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
REFERENCE:
DeBenign prostatic hyperplasia (BPH)
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 a raised prostate specific antigen (PSA) level
§ 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.
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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
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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.
Rye pollen extract: This substance may improve a number of BPH
symptoms, such as:
- 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:
CONTINUE READING BELOW
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- 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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