The ideal BPH treatment can vary depending on your symptoms.
Benign prostatic hyperplasia (BPH) is the term used to describe an enlarged prostate, a gland located below the bladder that’s normally the size of a walnut. More likely to occur in men age 50 and over, non-cancerous BPH can present noticeable issues for men of any age when it occurs.
- Some men may have a larger prostate that causes little or no symptoms, while others may have difficulty with urination due to pressure on the tube that transports urine out of the body (urethra).
- Treatment options can range from periodic observation to surgery.
For patients experiencing no significant symptoms from BPH, regular visits to a urologist may be all that’s recommended. Men looking to avoid the potential side effects of certain medications or avoid surgery may also prefer to opt for period observation if symptoms aren’t particularly disruptive.
With mild BPH, making changes to lifestyle habits may minimize or improve symptoms. Adjustments can involve simple steps like drinking fewer beverages before bed and reducing the consumption of alcohol and caffeine. When possible, reducing dosages of medications such as diuretics (water pills), decongestants, and antihistamines being taken to manage other conditions might be helpful. Lifestyle changes that may also be beneficial include:
- Strengthening pelvic floor muscles
- Kegel exercises
- Meals that include tuna, salmon, and other fish with significant amounts of omega-3 fatty acids
- Consuming a variety of green, leafy vegetables with nutrients that may naturally minimize prostate enlargement
In many instances, BPH can be successfully managed with medication. This option is usually suggested for patients with moderate symptoms that aren’t fluctuating too much or responding well to lifestyle adjustments alone. Alpha blockers work by relaxing prostate muscles and part of the bladder. Enlargement of the prostate is sometimes slowed or halted with 5-alpha reductase inhibitors (5-ARIs). Some patients taking 5-ARIs see their prostate shrink in size. For men with significantly enlarged prostates causing disruptive symptoms, both medications may be prescribed. Studies suggest supplements that include saw palmetto, beta-sitosterol, pygeum, and rye grass could help some men manage symptoms.
When medical therapy is unsuccessful, undesirable, or associated with significant side effects, in-office BPH procedures can be offered. These are procedures that can be performed with local anesthesia without needing to put the patient to sleep. Two procedures that are available and currently offered include UroLift and Rezūm. Approved by the FDA in 2013, UroLift treatment is a minimally invasive, outpatient procedure that preserves sexual function. It involves the insertion of small implants that separate prostate lobes to restore urine flow.
Rezūm uses the stored thermal energy in water vapor (steam) to treat the extra prostate tissue that is causing symptoms. Both procedures are quick and outpatient and have been associated with significant and durable improvements in voiding.
If other treatment and management attempts aren’t successful, surgery is often discussed. Surgery also becomes an option if symptoms worsen to the point where it’s difficult or impossible to urinate. Involving removal of prostate tissues that are causing the obstruction, transurethral resection of the prostate is one of the more common procedures performed. Another option is laser surgery to create a channel for the urethra to allow for a better flow of urine.
The nature of symptoms experienced with BPH sometimes changes over time as the prostate becomes larger. For this reason, it’s important to let your doctor or urologist know if you are having more frequent urination, specifically at night, or increasing difficulty going. Also, talk to your doctor if you’re suddenly having to go back and finish urination after going on a regular basis since this could increase your risk of developing urinary tract infections and bladder conditions.