes up your
penis and fills your bladder with a clear liquid. Thin tubes are also placed in
your back passage (rectum). The tubes measure the pressure in your bladder,
back passage and urethra. You will then be asked to empty your bladder, and the
pressures will be measured again while you urinate. You may have this test if
you’re thinking about having surgery to treat an enlarged prostate, or if
you’ve had surgery but your symptoms haven’t improved or are getting worse.
Flexible cystoscopy
This
shows whether you have a blockage or any abnormal tissue in your urethra or
bladder. A doctor or specialist nurse will pass a thin tube up your penis into
your bladder. You’ll be able to feel the tube moving, but anaesthetic gel will
be used to make the test more comfortable. The tube has a light and camera on
the end so the doctor or nurse can see the inside of your urethra and bladder
on a screen. You may have this test if you have severe urinary symptoms, blood
in your urine or pain, or if you often get urine infections. You may also have
this test if your doctor thinks your urethra or the opening of your bladder may
be too narrow – this is called a stricture.
Pad test
You may
have this test if you sometimes leak urine. Your doctor or nurse will ask you
to wear an incontinence pad for a certain amount of time. They then weigh the
pad to work out how much urine has leaked.
Enlarged prostate
ON THIS PAGE
An enlarged prostate is
an increase in the size of the prostate. It isn’t caused by cancer. The medical
term for an enlarged prostate is benign prostatic enlargement (BPE).
§ Benign – not cancer.
§ Prostatic – to do with the prostate.
§ Enlargement – an increase in size.
You might
also hear it called benign prostatic hyperplasia (BPH). Hyperplasia means an
increase in the number of cells. It is this increase in cells that makes the
prostate grow bigger (see diagram). In our information, we use the words
'enlarged prostate' to describe both BPE and BPH.
An enlarged prostate is very common in men over the age of about
50. Not all men with an enlarged prostate get symptoms. But as the prostate
grows, it can press on the outside of the urethra, causing the urethra to
become narrow. This can slow
down or sometimes even stop the flow of urine when you try
to urinate.
About 1
in 3 men over the age of 50 have urinary symptoms. The most common cause of
these symptoms is an enlarged prostate.
What causes an enlarged prostate?
We
still don’t really know all the things that cause the prostate to grow. But we
do know about two risk factors that can increase your risk of having an
enlarged prostate.
Age
Your
risk of having an enlarged prostate increases as you get older. Many men aged
50 or over have an enlarged prostate, but they don’t all get symptoms. And some
men have symptoms that don't bother them.
Hormone
levels
The
balance of hormones (oestrogen and testosterone) in your body changes as you
get older. This may cause your prostate to grow.
Other
factors
Some
studies show that obese men and men who have diabetes may be more likely to
develop an enlarged prostate. Regular exercise may help to reduce your risk of
urinary symptoms. But we still need more studies into the causes of enlarged
prostate to know for certain if, and how, we can prevent it.
There
is also some research that suggests you may be more at risk of developing an
enlarged prostate if your father or brother has one. Again, further studies are
needed to confirm this.
Enlarged
prostate: A guide to diagnosis and treatment
This booklet is for men who want to know more
about a non-cancerous condition called an enlarged prostate.
What are the signs and symptoms of an enlarged prostate?
An
enlarged prostate is the most common cause of urinary symptoms in men as they
get older. Possible symptoms include:
§ a weak flow when you urinate
§ a feeling that your bladder hasn’t emptied
properly
§ difficulty starting to urinate
§ dribbling urine after you finish urinating
§ needing to urinate more often, especially at
night
§ a sudden urge to urinate – you may sometimes
leak before you get to the toilet.
You may
not get all of these symptoms, and some men with an enlarged prostate don’t get
any symptoms at all. These symptoms can also be caused by other things, such as
cold weather, anxiety, other health problems, lifestyle factors, and some
medicines. Blood in your urine may be a symptom of an enlarged prostate.
But this is rare and is usually caused by something else.
If you
have any of the symptoms above, you should visit your GP to find out what may
be causing them.
Worried
about urinary symptoms?
Ask all the questions you need answers to, or
just talk. Our nurses have time for you.
Am I more likely to get prostate cancer if I have an enlarged
prostate?
No, having an enlarged prostate doesn’t increase your risk of getting prostate
cancer. The two problems usually begin in different parts of the prostate. But
men can have an enlarged prostate and prostate cancer at the same time.
If you’re worried about prostate cancer, talk to your GP
or call
our Specialist nurses.
How might an enlarged prostate affect my life?
Having
an enlarged prostate affects men in different ways. Some men can manage mild
symptoms and don’t need treatment. Other men find they need to stay near a
toilet. This can make it difficult to work, drive, be outdoors and attend
social events. If you need the toilet a lot during the night, this can affect
your sleep and make you feel more tired during the day.
Some
men with an enlarged prostate find their symptoms improve over time without
treatment. But for most, the symptoms will stay the same or slowly start to
cause more problems over time unless they have treatment.
What other problems might an enlarged prostate cause?
A small
number of men may find it difficult to empty their bladder properly – this is
called urine retention. If you’ve been diagnosed with an enlarged prostate,
your doctor will look at your test results to see if you’re at risk of urine retention.
You may be more likely to get urine retention if:
§ you’re aged 70 or over
§ your prostate is very large
§ you have severe urinary symptoms and a very
slow flow.
Chronic
urine retention
This is
where you can’t empty your bladder fully, but can still urinate a little. It
usually develops slowly over time. Chronic means long-lasting. The first signs
often include a weak flow when you urinate, or leaking urine at night. You may
feel that your abdomen (stomach area) is swollen, or that you’re not emptying
your bladder fully.
Chronic
urine retention is usually painless. But the pressure of the urine can slowly
stretch your bladder muscle and make it weaker. This can cause urine to be left
behind in the bladder when you urinate. If you don’t empty your bladder fully,
you might get a urine infection, need to urinate more often, leak urine at
night, or get painful bladder stones. You might also see some blood in your
urine. Chronic urine retention can damage your bladder and kidneys if it isn’t
treated.
There
are several treatments for chronic urine retention, including:
§ passing a thin, flexible tube called a
catheter to drain urine from your bladder
§ surgery to widen the urethra.
Acute
urine retention
This is
when you suddenly and painfully can’t urinate – it needs treating straight
away. If this happens, call your doctor or nurse, or go to your nearest
accident and emergency (A&E) department. They may need to drain your
bladder using a catheter. Before the catheter is removed, you may be offered a
medicine called an alpha-blocker. This may help stop you getting acute
retention again.
How is an enlarged prostate diagnosed?
Some
tests for an enlarged prostate can be done at your GP surgery. Your GP might
also arrange for you to see a doctor who specialises in urinary problems (a
urologist) or a specialist nurse at the hospital.
Tests for
an enlarged prostate
You might have several different tests to find
out whether you have an enlarged prostate.
What are the treatment options?
There
are three main types of treatment for an enlarged prostate:
§ lifestyle changes
§ medicines
§ surgery.
Read our information on treatment for an enlarged
prostate.
What to read next
Treating
an enlarged prostate
There are three main types of treatment for an
enlarged prostate: lifestyle changes, medicines & surgery.
Help improve our page
We'd
like to ask you two questions about our page.
How is an enlarged prostate treated?
ON THIS PAGE
There are
three main types of treatment for an enlarged prostate:
§ lifestyle changes
§ medicines
§ surgery.
If tests
show you have an enlarged prostate, your doctor or specialist nurse will look
at your test results and medical history to see which treatments might be
suitable. They will explain your treatment options and help you decide what’s
right for you. It’s important to see how you feel about each treatment before
making a decision.
Depending on the treatment you choose, you may have regular
check-ups with your GP, or with a specialist at the hospital. They may repeat
some tests to see
how well your treatment is working. If your symptoms don’t improve or your
treatment is causing side effects, you may be able to try a different
treatment.
Lifestyle changes
If your
enlarged prostate isn’t causing problems, you may decide to wait and see if
your symptoms get worse before having treatment. An enlarged prostate usually
develops slowly, and your symptoms may never get any worse.
There
are simple changes you can make to your lifestyle that might help your
symptoms.
Drink less alcohol,
caffeine, artificial sweeteners and fizzy drinks -
These can irritate the bladder and make urinary symptoms worse.
Drink less in the evening -
Try to drink less in the late afternoon and evening, so you’re less likely to
get up in the night. But make sure you drink enough during the day – 1.5 to 2
litres (3 to 4 pints) a day.
Empty your bladder before
leaving the house - Remember to use the toilet before long journeys, and
find out where there are public toilets before leaving home.
Double voiding - After
you urinate, wait a few minutes and then try to go again. This can help to
empty your bladder properly. But take care not to strain or push.
Check your medicines -
Ask your doctor whether any medicines you take, such as anti-depressants or
decongestants (medicines for a blocked nose), may be making your urinary
symptoms worse.
Eat more fruit and fibre -
This will help you avoid constipation (difficulty emptying your bowels), which
can put pressure on the bladder and make urinary symptoms worse.
Keep a healthy weight -
If you’re overweight, this can make your symptoms worse. Talk to your doctor if
you’re worried about your weight. They can help you think about ways to lose
weight healthily.
Exercise regularly -
Regular exercise may help your symptoms. If you’re not usually very active,
speak to your doctor before starting any kind of exercise plan. They can talk
with you about exercising safely.
Bladder retraining -
This technique can help you hold on for longer when you need to urinate. Ask
your doctor or specialist nurse for more information.
Urethral massage -
You might hear this called urethral milking. After you urinate, press gently
upwards at the base of your scrotum (the skin around your testicles) with your
fingertips. You should be able to feel your urethra. Keep pressing gently as
you move your fingers forward from the base of your penis to the tip. This will
squeeze out any urine that’s left in your urethra and prevent dribbling. Ask
your doctor or specialist nurse for more information.
Absorbent pads or urinary
sheaths - Absorbent pads and pants can be worn inside your
underwear, or instead of underwear. They soak up any leaks. Urinary sheaths
look like condoms with a tube attached to the end, which drains urine into a
bag. The sheath fits tightly over your penis and you can strap the bag to your
leg, under your clothes. Ask your doctor or specialist nurse for more
information.
Medicines
If
lifestyle changes don’t control your symptoms, medicines may be an option. Make
sure you tell your doctor about any medicines or herbal remedies you already
use, in case they interfere with medicines for an enlarged prostate.
The
main types of medicine for an enlarged prostate are:
You might be given both types of medicine – this is known as
a combination treatment.
You’ll
have regular check-ups to talk about your symptoms and any side effects you
might be getting.These check-ups may be with your GP or with a urologist or
specialist nurse at the hospital.
· Alpha-blockers
· 5-alpha-reductase
inhibitors (5ARIs)
· Other
medicines
· Combination
treatments
· Complementary
therapies
Surgery
Surgery
may be an option if your symptoms don’t improve with lifestyle changes or
medicines, or if your symptoms are severe.
Several
different types of surgery can be used to treat an enlarged prostate. Common
types of surgery include:
§ holmium laser enucleation of the prostate
(HoLEP)
§ transurethral vaporisation of the prostate
(TUVP)
§ bladder neck incision
§ open (simple) prostatectomy
§ prostatic
urethral lift (UroLift®).
Your
hospital might not offer all of these types of surgery. The options available
to you may also depend on the size of your prostate and any other health
problems you have. Your doctor or nurse will discuss the advantages and
disadvantages of each type of surgery they offer, to help you decide what is
right for you.
You can read a summary of the most common types of surgery for
an enlarged prostate below. Your doctor or nurse can give you more information,
or you can speak to our Specialist Nurses.
· Transurethral
resection of the prostate (TURP)
· Holmium
laser enucleation of the prostate (HoLEP)
· Transurethral
vaporisation of the prostate (TUVP)
· Bladder
neck incision
· Open
(simple) prostatectomy
· Prostatic
urethral lift (UroLift®)
· Other
types of surgery
· Possible
side effects of surgery
What if I can't have surgery
Surgery
isn’t always an option – you may not be fit or well enough for an operation, or
you may not like the idea of it. If surgery isn’t suitable for you and
lifestyle changes and medicines haven’t worked, your doctor or nurse may
suggest using a catheter. This is a thin, flexible tube used to drain urine
from your bladder. The catheter may be permanent or temporary.
A permanent catheter is
passed up into the bladder through your penis, or through a small cut in your
abdomen. The catheter is usually attached to a drainage bag, which you strap on
to your body under your clothing. Your doctor or nurse will usually change your
catheter every 12 weeks.
A temporary catheter (self-catheterisation)
is where you put a catheter in yourself when you need to urinate, rather than
leaving one in all the time. Your doctor or nurse will show you how to put the
catheter in and tell you how often to use it. Some men can urinate quite well
without a catheter and only use it once a day to make sure they empty their
bladder regularly. Other men need to use a temporary catheter several times a
day.
Urine
infections are common in men who use a catheter. Your urine should usually be a
pale yellow colour. If it becomes dark or cloudy with a strong smell, this
could be a sign of a urine infection. Other signs of a possible infection
include a fever (high temperature), a burning feeling when you urinate, and
feeling unwell. Tell your doctor or nurse if you have any of these symptoms.
They’ll usually give you antibiotics to treat the infection.
You can
lower your chances of getting a urine infection by keeping your catheter and
the area around it clean. You may find the following tips helpful.
§ Always wash your hands with warm, soapy water
before and after touching your catheter or drainage bag.
§ Wash the catheter and the area around it at
least twice a day with warm water and unscented soap. Use one wash cloth for
this and a different one for the rest of your body. Wipe downwards along the
catheter, away from your body, and dry it carefully afterwards.
§ Drink plenty of fluids (1.5 to 2 litres, or 3
to 4 pints a day).
§ Eat plenty of foods containing fibre – such as
fruit, vegetables and wholemeal bread – to avoid constipation. Constipation can
stop your catheter from draining properly.
Let
your nurse know if your catheter isn’t draining properly. If urine hasn’t
drained from your bladder for 2 to 3 hours, contact your GP or district nurse
straight away.
What are the symptoms of prostate cancer?
ON THIS PAGE
Most men with early prostate cancer don’t have any signs or
symptoms. But there are some things that may mean you're more likely to get
prostate cancer. You might hear these described as risk factors.
Even if you don't have any of the symptoms that we talk about below, speak to
your GP about prostate cancer if:
§ you are aged 50 or over
§ your father or brother has had prostate cancer
§ you are black.
Read more about things that can increase your risk of prostate
cancer.
What are the symptoms of prostate cancer?
Most
men with early prostate cancer don’t have any signs or symptoms.
One
reason for this is the way the cancer grows. You’ll usually only get early
symptoms if the cancer grows near the tube you urinate through (the urethra)
and presses against it, changing the way you urinate (pee). But because
prostate cancer usually starts to grow in a different part of the prostate,
early prostate cancer doesn’t often press on the urethra and cause symptoms.
If you do notice changes in the way you urinate, this is more
likely to be a sign of a very common non-cancerous problem called an enlarged
prostate, or another health problem. But it’s still a good idea
to get it checked out. Possible changes include:
§ difficulty starting to urinate or emptying
your bladder
§ a weak flow when you urinate
§ a feeling that your bladder hasn’t emptied
properly
§ dribbling urine after you finish urinating
§ needing to urinate more often, especially at
night
§ a sudden urge to urinate – you may sometimes
leak before you get to the toilet.
If prostate cancer breaks out of the prostate (locally advanced prostate cancer) or
spreads to other parts of the body (advanced prostate cancer), it can cause other
symptoms, including:
§ back pain, hip pain or pelvis pain
§ problems getting or keeping an erection
§ blood in the urine or semen
§ unexplained weight loss.
These symptoms can also be caused by other things that aren’t
prostate cancer, like prostatitis (infection
and swelling of the prostate), diabetes, or some medicines. But it’s still a
good idea to get any symptoms checked out by your GP so they can find out
what’s causing them and make sure you get the right treatment if you need it.
What if I don't have any symptoms?
You may want to speak to your GP if you're over 50, have a family history of prostate cancer, or are
a black man – even if you don't have
any symptoms. These are all things that can increase your risk of prostate cancer.
What
Tests Do I Need for BPH?
ARTICLES ONPROSTATE ENLARGEMENT / BPH - WHAT TESTS
DO I NEED FOR BPH?
Benign prostatic hyperplasia,
or BPH, is an enlarged
prostate gland. Its symptoms can look like prostate cancer, but
it’s not. BPH symptoms can also be hard to tell apart from urinary tract
infections and bladder or kidney problems.
Your doctor can do tests like a digital rectal exam and
a biopsy to know
for sure whether you have BPH.
Once you have a diagnosis, treatments can help you avoid
complications such as urinary tract infections or damage to the bladder
or kidneys.
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7 BPH Questions
The American Urological Association has a ratings system
to rate how severe your symptoms are. It’s called the “BPH Symptom Score
Index.”
It includes 7 questions about what’s been happening with
you over the past month. They are:
1. How often have you felt like you weren't able to fully
empty your bladder when you finished peeing?
2. How often have you had to go again less than 2 hours
after you last finished?
3. How often have you stopped and started while peeing?
4. How often have you found it hard to wait to go?
5. How often have you had a weak stream?
6. How often have you had to push or strain to start
urinating?
7. How many times do you have to get up and use the
bathroom during the night?
Each question is assigned points from 0 (none at all) to
5 (almost always). Your score will show whether your BPH is mild or severe and
guide your treatment.
Diagnosis
You can see your usual doctor for a diagnosis, or you
can visit a urologist, who is a specialist in diseases of the urinary tract
and male reproductive system.
This will likely involve the following:
Medical history: He will first ask you questions about your health
and any medicines you take.
General physical: Then you'll have a physical exam. The
doctor will feel your belly and groin areas to check for any lumps.
Digital rectal exam: This is a way for your doctor to feel if
your prostate is
enlarged. The prostate is right next to your rectum.
First, you'll bend over the exam table or you might lie
on your side with your knees pulled up to your chest. Your doctor will gently
slide a gloved, lubricated finger into your rectum to feel your prostate. He
will feel for any growths or lumps.
You might feel the need to pee or a little discomfort,
but the exam should be quick.
Other Tests
These tests can look for other causes of BPH symptoms,
such as a urinary tract infection,
a bladder problem, or prostate cancer.
Urine
test. For this, you'll pee
into a cup. A treated piece of paper placed into your urine can show
whether you have an infection. It might also be checked for small traces
of blood that could
signal bladder cancer or
other conditions.
Blood test. This can check your levels of two chemical waste products: creatinine and
blood urea nitrogen. High levels of these might mean your kidneys aren't
working as well as they should.
Urodynamic tests. This group of tests checks how well you hold and release
urine in your bladder and your urethra, which is the narrow tube in your penis through which pee and semen flow. You
might get these tests at your doctor's office or at a hospital.
- A post-void residual measurement checks how much urine is left in your bladder after you go to the
bathroom. First you will be asked to pee. Then the doctor will place a
thin tube called a catheter into your urethra. The tube will be threaded
into your bladder to remove any urine that's left inside. That leftover
liquid is measured.
- Uroflowmetry measures
how fast you release urine. This is called your flow rate. During the
test, you'll pee into a special toilet or container. A slow flow might
mean you have weak bladder muscles or a blockage in your urinary tract.
- Urodynamic pressure uses a meter to find out how much pressure needs to be on your
bladder for you to pee. It also tests your flow rate. This test can show
whether an enlarged prostate is blocking the flow out of your bladder.
Cystoscopy. This test lets the doctor see inside your urethra and
bladder. You will first get medicine so you don't feel pain. You might be
given something so you aren’t awake during the test.
The doctor will insert a tube called a cystoscope
through your urethra into your bladder. The tube has a lens on one end that
lets him look for problems inside your urinary tract.
Transrectal ultrasound. An ultrasound uses sound waves to make a picture of your
prostate gland. It can show whether it is enlarged or you have a tumor. You can
have this test at your doctor's office or a hospital.
A technician will insert a thin device called a
transducer into your rectum. As the device moves around, it will show different
parts of your prostate.
PSA test. This checks for levels of what’s called prostate
specific antigen, or PSA, in your blood.
PSA is a protein your
prostate makes. Both BPH and prostate cancer can raise your PSA level. This
test alone can't confirm that you have BPH. You will need other tests, too. If
your level is high and your doctor suspects cancer, you'll likely have a prostate biopsy.
Biopsy. For this test, you will first get medicine so you don't
feel any pain. The doctor will use an ultrasound, CT, or MRI scan to see
your prostate gland. He will then use a needle to take a small piece of tissue.
The sample will be sent to a lab where a technician will look at it under a microscope
to see whether it is cancerous.
Talk to your doctor about your test results. Make sure
you understand what they mean and how they will affect your treatment.
WebMD Medical Reference Reviewed
by Laura J. Martin, MD on October 04, 2016
Sources
© 2016 WebMD, LLC
Can
I Prevent BPH?
ARTICLES ONPROSTATE ENLARGEMENT / BPH - CAN I
PREVENT BPH?
Men with BPH have a larger-than-normal prostate. Some 9 in
10 men will have it by the time they’re in their 80s. Even with those chances,
you still might ask: Are there things I can do to prevent it?
The short answer is no. For most men, your prostate’s
just going to grow, and it might lead to benign prostatic hyperplasia,
as it’s formally known.
But it still helps to know when you’d want to see your
doctor, what makes you more likely to get it, and how you can keep the symptoms
at bay.
When Should I See a Doctor?
Growth of this gland, which is just below the bladder, is typical.
But problems when you pee aren’t. Even if you don’t think it’s a big deal, it’s
worth getting checked out if you have common BPH symptoms, such as:
- Dribbling when you finish peeing
- A hard time starting a stream
- Having to pee a lot -- 8 or more times a day
- Waking up several times a night to pee
- A weak urine stream
or you pee in stops and starts
Some problems with urine flow can be more serious. See
your doctor or go to the emergency room right away if you:
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- Can’t pee at all
- Feel intense pain or
discomfort in your lower belly
- Have blood in
your pee
- Keep needing to pee right away, it hurts to pee, and you
have fever and chills
Who’s More Likely to Get BPH?
You may have a greater chance of an enlarged prostate
based on your:
- Age. BPH is
more common the older you get and doesn’t usually affect men younger than
40.
- Family history. If
your dad or your brothers have the condition, you have a higher chance of
getting it, too.
- Ethnicity. This
affects black and white men more often than Asian men. Black men may get
symptoms at a younger age.
Some health conditions can also raise the odds you’ll
get BPH, such as:
- Diabetes, heart disease,
and problems with blood flow
- Erectile dysfunction
- Obesity
If you use beta blockers -- a type of medication used to treat conditions such
as high blood pressure and
migraines -- you may be more likely to get BPH.
Can Lifestyle Changes Help?
Lifestyle changes can’t prevent BPH, but they may still
be good for your prostate. For starters, exercise and
a heart-healthy diet can help manage your weight, which is
great for your prostate. Exercisealso helps
your bladder empty at a normal rate.
- To control symptoms, it may help to:
- Avoid or limit how you use decongestants and antihistaminesduring colds and allergy outbreaks as they tighten
the muscles that control urine flow and make it harder to pee
- Do exercises to strengthen your pelvic floor muscles
- Limit how much caffeine and alcohol you
take in; they make you pee more and can irritate your bladder
- Lower the amount of fluids you drink, especially before you go out
or go to bed
- Pee when you first feel the urge because it’s easier on your
bladder
- Stay warm. Cold can
make it feel more urgent to pee.
WebMD Medical Reference Reviewed by Laura J. Martin, MD on October 04, 2016
Sources
© 2016 WebMD, LLC
What’s
the Best Approach to Treating BPH?
ARTICLES ONPROSTATE ENLARGEMENT / BPH TREATMENTS -
WHAT’S THE BEST APPROACH TO TREATING BPH?
There’s no one-size-fits-all approach when you have
an enlarged prostate and
you’re trying to decide what to do next.
Each person reacts in his own way to the symptoms
of benign prostatic hyperplasia (BPH), a common condition for men as they age.
You can talk about your symptoms with your doctor, and
together you can decide on the best way for you to handle your case. Your
options may include:
- Watchful waiting and lifestyle changes
- Medications or supplements
- Surgery
Watchful Waiting
If your symptoms don’t bother you much and you haven’t
gotten any complications, you may choose to just have you and your doctor keep
a regular eye on things.
This means seeing your doctor once a year -- or sooner
if your symptoms change.
Some things to watch include:
- Needing to pee a lot
- The sensation that your bladder is
full, even after you’ve just gone
- An urgent need to go out of the blue
- A weak stream or dribbling at the end
- Trouble starting
- Having to stop and start peeing several times
- Urine leakage
Reasons to consider watchful waiting for an enlarged prostate:
- Your symptoms are mild.
- You don't want the side effects of medications.
- It’s less costly than medical or surgical treatments.
- Some men with mild BPH symptoms
find they get better without treatment.
If you choose watchful waiting, there are a couple of
things you can do to ease things:
- Make simple changes in your habits. Drinking fewer liquids before bedtime. Drink
less caffeine and
alcohol generally.
- Avoid some over-the-counter medications. Take a pass on cold and sinus medicines
that have decongestants or
certain antihistamines,
such as diphenhydramine (Benadryl), that
can make a prostate problem
worse. Read labels on these products before you buy them.
Should I Go With a Treatment?
If your symptoms become worse, it's time to talk to your
doctor about an active treatment. Some things to ask yourself and your doctor
about each option:
- How much will my condition improve?
- How long will the effects last?
- Is there a chance that the treatment will cause problems?
From there, you can talk with him about
medications, supplements or
surgery.
Prescription Medications
These may give you relief. Some reasons to consider going
on medication for an enlarged prostate include:
- You have moderate symptoms that aren’t getting better or might be
getting worse.
- You've tried making lifestyle changes, such as drinking fewer
liquids, with no results.
- You are at risk for complications related to BPH, such as not
being able to empty your bladder.
Two types of medications are available to treat moderate
BPH. Each works differently in the body, and each has its own side effects.
The two classes of drugs for an enlarged prostate are:
- Alpha blockers, which
relax muscles of the prostate and neck of the bladder to relieve
symptoms. Examples of alpha blocker medications include: Alfuzosin
(Uroxatral), Doxazosin (Cardura), Tamsulosin (Flomax), and
Terazosin (Hytrin).
- 5-alpha reductase inhibitors (5-ARIs), which help shrink the prostate and prevent additional
growth. Examples of 5 ARIs include: Finasteride (Proscar) and
Dutasteride (Avodart).
- Phosphodiesterase 5 inhibitors (PDE5 inhibitors): Tadalfil (Cialis), Sildenafil, (Viagra), Vardenafil (Levitra).
(PDE5) inhibitors have been shown to
improve prostate symptom score with increasing flow rate.
Men with very enlarged prostates may take more than one
medication, called combination therapy, to reduce the need for surgery.
However, men taking both might also get hit with the side effects of both
drugs.
The FDA requires labels on the 5-ARIs to include a
warning that they may be linked to an increased chance of high-grade (or
aggressive) prostate cancer.
Medications that contain 5-ARIs include: dutasteride(Avodart, Jalyn)
and finasteride (Propecia, Proscar).
Supplements
They aren’t as closely regulated as medicines your
doctor prescribes. That means their safety, quality, and effects can vary.
Saw palmetto is one of the best-studied and most
commonly used supplements to
treat BPH. Some small studies have shown benefit. However, several large
studies do not show that it reduces the size of the prostate or eases urinary
symptoms.
Three others are:
Three others are:
- Beta-sitosterol
- Pygeum
- Rye grass
Talk to your doctor before you start any supplement.
They may cause problems with prescription medicines, treatments, or tests you
might need.
Procedures
Sometimes BPH doesn't respond enough to lifestyle
changes, medications, or supplements. If that's true for you, there are
surgical options as well.
You and your doctor look to surgery when you can’t pee
at all or have:
- Kidney damage
- Lots of urinary tract infections or
bleeding
- Stones in the bladder
One of your options would be what’s called “minimally
invasive” surgery. In these types, doctors make much smaller cuts or are able
to work with probes they insert through your penis. These types of procedures often mean
faster recoveries and less pain and scarring.
Traditional, open surgery is the other option. You
should talk with your doctor about what’s best for your case.
WebMD Medical Reference Reviewed by Nazia Q
Bandukwala, DO on April 10, 2018
Sources
© 2018 WebMD, LLC
What
Medicines Treat BPH?
ARTICLES ONPROSTATE ENLARGEMENT / BPH TREATMENTS -
WHAT MEDICINES TREAT BPH?
Not too long ago, men who wanted relief from BPH had one main option: surgery. In
recent years, that’s changed. Drugmakers have come out with a number of
medicines that give you more choices to treat your symptoms.
Benign prostatic hyperplasia (you’ve
probably heard it called enlarged prostate)
can cause problems such as a weak urine stream or having to pee a lot all day.
Some medicines ease these symptoms by calming the muscles in the bladder and prostate. Others
stop prostate growth and shrink the size of the prostate.
Medicine is now the most common way to treat men with
mild to moderate BPH. Researchers are
still learning about long-term effects and when drugs can be most helpful. Talk
to your doctor to find out which medicine may be best for you.
Alpha Blockers
These work by relaxing muscles in your bladder and
prostate, which makes it easier to pee. They don’t change the size of your prostate,
but they do help with urine flow, waking at night to pee, and other symptoms.
And you won’t have to wait long to see results; they usually work right away.
If you have high blood pressure and BPH, alpha blockers
may be a good option for you because they treat both conditions.
CONTINUE READING BELOW
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If you are planning to have cataract surgery, it’s best
to avoid them. They can lead to problems during the procedure.
Side effects: Since alpha blockers affect your blood pressure, they
can make you feel very tired and cause these other things as well:
They may also lead to what you may hear a doctor call
“retrograde ejaculation.” This is when sperm go
backward into your bladder instead of out through your penis. It doesn’t cause any harm, but it means
you may not have any sperm when you ejaculate. Men who still want to have
children should keep this in mind.
Names: Your
doctor might suggest one of these alpha blockers:
- Alfuzosin (Uroxatral)
- Doxazosin (Cardura)
- Prazosin (Minipress)
- Silodosin (Rapaflo)
- Tamsulosin (Flomax)
- Terazosin (Hytrin)
5-Alpha Reductase Inhibitors
These stop your body from creating one of the hormones
that makes your prostate larger. They prevent growth and in some cases even
shrink it. This can improve your urine flow and ease other BPH symptoms as
well. They seem to be most helpful to men with very large prostates.
These drugs have two other benefits as well. They may:
- Lower the odds that BPH will lead to other problems, such bladder
damage
- Make you less likely to need surgery
It can take up to 6 months to see the full effects of
5-ARIs, and you have to keep taking them to get results.
Side effects: This medication is not for use by women. Pregnantwomen should not be exposed to
itbecause it can lead to birth defects in
male babies.
Other side effects when men take it may include:
- Erectile dysfunction
- Lower sex drive
- Retrograde ejaculation
Some of these side effects may get better as your body
gets used to the medicine.
5-ARIs may also lower your PSA (prostate-specific antigen), which
affects one way that doctors look for prostate cancer.
That isn’t harmful, but it may help to get a PSA test before starting these
drugs. Also, the FDA now requires labels on 5-ARIs to include a warning that
they may be linked to an increased chance of high-grade (or aggressive) prostate cancer.
Names: There are two main 5-alpha reductase inhibitors:
- Finasteride (Propecia, Proscar)
- Dutasteride (Avodart)
Phosphodiesterase-5 Inhibitors
These are the same medicines used to treat erectile dysfunction.
They smooth muscles in the bladder and prostate, which can help ease BPH
symptoms.
There are several kinds of phosphodiesterase-5
inhibitors, but the Food and Drug Administration has approved only Tadalafil (Cialis) to treat
BPH.
It’s not used as often as other drugs, but if you have
ED and BPH, it’s another option.
Side effects: When you take Cialis, you might get:
- Back and muscle pain
- Headaches
- Redness and warmth or burning on the face, neck, and upper body
- A stuffy nose
- An upset stomach after
eating
- Vision problems
Drug Combinations
If one medication on its own doesn’t help with symptoms,
your doctor may suggest taking two. Common combinations include:
- Finasteride and doxazosin
- Dutasteride and tamsulosin -- this comes in a single pill (Jalyn)
- Alpha blockers and antimuscarinics (drugs used to treat overactive bladder)
While these combos can be more helpful than a single
drug, they may also result in more side effects, since you’re taking two
medications instead of one.
WebMD Medical Reference Reviewed by Laura J. Martin, MD on October 09, 2016
Sources
© 2016 WebMD, LLC
Do
Supplements Help with BPH?
ARTICLES ONPROSTATE ENLARGEMENT / BPH TREATMENTS -
DO SUPPLEMENTS HELP WITH BPH?
When you try to find the right supplements to
treat a health condition, it can feel like a shot in the dark. You often have
to count on word of mouth. But some men with BPH have found success with supplements. And
there’s at least some scientific research to back them up.
When you have BPH (benign prostatic hyperplasia),
your prostateis larger
than normal. It can cause problems such as a weak urine stream or you need to
pee a lot throughout the day. Your doctor might suggest a prescription drug to
treat your symptoms, but you might find that the side effects are too much to
take. Or, you’d just rather not have to take medicine so often.
The Issue with Supplements
Supplements aren’t
as closely regulated as medicines your doctor prescribes.
That means their quality, safety, and effects can vary.
It’s best to talk to your doctor before you start any supplement. They may
cause problems with prescription medicines, treatments, or tests you might
need.
The Most Common Supplements
The best-studied, most commonly used supplements to
treat BPHare:
- Beta-sitosterol
- Pygeum
- Rye grass
- Saw palmetto
Beta-sitosterol: This is a substance found in many plants. It doesn’t
affect the size of the prostate, but it may help your bladder empty
and give you a stronger urine flow. It may improve other BPH symptoms as well.
Studies with Harzol and Azuprostat, two supplements that
contain beta-sitosterol from South African stargrass, have shown particular
promise.
Pygeum: This comes from the bark of the African plum tree. It
seems to help some men with BPH wake up less at night to pee, go fewer times
during the day, have a stronger urine stream, and empty their bladders better.
- Dribbling after you finish peeing
- Having to pee often throughout the day
- Painful urination
- Weak urine stream
- Urgent need to pee
Some research shows that it may also shrink the
prostate, give you a better flow, and help you empty your bladder.
Saw palmetto: This is a short tree that grows in North America.
Some small studies have shown a benefit. However, several large studies do not
show that saw palmetto reduces the size of the prostate or eases urinary
symptoms. Men may try it hoping to relieve common BPH symptoms such as:
- You have a hard time getting pee to start
- You must go often throughout the day
- A weak stream
- An urgent need to urinate
It may also help with waking up at night to go to the
bathroom and feeling like you still have to pee after you just went.
For men who’ve had success with saw palmetto, it takes
about 4 to 6 weeks to see results.
Supplements That Show Promise
Other supplements show hopeful signs of helping in
studies so far, but there’s less research on these than the more common
options.
Pumpkin seeds: These and pumpkin seed oil extract seem to help
with BPH symptoms and may shrink the size of the prostate. It may also be
helpful when used along with other supplements such as saw palmetto.
Stinging nettle: This is a type of herb, and its root may help with
urine flow and waking a lot at night to pee. It’s sometimes used along with
other supplements to treat BPH symptoms.
Too Early to Say
Then there are the supplements where it’s just too early
to know whether they’re useful. Early studies look good, but doctors need much
more data on them.
Some of these include:
- Aqueous garlic (garlic extract in water)
- Flaxseed lignin
extract
- Milk thistle
- Powdered, dried cranberry
- Quercetin (found in apples, tea, and red grapes, for example)
- Red clover
- Selenium
WebMD Medical Reference Reviewed by Laura J. Martin, MD on October 09, 2016
Sources
© 2016 WebMD, LLC.
Do
I Need Surgery for BPH?
ARTICLES ONPROSTATE ENLARGEMENT / BPH TREATMENTS -
DO I NEED SURGERY FOR BPH?
Medications can
help many men with an enlarged prostate,
but for some, they might not always be enough to ease symptoms such as weak
urine flow and dribbling.
When you’re one of those men, you have surgical options
to treat your benign prostatic hyperplasia,
or BPH.
5 Questions to Ask Before Surgery
As you think over the options for surgery, ask your
doctor these questions:
- Is there a good chance my condition will get better?
- How much will it improve?
- What are the chances of side effects from a treatment?
- How long will the effects last?
- Will I need to have this treatment repeated?
With newer technologies, doctors can do some procedures
with tiny cuts (incisions) or use tube-style instruments that they insert into
you. These can mean faster recoveries and less pain afterward.
Other times, the traditional “open” surgery is needed.
It all depends on your case and what you and your doctor decide is best for
you.
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Doctors can choose from these minimally invasive
procedures or open surgeries to treat moderate to severe symptoms. These
procedures are also used if tests show that your ability to pee is seriously
affected.
Minimally Invasive Procedures
There are minimally invasive procedures which utilize
various energy sources to destroy excess prostate tissue causing urinary
symptoms. These minimally invasive procedures are usually performed in the
office. Overall, these procedures may work better than drugs at easing symptoms
but may not be as effective as open surgery in some cases.
The following are some of the types you might talk about
with your doctor:
Transurethral microwave therapy (TUMT). This procedure uses a microwave antenna attached
to a flexible tube that your doctor inserts into your bladder. The
microwave heat kills off excess prostate tissue.
Transurethral needle ablation (TUNA). Your doctor inserts a heated needle into the
prostate through the urethra, the tube that carries urine and semen through
the penis. The heated
needle uses radiofrequency waves to heat up and destroy excess cells in the
prostate gland.
UroLift system. The UroLift system is the first permanent implant
for BPH. It works by
pulling back the prostate tissue that is pressing on the urethra.
Rezūm water vapor therapy. A device is inserted into the urethra, your urine
tube and a small needle delivers water vapor or
steam to treat the excess prostate tissue.
TUMT and TUNA have some urinary side effects that can
last for several weeks. All of these procedures are equally effective in easing
your symptoms.
The decisions you and your doctor make to use a
minimally invasive therapy are based on the size of the prostate, your other
medical conditions and other details of your case.
Surgical Procedures
Doctors often consider surgery the best long-term
solution for relief of bothersome urinary symptoms. Most of these involve
taking out the enlarged part of the prostate.
Surgery is usually recommended in treating moderate to
severe BPH-symptoms under
these conditions:
- You’re not able to pee at all.
- Lifestyle changes, medicines, or minimally invasive treatments
didn’t work for you.
- You find blood in your urine that
is not getting better.
- You get bladder stones.
- You get urinary tract infections a
lot.
- You have kidney damage.
Types of Surgery
The kinds of surgeries you might talk over with your
doctor could include:
Transurethral resection of the prostate
(TURP). Your doctor removes portions of the
prostate that are affecting your urinary flow. This is the most common surgical
procedure for BPH and remains the gold standard of interventional treatment
options.
There is no cutting and no external scars are seen since
a scope is inserted thorough the urethra to remove the excess tissue.
With TURP, some men might get what’s called “retrograde
ejaculation,” (ejaculation of semen into the bladder instead of through the
urethra).
Transurethral incision of the prostate
(TUIP). This surgery does not involve
removing prostate tissue. A few small cuts are made in the prostate to reduce
the gland's pressure on the urethra, making urination easier. This procedure is
an option for some men, such as those with smaller prostates.
With TUIP, there is much less risk of retrograde
ejaculation compared with TURP. However, it usually gives you symptom relief
equal to TURP.
One possible downside: Some men need a repeat TUIP.
Doctors decide which to use based mainly on the prostate's size.
Laser surgery. A doctor uses laser energy to kill off prostate
tissue and shrink the gland. This may not be as effective on larger prostates.
Laser procedures usually give you symptom relief and
better urinary flow similar to TURP. However, some laser therapies produce
fewer side effects than others.
Long-term studies are needed to find out whether laser
treatments are as effective as TURP.
Open prostatectomy (open surgery). A doctor often does this when the prostate is
greatly enlarged, when there are complications, or when the bladder has been
damaged and needs repair. In open surgery, the surgeon makes a cut and takes
out the enlarged tissue from the prostate.
Laparoscopic and Robotic Prostatectomy. Laparoscopic or
robotic surgery differs from traditional open surgery by making four small
incisions as opposed to one large one to perform surgery to remove the enlarged
tissue of the prostate.
Other Things to Consider
Before you have one of these procedures, talk with your
doctor about whether you’ll be given something to numb the area (“local
anesthesia”) or whether you’ll be given something so you won’t be awake
(“general anesthesia”) during the procedure. What you get and where you have it
depends on the procedure.
Your doctor will give you instructions on how to prepare
for any of them.
Surgery can ease many BPH symptoms, but it may not
relieve them all. If there are certain complications, such as a weak bladder,
there may still be urinary problems after surgery, although this is rare.
With any BPH surgery, there may be a slight risk of erection
problems. However, men who have normal erections before surgery likely won’t
have trouble afterward.
The best treatment for an enlarged prostate is not the
same for every man. Talk to your doctor about the risks and benefits of each
procedure.
WebMD Medical Reference Reviewed by Nazia Q
Bandukwala, DO on April 10, 2018
Sources
© 2018 WebMD, LLC
What
You Should Know About Saw Palmetto for BPH
ARTICLES ONPROSTATE ENLARGEMENT / BPH TREATMENTS -
WHAT YOU SHOULD KNOW ABOUT SAW PALMETTO FOR BPH
Saw palmetto is commonly used in Europe and the United
States as a treatment for enlarged prostate.
Some small studies have shown benefit. However, several
large studies do not show that saw palmetto reduces the size of the prostate or
eases the urinary symptoms that come with an enlarged prostate.
You might hear a doctor or nurse call that condition “benign prostate
hyperplasia,” or BPH.
Before you take saw palmetto, or any supplement for that
matter, talk with your doctor first. They may interfere with prescription
medicines, other treatments, or tests you might need.
What Is Saw Palmetto?
Saw palmetto (Serenoa repens) is a palm that
grows in the Southern coastal regions of the United States. It is about 2 to 4
feet high. Its leaves are fan-shaped and sharp, and it makes a lot of berries.
These fruits have a long history of use as medicine.
Some Native Americans used them to help with urinary problems in men.
Why Do People Take It?
Some small studies have shown saw palmetto might help you
with BPH symptoms in
several ways. Among them:
- You may need to get up less often at night to pee.
- It can improve your flow when you go.
- It can ease painful urination.
Can You Take It for Other Problems?
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You may have heard about people taking saw palmetto for
other reasons than BPH. Some of them include:
- Low sex drive
- Hair loss
- Low sperm count
- Migraines
- Ongoing pelvic pain
So far, studies have shown limited results for saw
palmetto helping with these other types of problems.
How Much Should You Take?
For BPH, studies have used a daily intake of 320
milligrams of saw palmetto split into two doses.
The doses will be different in other forms, such as
tinctures (a liquid preparation). Get advice from your doctor. It may take 4 to
6 weeks for saw palmetto to have an effect.
There are no food sources of saw palmetto.
Are There Any Complications?
Side effects are uncommon and typically mild. The most
common are:
Men taking saw palmetto have also reported erection
problems, testicular pain, and tenderness in the breasts.
You may also want to talk your doctor or pharmacist
about the following:
Interactions: If
you take any medicines regularly, talk to your doctor before you start using
saw palmetto supplements.
They could mix poorly with medicines such as aspirin, NSAID
painkillers such as ibuprofen (Motrin, Advil) and naproxen (Aleve), blood thinners, and
hormone treatments.
In combination with ginkgo biloba or
garlic, saw palmetto might seriously increase the risk of bleeding.
Other health conditions: People who have diseases or health conditions
should not use saw palmetto without talking to a doctor first.
There is some concern saw palmetto might interfere with
a man's PSA (prostate-specific
antigen) levels, a test used to screen for prostate cancer.
Talk to your doctor about this issue. You might consider a PSA test before you
start the supplement.
Saw palmetto is not recommended for children or for
women who are pregnant or breastfeeding.
WebMD Medical Reference Reviewed by Laura J. Martin, MD on October 09, 2016
Sources
© 2016 WebMD, LLC
What’s
the Best Approach to Treating BPH?
ARTICLES ONPROSTATE ENLARGEMENT / BPH TREATMENTS -
WHAT’S THE BEST APPROACH TO TREATING BPH?
There’s no one-size-fits-all approach when you have
an enlarged prostate and
you’re trying to decide what to do next.
Each person reacts in his own way to the symptoms
of benign prostatic hyperplasia (BPH), a common condition for men as they age.
You can talk about your symptoms with your doctor, and
together you can decide on the best way for you to handle your case. Your
options may include:
- Watchful waiting and lifestyle changes
- Medications or supplements
- Surgery
Watchful Waiting
If your symptoms don’t bother you much and you haven’t
gotten any complications, you may choose to just have you and your doctor keep
a regular eye on things.
This means seeing your doctor once a year -- or sooner
if your symptoms change.
Some things to watch include:
- Needing to pee a lot
- The sensation that your bladder is
full, even after you’ve just gone
- An urgent need to go out of the blue
- A weak stream or dribbling at the end
- Trouble starting
- Having to stop and start peeing several times
- Urine leakage
Reasons to consider watchful waiting for an enlarged prostate:
- Your symptoms are mild.
- You don't want the side effects of medications.
- It’s less costly than medical or surgical treatments.
- Some men with mild BPH symptoms
find they get better without treatment.
If you choose watchful waiting, there are a couple of
things you can do to ease things:
- Make simple changes in your habits. Drinking fewer liquids before bedtime. Drink
less caffeine and
alcohol generally.
- Avoid some over-the-counter medications. Take a pass on cold and sinus medicines
that have decongestants or
certain antihistamines,
such as diphenhydramine (Benadryl), that
can make a prostate problem
worse. Read labels on these products before you buy them.
Should I Go With a Treatment?
If your symptoms become worse, it's time to talk to your
doctor about an active treatment. Some things to ask yourself and your doctor
about each option:
- How much will my condition improve?
- How long will the effects last?
- Is there a chance that the treatment will cause problems?
From there, you can talk with him about
medications, supplements or
surgery.
Prescription Medications
These may give you relief. Some reasons to consider
going on medication for an enlarged prostate include:
- You have moderate symptoms that aren’t getting better or might be
getting worse.
- You've tried making lifestyle changes, such as drinking fewer
liquids, with no results.
- You are at risk for complications related to BPH, such as not
being able to empty your bladder.
Two types of medications are available to treat moderate
BPH. Each works differently in the body, and each has its own side effects.
The two classes of drugs for an enlarged prostate are:
- Alpha blockers, which
relax muscles of the prostate and neck of the bladder to relieve
symptoms. Examples of alpha blocker medications include: Alfuzosin
(Uroxatral), Doxazosin (Cardura), Tamsulosin (Flomax), and
Terazosin (Hytrin).
- 5-alpha reductase inhibitors (5-ARIs), which help shrink the prostate and prevent additional
growth. Examples of 5 ARIs include: Finasteride (Proscar) and
Dutasteride (Avodart).
- Phosphodiesterase 5 inhibitors (PDE5 inhibitors): Tadalfil (Cialis), Sildenafil, (Viagra), Vardenafil (Levitra).
(PDE5) inhibitors have been shown to
improve prostate symptom score with increasing flow rate.
Men with very enlarged prostates may take more than one
medication, called combination therapy, to reduce the need for surgery. However,
men taking both might also get hit with the side effects of both drugs.
The FDA requires labels on the 5-ARIs to include a
warning that they may be linked to an increased chance of high-grade (or
aggressive) prostate cancer.
Medications that contain 5-ARIs include: dutasteride(Avodart, Jalyn)
and finasteride (Propecia, Proscar).
Supplements
They aren’t as closely regulated as medicines your
doctor prescribes. That means their safety, quality, and effects can vary.
Saw palmetto is one of the best-studied and most
commonly used supplements to
treat BPH. Some small studies have shown benefit. However, several large
studies do not show that it reduces the size of the prostate or eases urinary
symptoms.
Three others are:
Three others are:
- Beta-sitosterol
- Pygeum
- Rye grass
Talk to your doctor before you start any supplement.
They may cause problems with prescription medicines, treatments, or tests you
might need.
Procedures
Sometimes BPH doesn't respond enough to lifestyle
changes, medications, or supplements. If that's true for you, there are surgical
options as well.
You and your doctor look to surgery when you can’t pee
at all or have:
- Kidney damage
- Lots of urinary tract infections or
bleeding
- Stones in the bladder
One of your options would be what’s called “minimally
invasive” surgery. In these types, doctors make much smaller cuts or are able
to work with probes they insert through your penis. These types of procedures often mean
faster recoveries and less pain and scarring.
Traditional, open surgery is the other option. You
should talk with your doctor about what’s best for your case.
WebMD Medical Reference Reviewed by Nazia Q
Bandukwala, DO on April 10, 2018
Sources
© 2018 WebMD, LLC
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