What are the treatment options for BPH?
In this article, we look at treatment options, lifestyle changes, and promising natural treatments for an enlarged prostate.
What is an enlarged prostate?
An enlarged prostate puts pressure on the bladder and urethra.
The prostate is a small gland that sits between the penis and the bladder. It functions as part of the male reproductive system.
If the prostate becomes enlarged, it can place pressure on the bladder and the urethra, which is the tube that carries urine from the bladder out through the penis. The medical term for an enlarged prostate is benign prostatic hyperplasia, or BPH.
BPH is a common health condition in older people. In the United States, according to the National Institute of Diabetes and Digestive and Kidney Diseases, BPH affects:
- around 50 percent of men aged 51–60 years
- up to 90 percent of men over the age of 80
Common symptoms of BPH include:
- needing to urinate more than eight times a day
- being unable to delay urination
- waking up frequently at night to urinate
- straining to urinate or having difficulty starting urination
- having a weak or intermittent urine stream
- being unable to empty the bladder completely, which is called urinary retention
- urinating accidentally, or urinary incontinence
- dribbling after urinating
BPH is a progressive condition, which means that if a person does not get treatment, their symptoms may get worse over time. Treatment options for BPH include:
Increasing physical activity can help to manage the symptoms of an enlarged prostate.
The primary stage of BPH treatment is usually called watchful waiting. During watchful waiting, the affected individual will be:
- learning about BPH
- making positive lifestyle changes, such as becoming more physically active
- taking no further action until their symptoms change
A doctor will also work with the individual and keep a close eye on their condition. Many people with an enlarged prostate remain at this level of care for some time.
When BPH becomes more advanced, a doctor may recommend medication. Medication can help to control the growth of the prostate and reduce the symptoms of BPH. Common medications for BPH include:
- Alpha blockers. These can relax prostate muscles and improve the functioning of the urinary system.
- Phosphodiesterase-5 (PDE5) inhibitors. Doctors primarily prescribe these for erectile dysfunction. However, PDE5 inhibitors can also relax muscles in the urinary tract to help relieve symptoms of BPH.
- 5-alpha-reductase inhibitors. These may help to limit the growth of the prostate gland in people with BPH.
- Combination medications. A doctor may recommend the concurrent use of two or more different types of medication to help improve BPH symptoms.
Minimally invasive procedures
When medication alone does not relieve the symptoms of BPH, the next level of treatment typically involves minimally invasive procedures. During these procedures, a doctor will insert an instrument into a person's urethra or rectum to either destroy excess prostate tissue or widen the urethra.
If medication and minimally invasive procedures are unable to improve the symptoms of BPH sufficiently, a doctor may recommend surgery. A person may also require surgery if their symptoms become severe or if complications develop. Potential complications include:
- pain or severe difficulty with urination
- recurrent urinary tract infections
- blood in the urine
- sexual dysfunction
- stones in the bladder
- kidney damage
Surgery is not uncommon for people with BPH. According to the Urology Care Foundation, around 150,000 men in the U.S. undergo transurethral resection of the prostate (TURP) for BPH each year. TURP is the most common type of surgery for BPH in the U.S., but there are now several other surgical options.
Some procedures can take place under local anesthetic on an outpatient basis, but others are likely to require full anesthesia and a hospital stay.
Surgical options for BPH include:
- transurethral incision of the prostate (TUIP)
- laser surgery
- open prostatectomy
People with BPH can take action to relieve their symptoms without medication or surgery, particularly during the watchful waiting phase.
They can try the following strategies to relieve symptoms:
- limiting consumption of caffeine and alcohol
- reducing liquid consumption for 2 hours and going to the toilet before sleep, long journeys, or other occasions when urinating may be difficult
- emptying the bladder as thoroughly as possible with each urination
- doing exercises to strengthen the pelvic floor muscles
- working with a physician to train the bladder to hold more urine for longer
- eating more fiber to help prevent constipation, which can worsen symptoms of BPH
- avoiding medications that can make BPH symptoms worse, such as antihistamines and decongestants
- reaching and maintaining a healthy weight
- adopting a healthful, low-fat diet and limiting spicy foods
- exercising regularly
Promising natural remedies
Some natural remedies have shown promise for treating symptoms of BPH. These include:
Saw palmetto berries may help reduce the symptoms of BPH.
Saw palmetto berries are a well-known natural remedy that may help to treat BPH. According to a 2016 review, some studies have suggested that berry extracts from saw palmetto can help to reduce the symptoms of BPH. The authors state that they may even be as effective as finasteride, a common medication for the treatment of urinary retention.
However, a 2012 Cochrane review of 32 trials concluded that saw palmetto in any form does not improve any of the symptoms associated with BPH, suggesting that this natural remedy cannot help people with this condition.
Traditional medicine practitioners use bark extract from Prunus africana, the African cherry, to treat a variety of health conditions. According to a 2016 review, some studies have suggested that the bark extract may be effective for relieving symptoms of BPH.
A Cochrane review states that more evidence is necessary, but that this plant may provide moderate relief from the symptoms that BPH causes.
Dietary polyphenols are complex chemicals that occur in certain foods, such as:
- fruits and vegetables
- nuts and seeds
- coffee and tea
Extracts and supplements containing dietary polyphenols have shown promise as potential treatments for BPH. According to a 2017 review, studies have indicated that:
- Equol supplements, which have soybeans as their source, may suppress BPH
- Supplements of lycopene, a pigment in tomatoes, may slow the progression of BPH
- Flaxseed extract may reduce the symptoms of BPH and improve quality of life
BPH can cause a range of urinary problems and affect a person's quality of life. However, there are a variety of treatment options and lifestyle changes that can relieve symptoms and slow the progression of this condition.
People with BPH should work closely with their doctor to ensure that they manage their symptoms effectively and use the most suitable forms of treatment.