There are many treatments for enlarged prostates (BPH), but all have side effects and possible complications. Learn what to expect -- and how to decide.
All his life, he slept like a stone. But now, there's an annoying trip to the bathroom every night, sometimes once or twice a night.
For most men, these nightly bathroom runs may be the first sign of an enlarged prostate. Other symptoms may include trouble starting a stream of urine, leaking, or dribbling. And, like gray hair, an enlarged prostate is a natural by-product of getting older, doctors say. Trouble is, the nightly bathroom runs become more frequent -- eventually edging their way into the daytime routine.
"They can't sit through a meeting or a plane flight without getting up," says Kevin Slawin, MD, a professor of urology at Baylor School of Medicine in Houston. "It's very annoying … and when they have to go, they really have to go."
It's a problem that has several names -- enlarged prostate, benign prostate hyperplasia, or simply BPH. According to the National Kidney and Urological Disease Information Clearinghouse, the most common prostate problem for men over 50 is prostate enlargement. By age 60, over one-half of men have BPH; by age 85, the number climbs to 90%, according to the American Urological Association (AUA).
Enlarged Prostate Symptoms and Causes
In men, urine flows from the bladder through the urethra. BPH is a benign (noncancerous) enlargement of the prostate that blocks the flow of urine through the urethra. The prostate cells gradually multiply, creating an enlargement that puts pressure on the urethra -- the "chute" through which urine and semen exit the body.
As the urethra narrows, the bladder has to contract more forcefully to push urine through the body.
Over time, the bladder muscle may gradually become stronger, thicker, and overly sensitive; it begins to contract even when it contains small amounts of urine, causing a need to urinate frequently. Eventually, the bladder muscle cannot overcome the effect of the narrowed urethra so urine remains in the bladder and it is not completely emptied.
Symptoms of enlarged prostate can include:
- A weak or slow urinary stream
- A feeling of incomplete bladder emptying
- Difficulty starting urination
- Frequent urination
- Urgency to urinate
- Getting up frequently at night to urinate
- A urinary stream that starts and stops
- Straining to urinate
- Continued dribbling of urine
- Returning to urinate again minutes after finishing
When the bladder does not empty completely, you become at risk for developing urinary tract infections. Other serious problems can also develop over time, including bladder stones, blood in the urine, incontinence, and acute urinary retention (an inability to urinate). A sudden and complete inability to urinate is a medical emergency; you should see your doctor immediately. In rare cases, bladder and/or kidney damage can develop from BPH.
Treatment Options for Prostate Enlargement
The type of treatment needed for prostate enlargement depends on the severity of the signs and symptoms being experienced. Bleeding from the urinary system, serious or frequent urine infections that can cause more lasting damage, discomfort or lifestyle problems may all indicate that active medical intervention is required. We summarize just some of the treatment options on offer:
Medication treatment prostate enlargement
There are two types of medication that help to control the symptoms of an enlarged prostate, they are alpha blockers and finasteride Proscar, Propecia. Alpha blockers are effective in about 75% of men. They work by relaxing the muscles at the neck of the bladder making urination easier. The FDA has approved three types: doxazosin Cardura; tamsulosin Flomax and terazosin Hytrin. You should see improvements within one or two days. Side effects can include dizziness, tiredness, and in some, a low blood pressure when you stand up and impotence.
Finasteride actually shrinks the prostate gland and is found to be most effective in men whose prostate is significantly enlarged. It can take a long time for the drug to show improvement in symptoms - up to a year for complete results. Side effects can include a reduced libido, impotence and a reduced semen release during ejaculation. Finasteride also has the side effect of hair growth and is also sometimes used for treating male pattern baldness.
Herbal Alternatives for prostate enlargement
Saw palmetto Serenoa repens has been widely tested and results are promising. It is thought to work by preventing testosterone from breaking down into another form of the hormone associated with prostate tissue growth. In 1998, researchers at the Department of Veterans Affairs reviewed more than a dozen studies involving saw palmetto. It found saw palmetto to be as effective as finasteride in reducing the size of an enlarged prostate and produce fewer side effects. The herbal alternative does work slowly with improvement in urinary symptoms within 1 to 3 months. If after that time there is no improvement then the herb should be discontinued. Additional research is required to determine the appropriate daily dosage of the supplement, its long-term effectiveness.
Many conventional drugs have a herbal basis, so just because we associate herbs with health does not mean they are necessarily ‘better’ for you. Also remember, as with many herbal products, saw palmetto may suppress PSA prostate specific antigen levels in your blood and can interfere with the effectiveness of the PSA test so it is important to tell your doctor before having a PSA test.
Heat therapies for prostate enlargement
Heat, delivered through the urethra and using a local anaesthetic, can be used to reduce the size of the prostate. Usually carried out on an out-patient basis, results should be quick and recovery from the procedure a few days. Types of heat therapy available are Electro vaporization, microwave therapy or laser therapy.
Surgical Options for prostate enlargement
Surgical intervention is now less common because of alternative effective and less invasive therapies. Surgery is often the most effective long term option for difficult to manage or more serious complications resulting from a enlarged prostate. There are a number of surgical procedures for it, transurethral resection of the prostate, transurethral incision of the prostate or Open Prostatectomy. All these procedures require hospital in-patient care, a general anaesthetic and time off work.Side effects can arise from infection, nerve or structural damage and include loss of bladder control, impotence, ejaculation problems.
Other treatment options include prostate tents and balloon dilation, good for men unable to tolerate the other forms of treatment.
