The prostate is a walnut-sized gland located at the base of the bladder and grows larger as men age. Prostatitis, Benign prostate enlargement (BPH) and prostate cancer are the most common prostate problems.
BPH is the unregulated growth of cells within the prostatic region. The incidence of BPH increases with age, with a prevalence of 8-90% in men over 60 years old.
BPH puts pressure on the bladder, obstructing the urethra. It is the most common cause of lower urinary tract complications in men (Kok et al., 2009).
This mechanical pressure is the cause of BPH urinary symptoms including painful urination, frequent urination , an overactive bladder and urinary incontinence. Research suggests that certain risk factors such as genetics, diet and lifestyle increase your risk and severity of symptoms.
Here, we discuss the most critical information about BPH. We highlight Known risk factors and the available evidence on their causal link to BPH.
What are the symptoms of BPH?
The severity of symptoms in men with Benign Prostatic Hyperplasia varies, but they tend to worsen over time. Common symptoms include:
- Frequent urination and Nocturia – Typically, the bladder can store urine until it is convenient to use the toilet. However, the impact of BPH on the lower urinary tract increases the frequency of urination, affects the the flow of urine, especially at night (nocturia).
- Urgent need to urinate – Like frequent urination, the prostate pressing on the bladder reduces bladder control, increasing the urge to urinate.
- Urine flow – BPH can induce a weak urine stream and dribble at the end of urination. In some patients, it makes it difficult to empty the bladder, which may increase the risk of urinary tract infection.
- Urinary incontinence – BPH and other prostate conditions can reduce bladder control over time, leading sudden uncontrolled need for urination or leaking due to strain.
- Sexual complication – BPH symptoms cause psychological stress, which reduces sex drive and sexual satisfaction.
- Infection and kidney damage – Urinary retention due to BPH associated reduced urine flow increases the risk of infections and renal damage.
What causes BPH?
The causes of prostate enlargement are not well understood. However, changes in the balance of sex hormones play a critical role. An imbalance in the ratio of oestrogen to testosterone increases the risk of BPH (Prezioso et al., 2007).
Oestrogen may remain unchanged in men at risk of BPH, but testosterone levels decrease as men age (Hammarsten et al., 2009). This deregulation can induce prostate enlargement. It is noteworthy that testosterone does not cause BPH but necessary for BPH to develop (Roehrborn and McConnell, 2012).
Further, emerging evidence supports the role of metabolic diseases and inflammation in the development of BPH. These diseases can alter insulin levels, which stimulate cell growth while inflammation can induce the release of growth factors.
Observational studies demonstrated that the prevalence of BPH rises with increased age. A histological prevalence of 50% and 80% is observed in men over 60 and 90 years of age, respectively (Taylor et al., 2006). Further, prostate volume increases with age, which is associated with an increased risk of BPH (Loeb et al., 2009).
There is a strong genetic component to BPH (Sanda et al., 1994), and family history is a strong predictor of a BPH surgery in men below the age of 60 years (Pearson et al., 2003). Some inherited genetic variations result in larger prostate volume and early onset of BPH (Pearson et al., 2003).
Studies show that modifiable risk factors such as diet, physical activity and alcohol consumption influence the development of BPH (Barnard et al., 2008). Consistently, increased total energy intake combined with high fat, dairy consumption, and physical inactivity increase the risk of BPH and its progression (Parsons et al., 2008).
Foods rich in vegetables, fruits and polyunsaturated fatty acids decrease the risk of BPH. Likewise, high levels of blood vitamin E, lycopene and carotene correlate with lower rates of the disease.
Obesity secondary to poor diet and physical inactivity creates metabolic syndrome, increasing the risk of prostate conditions (Parsons et al., 2013; Xue et al., 2020). Disruption in the regulation of serum insulin levels due to metabolic complication stimulates prostate growth (Gupta et al., 2006).
Inflammation promotes the development and progression of BPH (Bostanci et al., 2013). For instance, men on daily anti-inflammatory drugs show reduced risk of developing BPH and severe lower urinary symptoms (St. Sauver et al., 2006). Moreover, the majority of prostate tissues from BPH surgeries are inflamed. However, the underlying cause of prostate inflammation remains poorly defined. Autoimmune response, obesity and infection are potential sources of prostate inflammation.
Complications of BPH
In addition to urinary tract infections, BPH can lead to severe damage to specific organs. Common complications include:
- Bladder stones and damage – due to urine retention.
- Kidney infection and damage.
Can diet help with Symptoms of BPH?
Much of the variation in prostate health is related to diet, and several observational studies have linked the intake of different foods with reduced risk of BPH. Low-fat diets rich in grains, fruits and vegetables all enhance prostate health, reducing the risk of BPH.
Some beneficial foods include:
Tomatoes contain high levels of lycopene, a plant carotenoid found in red fruits and vegetables. This antioxidant protects against prostate conditions. A mixed supplementation with lycopene and selenium showed clinical utility for reducing prostate growth, evidence by reduced PSA levels (Gontero et al., 2015).
Sesame seed is rich in polyunsaturated fatty acids and a range of minerals. It has a potent anti-androgenic activity suitable for treating prostate conditions (Rashed et al., 2014).
Sesame seed contains a high amount of beta-sitosterol, a potent anti-inflammatory agent. A randomised clinical trial demonstrated that this compound significantly improved symptoms of urinary obstruction caused by BPH (Klippel et al., 1997). These results suggest that consumption of sesame seeds extract, or oil can improve BPH symptoms.
The level of daily tea consumption correlates with a low incidence of disease modulated by oxidative stress and inflammation. Green tea can reduce the risk of BPH and relieve symptoms (Peluso and Serafini, 2017).
Chickpeas and several legumes are rich sources of isoflavones that may reduce the risk of prostate conditions.
Salmon has unusually high amounts of omega-3 fatty acids, which are anti-inflammatory polyunsaturated fatty acids (Maroon and Bost, 2006). Several observational studies have consistently found that dietary intake of polyunsaturated fatty acids reduces the risk of BPH (Bravi et al., 2006). Salmon is also one of the few natural food sources of vitamin D. Increasing intake of vitamin D from diet and supplements can inhibit BPH development and progression (Espinosa et al., 2013).
Turmeric contains several naturally occurring compounds, including beta-carotene, vitamin C, and curcumin. In particular, curcumin is a potent antioxidant that can reduce the levels of pro-inflammatory factors (Zhang et al., 2010).
Seeds of grass-like plants are rich in fibre, vitamins and antioxidants. High-fibre diets lower the risk of metabolic syndromes and BPH (TARIQ et al., 2000; Wang et al., 2005).
Other fruit and vegetables
- Bell peppers
These foods are good sources of dietary fibre, rich in antioxidants, vitamin C, and other protective minerals.
Clinical trials demonstrated lower PSA levels (a marker of BPH) in men who received supplements containing pomegranate, green tea, broccoli and turmeric extracts (Thomas et al., 2014).
Fruit and vegetables reduce the risk of metabolic imbalance and the associated inflammation (Liu, 2003; Ness and Powles, 1997).
Lifestyle changes to manage BPH Symptoms
Lifestyle changes are effective in reducing the severity of BPH symptoms. Regular physical activity and dietary changes can help relieve symptoms.
Some key lifestyle changes to consider include:
Smoking can increase the risk of BPH through oxidative stress and inflammation. Smoking cessation will reduce exposure to free radicals and toxins. Speak to a doctor about smoking cessation options.
Chronic stress harms both mental and physical health. Stress can amplify BPH symptoms, potentially through altered immune function. Consider destressing methods like exercise and meditation.
Reduce fluid intake in the evening
Nocturia is a common BPH symptom, with a profound impact on health and quality of life. Reducing fluid intake in the evening can help reduce nocturia and the subsequent disruption to sleep.
Emptying the bladder when urinating
Make sure to empty the bladder completely to reduce the impact of urge incontinence. This adaption can also reduce the risk of BPH associated bladder infections.
Pelvic floor and bladder training exercises
The pelvic floor muscles support the bladder and bowel and help to control urination. These muscles weaken with ageing and by prostate enlargement. Doing pelvic floor muscle exercises can help strengthen these muscles. Strong pelvic muscles can reduce some of the urinary problems caused by BPH, including leaking urine and urge incontinence.
Medications like antihistamines, diuretics and decongestant can exacerbate the symptoms of BPH. Avoid these medications to help with the urinary symptoms of BPH.
Older men have an increased risk of developing BPH, which causes significant urinary complications and reduction in quality of life. The benefits of natural plant compounds in treating BPH are becoming realised as our knowledge of BPH pathogenesis increases. Further, many patients are exploring natural approaches for the management of BPH symptoms.
The advantages of these natural methods over conventional drugs and surgical approaches included improved safety, reduce side effects and improved quality of life.
Quality scientific evidence links physical activity, low-fat diets, high-fibre diets, and fruit and vegetables to improved prostate health. These natural approaches are also essential therapies for the treatment of BPH and promoting prostate health during the surveillance period in patients with BPH.