What Is Benign Prostatic Hyperplasia (BPH)?

Benign Prostatic Hyperplasia (BPH) occurs when the prostate expands to twice or even three times its regular size.

The growing prostate gland gradually presses against the urethra and restricts urinary flow.

This results in more frequent urination, and as the urethra becomes increasingly narrowed, the urine remains in the bladder, accounting for urinary problems.

As the word, benign suggests, BPH is not indicative of severe diseases like cancer or other malignancies, though it can cause some discomfort, as will be explained below.

What causes BPH?

Age

There is no concrete evidence for one cause of BPH. However, medical sources agree the condition is most likely linked to aging and the impact the production of testosterone has on older men.

50% of men over 50 will suffer from the condition, while 90% of men over 80 will develop benign prostatic hyperplasia.

Hormones

As men age, their production of testosterone (male hormones) naturally diminishes, and their production of estrogen (female hormones) increases.

The change in the hormonal balance is often noticeable as men start to get middle-age spread and lose some of their assertiveness.

Some studies have indicated that the body’s system for working off testosterone slows in middle age.

As a result, the body reacts by using this extra testosterone for the production of Dihydrotestosterone (DHT). High levels of DHT is associated with prostate growth.

Diet

Certain foods can encourage your body to produce these hormones, ultimately causing damage to your prostate’s health.

Daily consumption of red meat increases the chances of developing an enlarged prostate by 38%.

Replace red and processed meats with other forms of protein like fish, chicken, and turkey. You can also get protein from non-meat sources like beans and nuts.

Dairy is another offender. Cow’s milk is full of female hormones. Therefore, dairy products can further raise estrogen levels, upsetting your hormonal balance and increasing your production of DHT.

Family history and ethnicity

Family history and ethnicity should also be considered, with men of European ancestry being at a slightly increased risk of developing the condition, particularly those from southern Europe.

Still, other studies have drawn a connection between BPH and lifestyle factors such as high cholesterol, excessive weight, poor diet, and immoderate alcohol consumption.

Those with conditions such as diabetes, a lowered immune system, high blood pressure, metabolic syndrome, and atherosclerosis should also practice caution and remain vigilant for the development of BPH symptoms.

Lifestyle and BPH

The prevalence of metabolic syndrome is due to the western lifestyle (which includes higher intakes of processed food, animal fat, refined carbohydrates, excess calories, and physical inactivity).

These health conditions substantially increase the risk of BPH and advanced prostate cancer.

One example is the Baltimore Longitudinal Study of Aging. The male participants underwent a number of prostate examinations (MRI, PSA, and DRE) and anthropometric measurements (weight, BMI, waist and hip circumference) between 1992 and 2002.

The study found that for each 1 kg/m-2 increase in BMI, there was a 0.41 cc increase in prostate volume. Elevated fasting blood sugar levels and diagnosed diabetes were also linked with prostate enlargement.

Low HDL cholesterol and insulin resistance have both been suggested as possible reasons explaining the link between metabolic syndrome and BPH.

If you are looking to treat an enlarged prostate making changes to your lifestyle naturally.

For more information on how diet impacts on an enlarged prostate, click here.

What are the symptoms of BPH?

Enlarged prostate symptoms can be subtle and as a result, remain undetected.

Moreover, many men will dismiss their symptoms as ‘old age.’ However, by knowing what BPH feels like, you will more closely be able to determine if you are experiencing it.

The symptoms usually manifest as problems during and after urination.

This is due to the enlarged prostate pressing down on the urinary tract and inhibiting the urine flow.

LUTS (lower urinary tract symptoms) is a collective term used to describe a range of urinary symptoms.

Lower urinary tract symptoms related to linked to BPH can fall into two categories; obstructive or irritative

Irritative Symptoms of Prostate Enlargement

Irritative symptoms include urgent or frequent urination during the day and night.

• A need to pass to urinate more frequently and urgently (frequent urination). This is as the enlarged prostate gland puts increased pressure on the urethra and bladder, making it increasingly difficult to hold in urine.  
  
  
• A need to get up to urinate during the night. This is called “nocturia” and is defined as a need to urinate three or more times at night.  
  
  
• Feeling that the bladder can’t be emptied properly.

Obstructive Symptoms of Prostate Enlargement

Obstructive symptoms can cause a delay or straining when starting to urinate and result in a dribbling flow of urine.

• Poor urine stream
  
  
• Urinary hesitancy
  
  
• Weak urine stream
  
  
• Difficulty getting started when needing to urinate
  
  
• Dribbling at the end of urination
  
  
• Painful urination
  
  
• Pain during urination or ejaculation
  
  
• Blood in the urine (hematuria)

For more information on frequent urination in men, click here.

How is BPH diagnosed and evaluated?

If you start to experience BPH symptoms, your doctor will perform a thorough physical examination.

He will also consult your medical and familial history. The patient’s lifestyle will also be taken into account with issues like mobility and diet being given particular precedence.

DRE (Digital Rectal Exam)

The physical exam will most likely include a digital rectal examination (DRE).

This is one of the simplest and most effective procedures for detecting abnormalities like BPH in the prostate, as well as in the early detection of prostate cancer.

A doctor will insert a gloved finger up the rectum of the patient and will feel the prostate. If they detect any lumps on it, or irregularities, this could be a warning sign of cancer.

PSA Test

Doctors will often order a Prostate Specific Antigen (PSA) test to ascertain the level of antigens in the bloodstream.

Recent studies show that the PSA test is not an accurate indicator of prostate cancer. There are cases in which some men who don’t have prostate cancer are diagnosed with it.

As a result, they undergo unnecessary and dangerous invasive treatments with many long-term side effects.

Post-void residual

This tests the amount of urine left in your bladder after urination.

It can be completed either by inserting a catheter through your urethra and into your bladder or by using an ultrasound to show images of your bladder so that your Doctor or urologist can access how much urine is there.

Cystoscopy

A cystoscopy is a visual inspection of the prostate through a thin, lighted tube inserted into the urethra of the penis, is also used, though less often. This is passed into the bladder to allow a doctor to see inside. In some cases, small surgical instruments can be passed down the cystoscope to treat bladder problems.

Prostate Biopsy

A prostate biopsy is a procedure used to detect prostate cancer. Small samples of the prostate are removed and then observed under the microscope.

Doctors usually recommend a biopsy of your prostate gland based on individual findings.

One is when your prostate-specific antigen (PSA) blood test results are higher than normal for your age.

Another is when your Doctor detects some signs of a prostate problem during your digital rectal exam (DRE).

However, it should be noted that a biopsy can have a number of risk and life-changing side effects, including chronic infection, chronic pain, and bleeding of the urinary tract.

What PSA level indicates BPH?

High PSA levels do not always mean that you have prostate cancer or any other prostate problem.

Many factors can affect your PSA levels so that the Doctor won’t consider your PSA level on its own.

There is no specific normal or abnormal level of PSA.

Factors such as age and ethnicity make it hard for researchers to establish a normal range.

However, most doctors consider PSA levels of 4.0 ng/ml as high and would often recommend a prostate biopsy.

One study shows that men with this level of PSA often have prostate cancer.

Low PSA levels also don’t always mean that you don’t have prostate cancer. Studies show that some men with a PSA below 4.0 ng/ml do have prostate cancer.

How common is BPH (by age)?

An enlarged prostate is one of the most common health problems for men over the age of 50.

Though the actual cause is unknown, it is linked to aging and changes in the cells of the testicles.

As you age, you are more likely to develop an enlarged prostate. More than 90% of men over age 80 have this condition.

Often, this condition is not a cause for concern. Not all men with enlarged prostate experience symptoms.

What are the complications of BPH

Despite its prevalence, many cases of an enlarged prostate are left undiagnosed.

If left untreated, an enlarged prostate may lead to the following problems:

• Acute Urine Retention– Urinary retention is a condition where a person is unable to urinate. It needs urgent treatment, as the bladder can possibly tear if it stretches beyond its capacity.
  
  The increased pressure in the bladder can also prevent urine from passing through the lower urinary tract. Thus, urine gets back up into the bladder and kidneys, causing tissue damage and kidney failure.
  
  

• Chronic Urine Retention– Chronic urine retention occurs when the bladder is unable to empty itself of urine over a long period of time. In this case, the bladder may show a massive increase. This condition may require some type of surgical procedure.
  
  

• Bladder Stones– Bladder stones, like UTIs, can occur if you are unable to empty your bladder. Bladder stones are crystallized minerals in the bladder that form when urine becomes very concentrated.
  
  These stones can cause bladder irritation, blood in the urine, severe infections, and blockage of urine flow.
  
  

• Blood in the Urine– Blood in the urine, or hematuria, occurs when the veins on the surface of an enlarged prostate gland dilate. Gross hematuria occurs when blood in the urine is visible to the naked eye.
  
  

• Urinary Tract Infections– Urinary retention can cause urine to concentrate. If the bladder can’t empty itself, bacteria will soon grow in it. In this case, urine turns darker and with a strange smell.
  
  

• Bladder and kidney damage– Over time, the bladder may stretch and weaken if it cannot empty.
  
  The muscular wall of the bladder will be unable to contract normally, making it more difficult to empty itself.
  

Can BPH cause testicular pain?

BPH isn’t usually associated with testicular pain, but it could be if you have inflammation of the prostate, called prostatitis.

It’s possible for men to have either BPH or prostatitis, but also possible to have both conditions at the same time.

One of the common symptoms of prostatitis is discomfort, pain, or aching in your testicles or the area between your testicles and back passage.

See your doctor for a diagnosis of the condition. Once you get a diagnosis, you can then find the solution.

Can BPH cause hydronephrosis?

Hydronephrosis is a condition that occurs when a kidney swells as a result of urine failing to drain from the kidney to the bladder.

If there is an obstruction in the urinary tract, pressure can build up and eventually cause the kidneys to enlarge.

In severe cases that are left untreated, you can suffer kidney damage, which could lead to loss of kidney function.

Hydronephrosis is not a primary disease. It is an underlying condition of other health issues. There are many causes of hydronephrosis, with one of the most common being an enlarged prostate.

Benign prostatic hyperplasia (BPH) can compress and obstruct the urethra, resulting in difficulty passing urine.

Can BPH cause incontinence?

There is some evidence for a link between erectile dysfunction (ED) and BPH, although the consensus among medical professionals in this area is far from united on the topic.

However, some of the medical treatments used for BPH can do so. Once diagnosed, doctors usually recommend medication.

It is crucial you know that some of the drugs used to treat BPH have known side-effects.

Some of these include ED and a diminished sex drive. Other sexual health problems, in some cases, include retrograde ejaculation, lower sperm count, and low libido.

Men who take alpha-blockers (Flomax, Tamsulosin) and alpha-reductase (Finasteride, Dutasteride) are prone to develop erectile dysfunction.

Studies show that approximately 3% of men who took Dutasteride and 6.4% of men who took Finasteride experienced a loss of libido.

The active component of the prostate plays a crucial role in generating libido and sustaining erectile rigidity.

Therefore, it is not uncommon for men to experience flagging sexual desire and compromised erectile after initiation of treatment.

One example is Finasteride (Proscar), a drug that treats BPH symptoms by blocking testosterone. Studies reveal that 3.7% of men who use it experience erectile dysfunction, and 3.3% experienced decreased libido.

Can BPH cause hypertension?

When you look at the numbers, it appears that there’s a connection between BPH and hypertension. Twenty-five to 30% of all men over the age of 60 years old has both of them together.

Doctors say this makes sense because of the influence of stress on the body.

You may already know that the nervous system is composed of two primary parts – the sympathetic nervous system and the parasympathetic nervous system.

The sympathetic part is related to you reacting properly when you are facing a tiger or a lion-like stressor in your life. It helps you respond so you can survive.

The parasympathetic nervous system tries to help you regain composure after the lion or tiger response.

The higher the number of minutes your body spends in the parasympathetic nervous system, the better you will feel. This is the neurological state where you feel peace and contentment.

BPH can be the result of sympathetic nervous system activity and may be related to the development of high blood pressure.

What’s one of your best strategies to deal with stress?

It’s to relax, to reset your stress reflex mechanism via your brain, and don’t give up until you stop reacting to little stresses as if they were major ones. In this way, you can impact not only BPH symptoms but also hypertension.

Can BPH cause prostate cancer?

BPH and prostate cancer are conditions that increase in prevalence as men age. In many cases, these two conditions coexist.

Researchers have looked into the link between the two conditions to try and establish a direct relationship. A meta-analysis of observational research found BPH was associated with an increased risk of prostate cancer.

The risk was particularly high in Asian BPH patients. 16 case-control studies and 10 cohort studies, with 1.6 million participants included in the analysis.

Having BPH increased the risk of developing prostate cancer by 2.9 times. However, the study did not provide the absolute number of patients that had both prostate cancer and BPH.

Other research has reported contradictory findings. For example, a study published found men with smaller prostate sizes were less likely to develop prostate cancer and were less likely to develop aggressive prostate cancer.

Prostate cancer tends to develop in the peripheral zone of the prostate, while BPH usually occurs in the transition zone. Thus some scientists argue that there cannot be a direct link between the two conditions.

Men with BPH are more likely to be making regular visits to a urologist and undergoing prostate cancer screenings.

This may explain the link between BPH and prostate cancer. Family history is another strong risk factor that must be accounted for in research studies.

For more information on prostate cancer, click here.

What are the treatment options for BPH?

There are many treatments for an enlarged prostate.

The usefulness of each treatment for BPH depends on the severity of symptoms and whether you have other medical problems.

Treatment is also based on your age and overall health condition.

Medications

Drugs are the conventional treatment for an enlarged prostate. Different Types of BPH drugs include:

• Alpha-Blockers
  
  
• Tamsulosin (Flomax)
  
  
• Alfuzosin (Uroxatral)
  
  
• Doxazosin (Cardura)
  
  
• Prazosin (Minipress) 
  
  
• Silodosin (Rapaflo) 
  
  
• Terazosin (Hytrin)
  
  
• 5-Alpha Reductase Inhibitors
  
  
• Finasteride (Propecia, Proscar)
  
  
• Dutasteride (Avodart)
  
  
• Phosphodiesterase-5 Inhibitors 
  
  
• Tadalafil (Cialis)

Alpha-blockers like Tamsulosin (Flomax) block the action of the sympathetic nervous system and relax the muscles in the prostate and bladder neck.

However, they can come with many negative side effects and cause long-term dependency.

For more information on prostate medication click here.

Surgery for BPH

Along with drugs, surgical procedures are also performed to treat enlarged prostates.

The problem with almost all of these invasive procedures used to treat BPH is that they damage the prostate and, therefore, cause short or even long-term consequences.

The only difference between them is that they use different technologies, but it doesn’t matter how you damage the prostate, it was damage either way.

Before undergoing surgery, carry out extensive research and consult your Doctor on the after-effects and impact on the quality of life.

For more information on prostate surgery click here.

How can you reduce your prostate naturally?

Diet

As discussed above, diet can be a contributing factor to an enlarged prostate.

Certain foods can affect your hormonal balance, resulting in increased levels of DHT.

However, while some risk factors, such as family history, may be out of your hands, the good news is that diet can be modified.

The phrase ‘you are what you eat’ remains distinctly true, and some studies have identified foods that help or hinder your prostate health.

Therefore, all men should consider consuming a prostate friendly diet, including fruit and vegetables, legumes, nuts and seeds, healthy sources of fat.

Research has indicated that plant-based diets may reduce the risk of prostate diseases.

Fruits and vegetables contain antioxidants, polyphenols, vitamins, minerals, and fibers that reduce may help reduce inflammation in BPH and improve urinary symptoms.

A prostate, friendly diet includes plant foods such as rice bran, wheat germ, peanuts, corn oil, and soybeans containing beta-sitosterol, which may protect prostate health.

A study published by John Hopkins researchers evaluated the intake of fruit, vegetables, and antioxidants among men with BPH.

The results found that vegetable consumption, especially vegetables rich in beta-carotene, lutein, and vitamin C, was associated with a reduced risk of BPH.  To find out more about the relation between diet and an enlarged prostate, click here.

Exercise

According to the American Cancer Society, not being active is a key factor that can increase a person’s risk of cancer.

Countless studies have shown that exercise can prevent prostate enlargement and help to manage BPH symptoms.

A meta-analysis involving 43,083 men looked at the relationship between physical activity and benign prostatic hyperplasia (BPH).

The results suggested that men undertaking moderate or vigorous physical activity were less likely to develop BPH compared with prolonged sedentary time.

For more information on the benefits of exercise on prostate health click here.

Pelvic Floor Training

Pelvic floor training commonly referred to as Kegel exercises, has been shown to help strengthen pelvic muscles. These muscles make sure that the bladder, rectum, as well as the small intestines, are all in place.

When these muscles are weak due to prostate cancer surgery, for example, incontinence from urine and feces may increase.

This is also a non-invasive treatment for health problems in men with impotence or erectile dysfunction.

Stress

It is well known that stress has a significant effect on your overall health and wellbeing. However, the effects of stress on your prostate health tend to be underestimated.

High levels of stress and anxiety impair the body’s immune system, leaving you vulnerable and hindering your ability to fight off diseases and illness. When a man receives a diagnosis, his stress levels rise.

It is natural to feel anxious and worried when faced with the unknown.

This can result in a vicious cycle, whereby stressing about your prostate health can actually worsen it.

A research team at Ohio State University discovered a link between stress and the spread of cancer cells.

Their research showed that stress triggers a ‘master switch’ gene known as ATF3. This gene is expressed in all types of cells as a response to stressful situations.

Do supplements help with BPH?

The world is over-medicated, and people spend billions of dollars on prescription drugs each year.

However, several studies have already established the effectiveness of drugs is questionable. Many drugs often only mask the symptoms without fixing the root cause of the disease.

The truth is that prevention is way much better than cure, and supplements are a better option. They are natural therapies that are much safer and more effective.

Ryegrass pollen

Multiple clinical studies support its effectiveness in the treatment of an enlarged prostate.

One 2017 meta-analysis consisting of 10 clinical studies actually revealed an 83% positive response rate from patients, with no side effects reported.

Beta-Sitosterol

Beta-sitosterol is a sterol, similar to cholesterol, found in plant foods. It has been shown to help reduce the symptoms of BPH, including improving urination flow and prostatitis.

Many studies have been conducted, reviewing the effectiveness of beta-sitosterol as a natural treatment for an enlarged prostate.

French researchers say this well-known herb is a suitable replacement for Flomax, plus it decreases 65% of biomarkers for chronic prostate inflammation. That’s a good amount since the drug only decreased the biomarkers 46%.

For more information on prostate supplements, click here.

Boron

In recent years, there have been many studies that demonstrate that boron can kill prostate cancer cells while leaving healthy cells unharmed selectively.

In addition, boron has been found to lower PSA—which was previously believed to be only a marker for prostate cancer.

More recent research shows that elevated PSA is a causal factor in prostate cancer progression.

Pygeum Africanum

Pygeum Africanum is a cherry tree found in Africa.

Pygeum contains a wide variety of active components, including the phytosterols beta-sitosterol.

Phytosterols found in plants produce an anti-inflammatory effect, helping to relieve the uncomfortable symptoms of BPH.

One study reviewing the benefits of pygeum africanum found that men using the herb were more than twice as likely to report an improvement in overall symptoms.

Turmeric (Curcumin)

The active ingredient in turmeric, known as curcumin, is a powerful weapon against inflammation, even matching the effectiveness of some anti-inflammatory drugs such as ibuprofen, aspirin, tamoxifen, sulindac, and naproxen, but without adverse side effects.

Ellagic Acid

Ellagic acid is an antioxidant naturally found in 46 different types of fruit. Studies carried out by The Hollings Cancer Institute found that ellagic acid can cause apoptosis (death of cancer cells) for prostate cancer cells within 72 hours.

Japanese Sophora (Flower Buds) Quercetin

Quercetin is a flavonol, derived from plants. Many studies have shown it to be an effective anti-inflammatory, helping to reduce prostate-related pain and swelling.

Quercetin has been labeled a Tier 1 Supplement. That means that quercetin has many successful clinical studies and research that support its effectiveness.