What is benign prostatic hyperplasia?
Benign prostatic hyperplasia (BPH) usually appears after the age of 40 years. The person may notice that they urinate more often, especially at night. They may also have problems with urination, such as needing to urinate suddenly or having difficulty starting to urinate.
Doctors do not know exactly what causes BPH. It is different than prostate cancer, although it may share some of the same symptoms, and it does not seem to increase the risk of this disease developing.
Find out more about BPH in this article, including who is at risk and the symptoms and treatment options.
What is BPH?
People over 40 years of age are more at risk of developing BPH.
The prostate is a small gland that is part of the male reproductive system. It sits under the bladder and surrounds the urethra. The urethra is a thin tube-like structure through which semen and urine leave the body.
Along with two other glands called the seminal vesicles, the prostate makes fluid that combines with sperm to create semen.
Usually, urine flows from the bladder through the section of the urethra that the prostate surrounds and leaves the body.
When a person has BPH, the enlarged prostate can press on the urethra, resulting in a blockage and urination problems.
BPH occurs when the cells in the prostate multiply, and the gland becomes enlarged. It is a common occurrence.
Studies suggest that the average prostate gland weighs:
- 25–30 grams (g) for men between the ages of 40 and 49 years
- 30–40 g when they are 50 to 59 years of age
- 35–45 g when they reach 60 years of age
BPH is a benign condition, which means that it is not cancerous. However, it can lead to bladder infections and other complications.
Some people will have no symptoms and will not need treatment. If symptoms are bothersome, however, or there is a risk of complications, a doctor may recommend treatment.
What makes urination painful in men? Find out here.
Doctors do not know exactly why BPH happens. According to the National Institute of Diabetes and Digestive and Kidney Diseases, experts believe that aging and hormonal factors may play a role.
Testosterone and estrogen balance: Males produce testosterone throughout their life, along with a smaller amount of estrogen. Females also produce these hormones, but they produce less testosterone and more estrogen. As males get older, they produce less testosterone in proportion to estrogen. It may be the estrogen that triggers additional growth in the prostate.
Dihydrotestosterone (DHT): DHT is another male hormone that enables the prostate to develop and grow. Scientists have found that even when testosterone levels fall, DHT levels can remain high. Not all men produce DHT, and those who do not produce it do not appear to develop BPH. This fact suggests a possible link between high DHT levels and BPH.
Several risk factors appear to increase a person's likelihood of developing BPH.
Age: According to the Prostate Cancer Foundation, about 20% of men will develop BPH by the time they are in their 50s, increasing to 70% by the time they reach 70 years of age.
Family history: People with a close relative who has BPH may have a higher risk of developing it.
Lack of exercise: People who do not exercise regularly may have a higher risk of BPH.
It is not possible to control all of these factors. However, following a healthful lifestyle from a young age, including a nutritious diet and regular exercise, may help.
A person with BPH may find it difficult to start urinating.
The early symptoms of BPH often include the need to urinate more often.
As the prostate grows, it puts more pressure on the bladder, which makes it difficult to hold in urine. The result is more frequent trips to the bathroom, including during the night.
Other problems include:
- needing to urinate suddenly and not being able to wait
- difficulty starting to urinate
- a weak or broken urine stream
- dribbling after urination
- an inability to empty the bladder
- pain when urinating or after ejaculation
- changes in the smell or color of urine
About 10–20% of people with BPH will also have pelvic pain.
It is important to note that not everyone with urinary problems will have BPH, and not everyone with BPH will have these symptoms.
However, anyone who experiences urinary problems should see a doctor. An early diagnosis can help prevent complications, as well as ruling out cancer.
Sometimes, a person without symptoms will receive a diagnosis during a routine screening test for prostate cancer.
What causes pelvic pain in men? Find out here.
Without treatment, BPH can lead to complications. These include an inability to urinate or empty the bladder and urinary incontinence.
If urine remains in the bladder, the following can develop:
Urinary incontinence can also affect a person's confidence and quality of life.
Most people with BPH do not develop complications. However, anyone who has severe or worsening problems with urination, pain, or blood in the urine should see a doctor.
What causes blood to appear in a man's urine? Find out here.
When to see a doctor
Anyone who experiences changes in their urination patterns should see a doctor.
They should do so at once if they have:
- pain or a burning sensation on urinating
- blood in the urine
- an inability to urinate
Learn more about the link between BPH and kidney failure.
The doctor will consider the person's symptoms and medical history. They will also carry out some tests to rule out other conditions with similar symptoms, such as:
Tests for BPH
The tests will probably include:
Digital rectal exam: The doctor will insert a gloved finger into the rectum to check the shape, size, and thickness of the prostate.
Cystoscopy: The doctor will insert a thin tube with a camera on the end to see the inside of the bladder and urethra.
Urine tests: Urinalysis can rule out infections. Other urine tests assess how fast the urine flows, how much remains in the bladder after urinating, and how much pressure there is in the bladder.
Blood test: PSA is a chemical that the prostate produces. When the prostate gets bigger, PSA levels rise.
Ultrasound: This scan will show any changes in the appearance of the prostate.
In some cases, a doctor may order additional tests to rule out other conditions.
The type of treatment usually depends on the severity of the symptoms. In some cases, no treatment may be necessary.
Doctors may decide to monitor the prostate if the person has mild or no symptoms. This monitoring may involve an annual prostate exam and review of symptoms.
If necessary, various treatments are available.
Medications that treat BPH include:
Alpha-blockers: These improve urine flow by relaxing the muscle tissue in the urethra and neck of the bladder. Side effects may include decreased blood pressure and dizziness.
5-alpha reductase inhibitors: These can reduce urinary symptoms by shrinking the prostate. According to the Prostate Cancer Foundation, they may also reduce the risk of prostate cancer by about 25%.
Sometimes, a doctor may prescribe a combination of drugs.
Minimally invasive surgery
If medication is not effective, surgery may be an option. Often, this will be a minimally invasive procedure, such as:
A prostatic urethral lift: The surgeon uses a needle to insert implants that raise the prostate so that it does not block the urethra.
Convective water vapor ablation: This procedure uses steam to kill unwanted prostate tissue. A surgeon will inject thermal energy from the steam into the prostate with a needle.
Transurethral microwave therapy (TUMT): The doctor inserts a catheter with an antenna through the urethra. The antenna delivers microwaves, which kill the unwanted tissue.
Catheterization: A doctor will insert a tube into the bladder, through which urine can pass. Catheterization makes it possible to drain the bladder.
These interventions often improve urine flow, but further treatment may be necessary at a later date. Taking medication may help reduce the risk of BPH reoccurring.
A person with severe symptoms may need surgery to remove any tissue that is causing a blockage. There are several types of surgery, some of which are more invasive than others.
Prostate artery embolism is an emerging treatment that involves injecting particles into the blood vessels that lead to the prostate. Scientists are still investigating whether this is safe and effective.
Some people may be interested in asking about participating in a clinical trial, as these can provide access to treatments that are not yet widely available.
Learn more here about the treatment options for BPH.
Some people use natural remedies for BPH. According to the National Center for Complementary and Integrative Health, however, there is little evidence that most of these are effective.
Saw palmetto: There is not enough evidence to show that this herbal supplement works for BPH, although it may provide relief if people use it with stinging nettle.
What does the research say about saw palmetto for BPH? Find out here.
African plum tree (Pygeum africanum): This plant may provide short term relief from urinary symptoms.
Stinging nettle (Urtica dioica): Similar to African plum tree, it may help, especially if people use it with saw palmetto.
Lycopene: This natural pigment occurs in tomatoes. There is not enough evidence to prove that it can help with BPH.
Pumpkin seed: In a 2019 study, 60 men with BPH took a pumpkin seed extract once a day for 12 weeks. The results suggested that they experienced a better quality of life and less need to urinate at night. However, more studies are necessary to confirm this finding.
Flaxseed: In research from 2015, 60 people took either a flaxseed hull extract or a placebo for 8 weeks. Both groups experienced improvements in obstructive and irritable symptoms of BPH, so it remains unclear whether flaxseed can help.
People should speak to their doctor before using an alternative remedy for BPH. Some herbal remedies can interact with other medications, while others may be a waste of money.
In addition, the Food and Drug Administration (FDA) do not license this kind of treatment. As a result, a person cannot guarantee its quality.
BPH affects many males as they get older, and it may not be possible to prevent it.
However, the following factors may help reduce the risk:
- maintaining a healthy weight
- exercising regularly
- eating a healthful diet that contains plenty of fresh fruits and vegetables
- avoiding alcohol or drinking it in moderation
Screening for prostate cancer aims to detect cancer in the early stages, but it can also show if BPH is present. This detection can enable early treatment, if necessary.
There are no guidelines for screening for prostate cancer, but a doctor can advise the individual on the best approach for them. People should ask their doctor about starting screening from the age of 40–50 years, depending on their risk level.
Tips for living with BPH
People with BPH can talk to their doctor about treatment options.
The following tips may help ease symptoms:
- Avoid any medication that makes it harder to urinate, such as antihistamines. Consider timed voiding, which involves scheduling times to urinate before feeling the urge to do so.
- Avoid caffeine, alcohol, and spicy foods.
- Stop drinking a few hours before bed, as this may help reduce the need to urinate at night.
- Do pelvic floor exercises to strengthen the muscles that control urine flow.
- Seek medical help as many treatment options are available.
BPH is not cancer, and treatment can help control symptoms and prevent complications. Many people need no treatment.
Some people need more than one intervention to relieve a blockage. However, taking medications can also help prevent BPH from coming back.
Anyone who has symptoms or a diagnosis of BPH should follow their doctor's instructions, as this will help them manage the condition.
Can BPH become cancerous?
Experts do not believe that BPH is a risk factor for prostate cancer, but the research is conflicting.
BPH occurs mostly in the center of the prostate gland, while prostate cancer occurs in the peripheral cells.
Both of these conditions can exist at the same time. It can be difficult to determine whether BPH is the direct cause of prostate cancer because people who have BPH symptoms are more likely to undergo testing for prostate cancer.
The research tends to be in favor of no direct relationship, but further studies need to confirm this.Kevin Martinez, MD Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.