By Taylor Setterfield
2022 UBC PharmD Candidate
Benign prostatic hyperplasia (BPH) — an enlarged prostate — is a normal condition of aging in men. It is very common, with the incidence increasing significantly after the age of 40, and affecting nearly 3 out of every 4 men who are over 70.(1)
The prostate is a small, walnut-sized gland that is part of the male reproductive system, sitting below the bladder.
We don’t know exactly why the prostate enlarges as men age. We know that some sex hormones are required for the development of BPH, but they do not have a direct role in causing it. Studies have shown that there are several modifiable risk factors (including hypertension, diabetes, high cholesterol, and obesity) and non-modifiable risk factors (such as age, genetics, and a family history of BPH).
What are the symptoms?
Symptoms can vary widely in how they impact your quality of life. Enlargement of the prostate can cause problems with urination due to compression and obstruction, and the muscles surrounding the prostate can also be weakened. The most common symptoms include:
- Feeling like your bladder is not empty after urination;
- Frequent urination less than 2 hours apart;
- Urination that is disrupted, weak, or hard to control;
- Straining upon urination;
- Waking up in the night to urinate.(2)
Can BPH be prevented?
While we can’t prevent aging, addressing the modifiable risk factors mentioned earlier is the best way to reduce your chances of developing or worsening BPH. Reducing weight through diet and exercise is the number one option for prevention of many chronic diseases. In this case, excess fat cells cause inflammation and an increase in estrogen levels. Alcohol is high in calories and is a diuretic, making it harder to lose weight while also increasing the frequency of urination.
How is it treated?
Since the severity of symptoms varies widely between individuals and there are other conditions with similar symptoms that must be ruled out, speak with your doctor to get a proper diagnosis.
Many patients do not find the symptoms of BPH too bothersome and are able to manage them effectively with non-drug measures, such as decreased fluid intake, decreasing use of diuretics like coffee and alcohol, or bladder training that focuses on timing and complete voiding. When symptoms are more bothersome, there are effective medications that your doctor can prescribe for you. These types of medications are referred to as “alpha-blockers” or “5-alpha-reductase inhibitors.”
- Alpha-blockers cause the muscles surrounding the prostate to relax, improving the flow of urine. These medications are usually well-tolerated and work quickly (within a few days). Since they can also relax your blood vessels, they can cause dizziness due to low blood pressure, but this is avoided by choosing medications that specifically target the muscles surrounding the prostate and by starting at a low dose and slowly increasing the dose.
- 5-alpha-reductase inhibitors decrease the production of dihydrotestosterone, which is the main hormone that causes cell growth in the prostate. These drugs can decrease the size of the prostate by 20-25%, making them especially useful in situations where the prostate has increased in size by a large amount, though it can take several months to achieve results.
In more serious cases or where medications are ineffective, surgery may be warranted.
Natural health products that claim to help with symptoms of BPH include beta-sitosterol, cernilton, Pygeum africanum, and saw palmetto. However, the evidence for these products is poor, because it is based on small, outdated studies using unknown preparations.(3) Another concern with natural health products is that they are not regulated like pharmaceutical products, so there are no guarantees on what you get. And they can be pricey compared to the prescription medications, especially when considering the limited benefits. Talk with your doctor or pharmacist before starting natural health products. They will want to ensure that you are properly diagnosed and have ruled out other possible causes for your symptoms, review any interactions with your other medications, and explain the evidence and safety of treatment options.
Overall, benign prostatic hyperplasia is a very common condition for older men, but it can be managed effectively. At The Medicine Shoppe Pharmacy in Courtenay, we are happy to meet with you for a medication review, during which we can discuss any medication questions or concerns.
- Urologic Diseases in America Project: Benign Prostatic Hyperplasia https://www.auajournals.org/doi/abs/10.1097/01.ju.0000155709.37840.fe
- International Prostate Symptom Score (IPSS) https://www.healthlinkbc.ca/health-topics/ug1952
- Enlarged Prostate: Herbal Therapy https://www.healthlinkbc.ca/health-topics/ug1905