The prostate is a small, ping-pong ball-sized gland that is located deep inside the groin, between the rectum and the base of the penis. Some of the more severe diseases he prostate is susceptible to are prostatitis (inflammation of the prostate gland) and prostate cancer. However, one of the more common ailments, particularly in older men, is an enlarged prostate, also known as benign prostatic hyperplasia (BPH). Your doctor will perform an exam and order tests to distinguish between BPH and more severe diseases. About 20 percent of men in their fifties have an enlarged prostate. The risk increases as men age as about 70 percent of men have BPH in their seventies.1 Let’s take a closer look at the prostate, some common symptoms of an enlarged prostate, and the treatments available.
Is Having an Enlarged Prostate Dangerous?
Can an enlarged prostate turn into cancer? BPH does not make a man more likely to develop prostate cancer. BPH produces a variety of symptoms that are hard to ignore.5 Although an enlarged prostate doesn’t directly pose any serious health risks, it can contribute to some discomfort and keep you from living your life to its fullest. You may find yourself needing to urinate more often, which can be a nuisance when you’re in a business meeting, watching a movie, or enjoying time with your loved ones. If left untreated, an enlarged prostate can potentially lead to some serious complications, including:
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Bladder stones
As you fail to completely empty your bladder, minerals from your urine may crystallize. Bladder stones can cause further obstruction of urine flow and may lead to infection, irritation, and blood in your urine.
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Kidney damage
Pressure that builds up in the bladder can cause direct damage to the kidneys or allow a bladder infection to reach the kidneys.
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Urinary Tract Infection
The inability to fully empty your bladder makes for an environment that bacteria and pathogens may thrive, potentially resulting in an infection of your urinary tract. 6
The Importance of the Prostate Gland
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Sex and Reproduction
The prostate is not required to live, but it is essential for reproductive health. The prostate gland’s main role involves secreting fluids that help to nourish and protect sperm. During ejaculation, the prostate pushes this fluid into the urethra, mixing with sperm cells as semen.2
Healthy prostate fluid protects sperm cells while providing an optimal environment for transit and fertilization. This fluid contains a variety of substances created within the prostate and seminal vesicles, including citrate, fructose, and zinc, as well as antibodies that protect the urinary tract and sperm cells from harmful pathogens.3
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Testosterone
The prostate naturally grows based on the male hormone testosterone and dihydrotestosterone (DHT). Testosterone is mainly made in the testes, though the adrenal glands above the kidneys also create a small amount. Testosterone is converted to DHT with the enzyme 5-alpha-reductase. DHT is about 2.4 times more potent than testosterone when comparing their relative effects on prostate growth.
What Causes Enlarged Prostate?
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High Levels of DHT and Testosterone
Enlarged prostate or benign prostatic hyperplasia is a condition that commonly affects men as they get older. High levels of testosterone and DHT cause cells in the prostate gland to multiply, eventually creating an enlargement that puts pressure on the urethra, which is the tube that transports urine and semen out of the body. Continued pressure narrows the urethra, which forces the bladder to contract more intensely to push urine through the urethra and out of the body. Over time, this can cause the bladder muscle get stronger and thicker. While that sounds good, that also makes your bladder much more sensitive, meaning it may contract even if it’s not filled with much liquid. Eventually, the bladder may have trouble fighting back against the effects of such a narrow urethra, resulting in urine staying in the bladder.4
Common Symptoms of Enlarged Prostate
Not everyone with benign prostatic hyperplasia will necessarily show symptoms. The severity of symptoms can vary, though you can generally expect symptoms to get worse over time. Most common signs and symptoms of an enlarged prostate are related to urinary function. These include:
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A frequent and urgent need to urinate
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Nocturia (increased frequency of urination at night)
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Difficulty beginning urination even if you need to go
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A weak urine stream
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A urine stream that intermittently starts and stops
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Erectile Dysfunction
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Decrease in semen ejaculated during sex
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An inability to completely empty the bladder during urination
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Lower back, hips or pelvic pain
More serious but less common symptoms include:
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Urinary tract infections
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Blood in urine
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A general inability to urinate
Does Size Matter?
Contrary to what you may think, the size of your prostate does not coincide with the severity of symptoms. Some men with significantly enlarged prostates may experience minor symptoms, while some men with minimally enlarged prostates may experience severe symptoms. Everyone is different. For some, symptoms may stabilize and improve on their own.6
Diagnosing an Enlarged Prostate
Some of the symptoms of an enlarged prostate may resemble those of other common conditions, including:
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Urinary tract infection
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Bladder or kidney stones
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Narrowing of the urethra (known as urethral stricture)
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Prostate inflammation (prostatitis)6
If you think you may be exhibiting symptoms of an enlarged prostate, it’s best to get a professional diagnosis from your physician. Any diagnosis starts with the doctor asking about your health and medical history. From there, they will perform a physical exam, which may involve a prostate exam.
The most common and easy way to determine if you have an enlarged prostate is with a digital rectal rectal exam. This involves the doctor inserting a gloved and lubricated finger into your rectum to feel your prostate for any uneven lumps or growths. The pressure of the doctor’s finger against your prostate may make you feel like you need to urinate, but the exam is quick and a fairly conclusive means of determining if you have an enlarged prostate.7
Your doctor may also conduct a urine test, which can help to rule out infections and other ailments that can cause similar symptoms. A blood test can help to detect kidney problems. Your doctor may also perform a prostate-specific antigen blood test. PSA is a protein produced by the prostate. Levels of PSA go up when your prostate is enlarged, though high PSA levels can also come as a result of a recent surgical procedure.8
Natural Remedies for Enlarged Prostates
Some simple changes in your lifestyle and home remedies for enlarged prostate can go a long way to help you better cope with and even potentially relieve an enlarged prostate.
- Drink less alcohol and caffeine. These drinks cause you to produce more urine and irritate the bladder.
- Limit your drinking in the evening. This will keep you from having to get up at night to pee. However, still make sure that you drink enough throughout the day.9
- Limit your antihistamines and decongestants, which often contain ingredients that tighten the muscles around your urethra that control urine flow and make it harder to urine.
- Go when you need to. Waiting too long to urinate only overstretches the bladder, causes damage, and increases your risk of urinary tract infection.
- Schedule your bathroom visits to essentially train your bladder to go at certain times.8
You may also find it helpful to take prostate supplements such as DrFormulas Prostate Support that can help to support a healthy prostate and urinary tract.
As always, it’s a good idea to eat a healthy, well-balanced diet and maintain a moderately active lifestyle. Studies suggest that obesity can increase your risk of an enlarged prostate.10
Medicine for an Enlarged Prostate
Medication tends to be the most common treatment for most cases of enlarged prostate. This includes:
- Alpha blockers – Alpha blockers relax the muscles in the urethra and muscle fibers in the bladder, blood vessels, and prostate which allows for easier urination. These medications usually ends an -zosin such as terazosin, alfuzosin, doxazosin, tamsulosin, and silodosin. These drugs are also helpful in reducing blood pressure.
- 5-alpha reductase inhibitors – 5-alpha reductase is the enzyme responsible for converting testosterone into dihydrotestosterone, which contributes to prostate growth. By inhibiting this enzyme, this medication may help to rebalance hormones. These work over a longer period of about six months.
- Combination medication – Depending on your symptoms and needs, your doctor may prescribe a mix of alpha blockers and 5-alpha reductase inhibitors at the same time.8
Surgery for Enlarged Prostate
Surgery is often only reserved for more severe cases of BPH or cases where medication has been ineffective. There are several types of minimally invasive surgery that can definitively treat an enlarged prostate, including:
- Transurethral resection of the prostate (TURP) – The surgeon removes all but the outermost portion of the prostate. This procedure relieves symptoms almost immediately, and most men will experience a stronger urine flow after the procedure.
- Transurethral incision of the prostate (TUIP) – Instead of removing any part of the prostate, the surgeon makes one or two small incisions in the gland, which can remove some of the pressure and make it easier for urine to pass through the urethra.
- Gat-Goren Technique – Dr. Gat and Dr. Goren are two Israeli doctors who have proposed that the cause of BPH are varicoceles in the veins that drain from the testes to the prostate. Blood from the testes is higher in testosterone and DHT and treating the varicoceles has been successful in restoring function.11
- Transurethral microwave thermotherapy (TUMT) – Using an electrode, the surgeon transfers microwave energy into your prostate. This energy destroys the inner portion of the prostate, allowing it to shrink and relieve pressure on the urethra.8
Sources:
- https://www.pcf.org/about-prostate-cancer/what-is-prostate-cancer/prostate-gland/what-is-bph/
- https://www.webmd.com/urinary-incontinence-oab/picture-of-the-prostate#1
- https://www.pcf.org/about-prostate-cancer/what-is-prostate-cancer/prostate-gland/
- https://www.webmd.com/men/prostate-enlargement-bph/features/enlarged-prostate-bph-complex-problem#1
- https://www.pcf.org/about-prostate-cancer/what-is-prostate-cancer/prostate-gland/what-is-bph/
- https://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/symptoms-causes/syc-20370087
- https://www.webmd.com/men/prostate-enlargement-bph/tests-for-bph#2
- https://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/diagnosis-treatment/drc-20370093
- https://prostatecanceruk.org/prostate-information/further-help/enlarged-prostate/enlarged-prostate-treatment
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4789344/
- https://www.afr.com/lifestyle/health/mens-health/israeli-prime-minister-opts-for-a-novel-treatment-for-his-enlarged-prostate-20150705-gi5sg1
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC507713/
About the Author:
Dr. Bryan Do, D.O. is an osteopathic physician whose research interests include gastroenterology, immunology, and dermatology. He is particularly interested in the role of probiotics in the gut-brain-skin axis and has written many articles on the topic. He graduated from University of California, Los Angeles (UCLA) before graduating from Marian University College of Osteopathic Medicine in Indianapolis, Indiana and becoming a Doctor of Osteopathic Medicine. Osteopathic physicians are taught to take a holistic approach to medicine and to consider mind, body, and spirit when treating a patient. Osteopathic physicians receive training in Osteopathic Manipulative Medicine (OMM) in addition to the standard rigorous medical school curriculum. Both physicians with a Doctor of Osteopathic Medicine (D.O.) degree as well as a Doctor of Medicine (M.D.) can practice medicine.