General Description

What is Benign Prostatic Hyperplasia?

Benign prostatic hyperplasia, also known as BPH, is a men’s health condition caused by the enlargement of the prostate gland.  While several of the symptoms of BPH mimic those of prostate cancer, the condition is not malignant; however, it can cause a variety of uncomfortable symptoms that, if left untreated, can lead to kidney, bladder, or urinary tract problems. Bladder stones and kidney stones are also potential long term effects of the condition. Untreated BPH may also lead to incontinence, which is a permanent condition.  It is widely acknowledged that the enlargement of the prostate occurs as the result of aging, but what specifically triggers this growth is yet unknown.

Thanks to cutesy commercials for prostate medications and joke material used by many aging comics, the symptoms of benign prostate hyperplasia have been turned into a shoulder-shrugging punch line about men getting older. Yet the symptoms of the condition can progressively deteriorate the quality of a man’s life as he ages, both physically and emotionally.

While BPH is considered to be a completely physical condition, the stress and emotional strain the symptoms of the condition can place on a man often lead to greater incidences of anxiety, irritability, depression, and other mental symptoms.  Therefore, when considering the symptoms of BPH, it is important to treat all aspects of the condition.

The classic physical symptoms of early stage BPH include the following:

• Difficulty initiating urination
• Urine stream starts and stops during urination
• Urine drips or dribbles out of the penis after urination is complete

Some serious potential results of leaving BPH untreated include the development of renal failure, blood in the urine, bladder infections and urinary tract infections.

The symptoms of BPH can not only disrupt an individual’s ability to perform daily activities as normal, but can also cause serious emotional symptoms as well. In the February 2009 edition of WholeFoods magazine, health writer Katie Agin notes that in men who experience BPH, “impotence and other sexual troubles develop, often leading to emotional, psychological, and relationship dilemmas.”

Anxiety is a common emotional symptom of men who suffer from BPH, especially those who have had an experience of not being able to control their bladder in public or private situations. A study published in the October 2004 edition of the International Journal of Urology reported that men who are diagnosed with a condition related to their urinary tract, such as BPH, are likely to experience feelings of anxiety and depression. Ironically, these emotional conditions can lead to impotence or inability to sexually climax which will cause more depression and anxiety.

For more valuable information on the symptoms of BPH, check out our full length report!

Causes

BPH is estimated to affect up to 90% of the male population over 70 years of age; however in spite of its prevalence, the medical community has not been able to identify one specific cause of the condition. There are a variety of theories as to what causes the gland to enlarge over time, most of which focus on hormonal triggers.

• Dihydrotestosterone - Dihydrotestosterone (DHT) is a metabolic derivative, or sub-type, of testosterone.  DHT is more concentrated than testosterone and is responsible for the formation of male genitalia, including the prostate, testes, and penis. It is produced throughout a man’s life. DHT build-up has long been seen as a cause of BPH, however, there is growing concern in the medical community that DHT’s role in prostate enlargement has been misunderstood and that DHT may potentially reduce the size of the prostate.

• Estradiol - Estradiol is the main form of estrogen found in humans; it is produced from an enzyme reaction with testosterone. As a man ages, more of his testosterone becomes converted to estradiol, which can cause other biological chemicals to accumulate in the prostate.   In a 1994 report published in the Proceedings of the National Academy of Sciences, it was concluded that increased estradiol levels led to an enlarged prostate due to a rapid accumulation of cAMP, a common cellular messenger.

• Estrogen Dominance - Estrogen dominance occurs in men when the levels of estrogen surpass the levels of testosterone, becoming the governing hormone in the body. This causes several hallmark symptoms, including loss of muscle mass, reduced libido, and weight gain, particularly around the belly. The role of estrogen in the prostate and other male reproductive glands is still not fully understood, and many questions remain. The hormone is currently under serious scrutiny by myriad researchers around the world and is likely to emerge as an even more significant player in BPH in the coming years.

• Additional Causes - In addition to hormonal shifts, several other theories regarding the cause of BPH have been postulated over the past twenty years. One interesting theory asserts that heavy metals, such as nickel, play a role in the enlargement of the gland. Heavy metals like nickel do not belong in the body, and when it is present attracts bacteria which lead to an enlarging of the prostate. Heavy metals are not the only damaging substances that accumulate in the prostate. Environmental toxins, such as xenoestrogens, also build up in the gland. Xenoestrogens are foreign estrogens that enter the human body and act in the same way naturally produced estrogen would, leading to a surplus of estrogen and estrogen dominance. These toxins can affect the hormonal shift men naturally experience as they age and enhance the effects estrogen has on the body. Click here for more information on Estrogen Dominance

For more valuable information on the causes of BPH, check out our full length report!

Traditional Treatments

Traditional treatment options for an enlarged prostate include everything from prescription medications to surgery. However, while it is important to review all possible options for treating your enlarged prostate, we here at Health911 would like to emphasize that over the last 10 years there has been a considerable shift among members of the medical community toward alternative therapies for this condition due to the broad range of side effects associated with most traditional treatments. If your health care professional suggests any of the following treatments, be sure you are clear on the potential side effects as some are irreversible.

• Prescription Medication - There are several prescription medications available to treat a mildly to moderately enlarged prostate gland. In 2006, the National Institute of Diabetes and Digestive and Kidney Diseases (a division of the National Institutes of Health) reported that using these two types of drugs together “reduced the risk of BPH progression by 67 percent, compared with 39 percent of [the alpha blocker] alone and 34 percent of [the 5-alpha reductase inhibitor] alone.”

• Alpha blockers - Alpha blockers are characterized by their ability to help muscles relax. The benefit of alpha blockers is that patients will notice an improvement in comfort and ability to urinate within a few days. Most patients also notice a reduced need to urinate. Alpha blockers can cause a variety of side effects, including headache, weight gain, and irregular or “pounding” heartbeat. After the first few doses, a patient may experience a rapid drop in blood pressure, which can cause dizziness and fainting. Men who take alpha blockers may experience retrograde ejaculation, a condition that occurs when semen backs up into the bladder instead of ejaculating out of the penis during an orgasm. Some popular brand name alpha blockers used for BPH include Hytrin, Rapaflo, Uroxatral, and Flomax.

• 5- alpha reductase inhibitors- 5-alpha reductase inhibitors are a type of medication that can help decrease the size of the prostate by reducing the amount of dihydrotestosterone (DHT) in the gland. This class of medication, most commonly prescribed under the brand names Proscar and Avodart, can take several months to improve symptoms. They also cause several sexual side effects, including reduced libido, erectile dysfunction, and retrograde ejaculation. 

• Transurethral Microwave Procedures - Transurethral Microwave Procedures, also known as Transurethral Microwave Thermotherapy, utilizes a machine that focuses microwaves heated to at least 111 degrees Fahrenheit to burn off and destroy enlarged prostate tissue. The procedure does not require any anesthesia and are performed on an outpatient basis.

• Transurethral Needle Ablation - During the procedure, two needles are inserted into the pelvis and directed at the areas of abnormal prostate growth. Low levels of radio frequency energy are shot through the needles to destroy portions of the prostate to help relieve symptoms of bladder pressure and strained urine flow. This procedure is considered effective for reducing specific portions of the gland, unlike the transurethral microwave procedure which is harder to focus on a particular area. Local anesthesia is typically utilized during this procedure and it does not cause incontinence and impotence. However, in 2007 a study published in The Journal of Urology noted that the procedure has a high rate of failure and the majority of patients are required to undergo it again immediately to correct the first attempt.

• Surgical Options - If other prescription or minimally invasive outpatient procedures are unable to reduce the size of the prostate due to size or continued regrowth, a medical professional may suggest a man undergo surgery to handle the issue. The point of the surgery is not to remove the entire prostate, but simply remove the enlarged tissue that is placing pressure on the urethra or bladder.

• Transurethral Resection of the Prostate – This procedure is used in approximately 90% of all prostate surgeries related to BPH annually in the United States. During this surgery, the patient in placed under general anesthesia, and a resectoscope, a device that contains a light, camera, and irrigation system, is inserted through the opening at the end of the urethra. The resectoscope, which is approximately one foot long and .5 inches in diameter, also has a cutting utensil attached which can cut tissue and also clot it shut with extreme heat. Small pieces of enlarged tissue are cut off and allowed to collect in the bladder to be voided with urine after the procedure is completed. No incisions need to be made on the patient, as the entire procedure is conducted through this opening.

• Transurethral Incision of the Prostate - Transurethral Incision of the Prostate (TUIP) requires additional incisions to be made to widen the urethra channel and bladder neck to relieve urination problems.  The goal of this procedure is to improve symptoms without placing the patient at risk for retrograde ejaculation; however, this procedure has not been used for long enough to note long term effects. Open surgery, where an external incision is made in the lower pelvis, is only used in instances where success is not achieved with TURP or TUIP or there are additional medical complications.

• Laser Surgery - The gland is sliced off and “vaporized” with Nd: YAG lasers. It is perceived to be the next generation in prostate surgeries by many in the medical field because it allows for a quicker recovery time than TURP and reduces blood loss. However, like TUIP, the procedure has not been performed for long enough to observe long term effects or its effectiveness on non-typical glands or larger glands.

For more valuable information on the tradition of BPH, check out our full length report!

Misdiagnosis of Symptoms

Talking with a doctor frankly about sexual problems, urinating issues, or other concerns about your genitals can be uncomfortable, embarrassing, and feel “unmanly” – men are supposed to suck it up and deal with whatever discomfort they are feeling. However, the difference between BPH and some other condition can be as slight as one symptom; to receive the proper diagnosis and avoid misdiagnosis, you need to volunteer every symptom you are aware of to your health care professional. If you feel uncomfortable talking to your health care provider about your symptoms, check out Talking About Your Prostate Health for tips on making the most of your appointment.

• Prostatitis - Prostatitis is a term used for a group of disorders of the prostate that include bacterial infection, inflammation, and a chronic form unrelated to infection. If left untreated, there is some evidence that prostatitis can increase a man’s risk for developing prostate cancer. Symptoms of prostatitis include painful urination, difficulty passing urine, dribbling urination, frequent nighttime urination, painful ejaculation, pain in the lower back and groin region. Prostatitis can be distinguished from BPH by pain. While men who are suffering from BPH may experience a sensation of pressure or discomfort due to their swollen prostate pressing against the urethra or bladder, they typically do not report pain in the back, groin, during urination, or during ejaculation. A urine and semen analysis can be conducted to verify the proper diagnosis.

• Urinary Tract Infection - A urinary tract infection (UTI) can indicate a bacterial infection of any part of the urinary tract, including the urethra, bladder, or kidneys. Symptoms of UTIs typically include painful urination, burning when urinating, frequent need to urinate, strong smelling urine, and cloudy urine. As the infection gets worse, an individual may experience lower back pain and a fever. The symptoms of a UTI tend to come on suddenly and increase in severity at a rapid rate. A simple urine analysis can alert your health care provider to a UTI.  

• Depression - Depression is an emotional state characterized by persistent and pervasive low mood. It may be triggered by a traumatic event, such as death, loss, or pregnancy, or a chemical imbalance in the brain. It is treatable through a variety of traditional medications and alternative practices. Depression is often a symptom of BPH and can, from the perspective of a medical professional, mask the original condition due to a heightened social sensitivity to depression and classic signs. Sexual dysfunction, inability to sleep, anxiety over not being near a bathroom, and even problems urinating can fit into a diagnosis of depression if the health care provider sees other signs. To avoid a misdiagnosis, be sure you emphasize your urinary problems as vehemently as any sexual symptoms you are having. Also, don’t feel afraid to ask for your prostate to be checked.

• Prostate Cancer - From the perspective of most health care professionals, it is hard to tell just based on reported symptoms whether a man has BPH or prostate cancer. Further testing of the prostate is almost always performed, which may include a digital rectal exam or an ultrasound. A blood test which measures levels of PSA (prostate-specific antigen) is typically also performed. The health care professional may decide to take a sample of the prostate tissue and examine it further. Based on the results of these tests, it should be clear if an individual is suffering from BPH or prostate cancer.  

For more valuable information on the misdiagnosis of BPH, check out our full length report!

Changes to Make