If you have benign prostatic hyperplasia, read on about how behavioral changes, medication, and surgery can help.
Every night, between 12 and 15 million men in the U.S. are likely to have sleep interrupted by the need to get up and urinate, often multiple times, because of an enlarged prostate.
The prostate gland is typically the size and shape of a walnut and is located in the lower part of the pelvis, below the bladder. It envelops the urethra, the tube through which urine flows from the bladder out of the body. When the prostate gland grows bigger – which happens to virtually every man as he ages – it can squeeze the urethra and make it difficult to pass urine.
An enlarged prostate, a condition known as benign prostatic hyperplasia, affects about half of men age 50 and above, says Dr. Robert Cornell, a urologist at St. Joseph Medical Center in Houston, Texas. BPH is increasingly common in men as they age, affecting as many as 90 percent of men ages 80 and above.
An Array of Symptoms
Men’s prostate glands start getting bigger in their 30s, but it’s rare for men under 40 to experience symptoms. Younger men who experience these types of symptoms should get a urological exam to determine if there’s another cause of obstruction or a neurological problem, Cornell says.
The mild to severe urinary symptoms BPH causes can negatively impact one’s quality of life. An enlarged prostate can lead to increased frequency in urination, an urgent need to urinate, a weak urinary stream that may stop and start, a sense of incomplete bladder emptying, incontinence, and sexual dysfunction. Because the condition often causes the need to go to the bathroom at night, it can lead to fatigue the next day – which, in turn, is linked with everything from irritability to an increased risk of hip fractures, impaired daytime performance, and reduced testosterone levels.
BPH does not cause prostate cancer or affect a man’s ability to have kids, but if the symptoms bother you, seek treatment. If left untreated, BPH can lead to urinary retention and cause bladder, urinary tract, and kidney problems.
Who’s Most at Risk
While not every man with an enlarged prostate will experience severe symptoms, virtually every man will get BPH if he lives long enough, says Kevin McVary, chairman of urology at the Southern Illinois University School of Medicine in Springfield, Illinois, and co-chairman of the American Urological Association’s Clinical Guidelines for BPH. “Urination problems attributed to an enlarged prostate are common in all men, regardless of race, ethnicity or country of origin,” McVary says. “It is ubiquitous around the world.”
Though the condition is common among all kinds of men, some are at higher risk than others, according to the Mayo Clinic. Obesity markedly increases the risk of having an enlarged prostate, and exercise can lower it. Men who have a family member, such as a father or brother who’ve had BPH, are at a higher risk of developing an enlarged prostate. Black men have a higher chance of experiencing symptoms at a younger age than white men, and prostate enlargement is less common in Asian men. Men who have diabetes and take beta-blockers – prescription drugs used to treat heart disease and other conditions – may also be at higher risk of BPH.
The millions of middle-aged and older men who grapple with BPH can’t prevent it from occurring, but they can take steps to mitigate its effects, McVary says. Here are some strategies he and other doctors suggest:
If your urination habits change, get checked out by a doctor. Such changes could be symptoms of BPH or something else, and you should make an appointment with your primary care physician or urologist, McVary says. An increase in urination, for example, could be caused by uncontrolled diabetes rather than an enlarged prostate. Men can also take an AUA questionnaire detailing urinary symptoms that can provide a score that indicates whether they’re mild, moderate, or severe.
Try behavioral changes. Some simple changes in your daily routine, such as limiting your fluid intake at night and not drinking anything for two hours before bedtime, can help cut down on the need to urinate during the time you should be sleeping, says Dr. Blaine Kristo, a urologist at Mercy Medical Center in Baltimore. “Don’t drink a bottle of water before you go to bed,” Kristo says. “Don’t keep a bottle of water on the end table near your bed,” McVary says he once treated a middle-aged patient who was concerned that he was getting up several times a night to urinate. When the man said he was drinking six beers nightly, McVary advised him to reduce his beer intake. The man did, and he no longer needed to get up every night to urinate. Experts also say to be wary of foods and beverages that are diuretics (and will therefore prompt you to urinate more), such as coffee, caffeinated tea, herbal tea, lemon juice, chocolate, pineapple, grapes, and cherries.
If those adjustments don’t help much, consider medication. A change in habits will help some but not all men with BPH, and for those whose symptoms aren’t relieved, medication is an option, says Dr. Peter Walter, a urologist in Jamestown, New York. Among the medications doctors prescribe are alpha-blockers, which can relax the muscle at the base of the bladder and the prostate, and 5 alpha-reductase inhibitors, which can, over a period of months, shrink the prostate, Walter says. Both medications have potential side effects; alpha-blockers can cause the person taking them to pass out and increase his blood pressure, for example. And 5 alpha-reductase inhibitors can cause sexual dysfunction, such as impotence. Some physicians are also prescribing tadalafil, commonly known by its brand name Cialis, which is often marketed as a drug that treats erectile dysfunction, McVary says. It works by helping to relax the prostate.
As a last resort, surgery’s an option. If behavioral changes and medication don’t work or cease to be effective, surgical procedures are an option, McVary says. Annually, about 200,000 men undergo procedures to shrink their prostates. By far, the two most common procedures are a transurethral resection, in which an instrument is inserted up the urethra to cut out the part of the prostate that’s blocking urine flow, and a laser procedure, which vaporizes the tissue obstructing the urethra. Both procedures are typically effective but carry the risk of side effects such as erectile dysfunction. Other, newer procedures, such as the UroLift System, in which a urologist places tiny implants in the prostate to increase the opening of the urethra and allow for greater urine flow, show promise, but more research is needed to determine their long-term effectiveness, McVary says.