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What is BPH and How is It Treated?

June 01, 2017 | Dr. Patrick Waters

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understanding bphLet’s start by getting one thing clear: Benign prostatic hyperplasia (or BPH) is not cancer. So what is BPH?

According to the National Institutes of Health, BPH is “a condition in men in which the prostate gland is enlarged and not cancerous.” It’s also fairly common as men age.

The prostate goes through two main growth periods. It doubles in size in early puberty. Then around age 25, it begins growing again and continues for most of a man’s life. It is during this second growth phase that BPH can occur.

WebMD uses a fruit analogy to describe the growth. By the time a man reaches age 40, his prostate might have gone from the size of a walnut to the size of an apricot. By the time he reaches 60, it might be the size of a lemon.

As the prostate enlarges, it presses against and pinches the urethra. This can cause symptoms such as a frequent or urgent need to urinate. It can cause a weak or interrupted urine stream. The pressure on the urinary tract can also cause pain during urination or ejaculation.

Luckily, BPH is fairly normal. Some eight out of 10 men eventually develop an enlarged prostate. The good news is that the majority of men with BPH—about 70 percent—are not bothered by the condition.

For the other 30 percent, however, it’s a different story. BPH can be annoying, painful and disruptive to daily life. Potential treatment depends largely on how much trouble your enlarged prostate is causing.

For example, if a man has to get up once a night to urinate, that can potentially be fixed by simple lifestyle changes. Cutting back on fluid—especially alcohol or drinks with caffeine—before bedtime can make a big difference.

Medicine with anticholinergic properties that weaken bladder contractions can aggravate BPH symptoms. These include antihistamines such as diphenhydramine, as well as various antidepressants. While it’s not advisable to simply stop taking any prescription drugs, it’s certainly something to ask your doctor about if you are experiencing BPH symptoms.

It may sound simple, but doctors also recommend never passing up an opportunity to use the bathroom. Headed on a long car ride? Go first. Is the movie about to start? Go first—and choose an aisle seat.

If lifestyle modifications are not enough, there are also drugs commonly prescribed to treat BPH:

  • Alpha-blockers, such as tamsulosin (Flomax) or terazosin (Hytrin), relieve symptoms within a few weeks by relaxing smooth muscle tissue within the prostate, which blocks the effect of nerve impulses signaling the muscles to contract. They do not decrease the size of the prostate.
  • 5-alpha reductase inhibitors, such as dutasteride (Avodart) and finasteride (Propecia and Proscar) actually help shrink the prostate, which helps to open up the urethra and thus alleviates symptoms.
  • Combination therapy. Doctors often prescribe alpha-blockers and 5-alpha reductase inhibitors if neither treatment is working sufficiently on its own.
  • Tadalafil (Cialis) is often used to treat erectile dysfunction, but can also treat prostate enlargement — as you’ve no doubt seen from the barrage of commercials that have hit the air lately.

If lifestyle changes and medication don’t help alleviate BPH symptoms—or if you’d prefer not to take medication— there are several minimally invasive options available, including UroLift and Rezūm.

UroLift is performed by a urologist, who places tiny implants to hold the prostate lobes apart, which relieves compression on the urethra and allows urine to flow normally again. UroLift is typically an outpatient procedure and most patients return home the same day without a catheter. What’s more, ongoing studies have found no cases of sustained erectile dysfunction or ejaculatory dysfunction resulting from the procedure. There is durable five year data showing excellent efficacy.

Rezūm, on the other hand, is performed using a hand-held device that delivers radiofrequency generated thermal therapy, in the form of water vapor, directly to the extra prostate tissue that is causing symptoms. It’s performed as either an in-office or outpatient procedure and has also been shown to preserve sexual function.

An enlarged prostate is a normal part of aging. The problem occurs when you ignore symptoms that take away from your quality of life. BPH is treatable.

Contact us today to meet with one of our specialists, who will help you formulate a plan of attack that works for you in understanding BPH. 

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