Benign prostate hyperplasia (BPH) is a pathological condition characterized by enlargement of the prostate glands. BPH is a common condition in men and the risk of developing BPH increase with age. The hyperplasia or enlargement of the glands is non-cancerous; the tumor does not spread to other parts of the body. The prostate glands are located around the urethra at the exit point from the bladder. Enlargement of the glands results in constriction of the urethra and obstruction of urine flow, causing BPH to experience pain during urination. This article presents a detailed discussion of BPH, including the causes, treatments, management, and drugs used to treat the condition.
Causes
The prostate is a walnut-sized, muscular gland around the urethra responsible for producing fluids that make up semen and nourish the sperms after ejaculation. In healthy men, the prostate remains relatively small in size. However, the prostate could be enlarged following the rapid multiplication of the cells in the prostate glands. The exact cause of prostate enlargement is unknown, and it is widely believed that it is a typical age-related change in men. Several studies have proposed a link between age-related changes in sex hormones and the development of BPH. Androgens play a crucial role in the development of prostate glands, and hence changes in the sex hormone level with age could contribute to the development of BPH. Also, conditions like hyperinsulinemia decrease the production of sex hormone-binding globulin by the liver, affecting normal prostate development. Additionally, increased levels of dihydrotestosterone (DHT) have also been linked to BPH development since the hormone is responsible for influencing the growth of the prostate.
BPH results in a wide range of symptoms that can be used to diagnose the condition. The most common symptoms include painful urination, incomplete bladder emptying, nocturia, weak urinary stream, either delayed or slowed, and urinary incontinence. All these symptoms result from the obstruction of the urethra by the enlarged prostate. The symptoms can cause significant impairment and decrease the patient’s quality of life. BPH is also associated with an increased risk of developing complications such as urinary tract infections (UTIs), bladder damage, urinary incontinence, kidney damage, and bladder stones which can have devastating impacts on an individual’s health. Also, most elderly males have other comorbid conditions like diabetes, arthritis, and hypertension that require frequent medical attention, hence the need to effectively treat and manage conditions like BPH to minimize the health burden on the patients.
Treatment and Management
For most men, prostate enlargement may not be a significant concern. However, the enlargement may result in benign prostatic hyperplasia (BPH), requiring medical attention. The goal of treatment in BPH is to alleviate the symptoms and improve the patient’s quality of life. A clinical diagnosis of BPH must first be established before treatment options are reviewed. BPH can be diagnosed using several techniques, including urinalysis, cystoscopy, prostate-specific antigen (PSA), and urodynamic tests. Several treatment options can be considered based on the severity of the enlargement and its impact on a patient’s health.
Lifestyle Changes
First, all individuals with BPH or at risk of developing BPH are always advised to adopt lifestyle changes. Some changes individuals may adopt are physical exercises targeting the pelvic floor muscles. However, it is essential to note that pelvic floor muscle strengthening can decrease urinary incontinence and significantly improve patient’s quality of life with BPH. Reducing alcohol and caffeine consumption has also been associated with improved BPH prognosis. Reducing caffeine and alcohol intake results in reduced urinary frequency and hence decreased severity of the symptoms. Recent studies on the risk factors of BPH showed that it could be modified and found that moderate alcohol consumption and reduced smoking significantly decreased the risk for BPH. Another meaningful lifestyle change is diet; diet also may play a role in developing BPH either by increasing risk factors such as diabetes and obesity or by directly contributing to the symptoms. For instance, increased fluid intake can cause increased urinary frequency, which increases the severity of BPH symptoms.
Pharmacological Interventions
Pharmacological interventions are the most commonly used approach to treat and manage BPH after a clinical intervention; this involves using different drugs meant to treat or decrease the severity of the symptoms. Additionally, pharmacological interventions may be used in patients when lifestyle changes are insufficient to achieve desirable outcomes. Some of the drugs used in the treatment and management of BPH include:
Alpha-1 Blockers
Alpha-1 blockers or alpha-adrenergic blocking agents decrease muscular contraction and promote relaxation of the bladder and prostate muscles. The drugs bind on the alpha-1 adrenergic receptors and prevent the binding of catecholamines responsible for stimulating muscular contraction. By promoting muscular relaxation in the bladder and prostate, these drugs help relieve symptoms such as painful urination and weak urinary stream as they reduce the urethra obstruction caused by the enlargement. Examples of commonly administered alpha-1 blockers include doxazosin, tamsulosin, alfuzosin, and prazosin.
Hormone Therapy
Hormone-blocking medications may also be used to treat BPH in patients where the primary cause of enlargement is the overproduction of hormones. Also, there is a link between sex hormone production and BPH, revealing a possible association between regulating sex hormone production and BPH management. This association forms the basis for hormone reduction treatment of BPH by administering drugs that lower the levels of dihydrotestosterone hormone, which is responsible for influencing prostate growth. In some cases, it has been found that decreasing the levels of DHT in the body could reduce the prostate’s size, relieving urethra obstruction and improving urine flow. However, long-term hormone reduction therapy in treating BPH could result in impotence since sex hormones are required for normal reproduction. Additionally, the treatments could decrease the sex drive of the patient. For instance, finasteride, a drug used to reduce DHT, is known to cause erectile dysfunction.
Antibiotics
Enlargement of the prostate may result in inflammation, increasing the risk of infection and bacterial prostatitis. Antibiotics are administered to patients with severe inflammation to treat bacterial prostatitis. However, antibiotic treatment should only be used when there is a confirmed clinical diagnosis of bacterial infection. If bacteria did not cause the infection, antibiotic treatment may be futile and only increase the risk of antibiotic resistance.
Surgery
Surgical interventions may be considered, especially in severe cases with complete or near-complete obstruction of the urethra. Also, surgery is regarded as a second-line intervention for patients who are unresponsive to medications. With recent developments in surgery, BPH can be effectively treated through non-invasive or minimally invasive surgical procedures such as photoselective vaporization of the prostate (PVP), which vaporizes the enlarged prostate tissues reducing the obstruction on the urethra.
In conclusion, benign prostatic hyperplasia (BPH) develops in most men as a normal aging condition. However, BPH may cause significant discomfort and increase the risk of other complications such as urinary tract infections, bladder damage, and urinary incontinence. Therefore, effective treatment and management of BPH using pharmacological interventions such as alpha-1 blockers and hormone-reduction medications are crucial. In addition, lifestyle changes like pelvic floor muscle training, diet, and reducing caffeine and alcohol consumption are also effective interventions for managing BPH.