Benign Prostatic Hyperplasia (BPH): Things Men Need to Know

July 27, 2021

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 for 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 on BPH, including the causes, treatments, management, and drugs used to treat the condition.

Causes

The prostate is a walnut-sized, muscular gland located around the urethra responsible for producing fluids that makeup semen and nourish the sperms after ejaculation. In healthy men, the prostate remains relatively small in size. However, the prostate could be enlarged following rapid multiplication of the cells in the prostate glands. The exact cause of prostate enlargement is unknown, and it is widely believed that the condition 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 hormones level with age could be a contributing factor to the development of BPH. Also, certain conditions like hyperinsulinemia decrease the production of sex hormone-binding globulin by the liver, which affects the normal development of the prostate. 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 emptying of the bladder, nocturia, weak urinary stream, which is either delayed or slowed and urinary incontinence. All these symptoms are a result of the obstruction of the urethra by the enlarged prostate. The symptoms can cause significant impairment and decrease the quality of life of the patients. 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, and 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, enlargement of the prostate may not be a significant concern. However, the enlargement may result in benign prostatic hyperplasia (BPH), a condition requiring medical attention. The goal of treatment in BPH is to alleviate the symptoms and improve the quality of life of the patients. A clinical diagnosis of BPH must first be established before treatment options are reviewed. BPH can be diagnosed using a number of techniques, including urinalysis, cystoscopy, prostate-specific antigen (PSA) test, and urodynamic tests. Based on the severity of the enlargement and its impact on a patient’s health, several treatment options can be considered.

Lifestyle Changes

First, all individuals with BPH or who are at risk of developing BPH are always advised to adopt lifestyle changes. Some of the changes that 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 patients’ 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 out 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 either treat BPH 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 function to 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 regulation of sex hormone production and BPH management. This association forms the basis for hormone reduction treatment of BPH through the administration of 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 result in a reduction in the size of the prostate and hence relieving the urethra obstruction and improving urine flow. However, long-term hormone reduction therapy in the treatment of 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, which is one of the drugs used to reduce DHT, is known to cause erectile dysfunction.

Antibiotics

Enlargement of the prostate may result in inflammation which increases the risk of infection and bacterial prostatitis. Antibiotics are administered to patients with severe inflammation for the treatment of bacterial prostatitis. However, antibiotics treatment should only be used when there is a confirmed clinical diagnosis of bacterial infection. If bacteria did not cause the infection, treatment with antibiotics may be futile and only increase the risk of antibiotic resistance.

Surgery

Surgical interventions may be considered, especially in severe cases where there is 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.

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