The causes of prostate enlargement are not yet fully understood but are thought to be related to the male sex hormone (testosterone) which controls the growth of the prostate.
The prostate is initially quite small, but as men age, testosterone ‘feeds’ the prostate and it starts to get bigger. From birth to around the early teenage years, the prostate increases in size by around 8 times. It doubles again in size from around the early 20s through to 50 years of age and doubles again by around the age of 80.
With such large increases in size, it’s easy to see why the prostate can begin to squeeze the urethra and make it difficult to urinate.
There may also be a genetic link to prostate enlargement because the sons of men with an enlarged prostate are more likely to develop prostate disease.
There are a number of things that can aggravate the symptoms of prostate enlargement, including:
- Medicines used to treat depression or Parkinson’s disease;
- Some heart drugs;
- Some cough and cold medicines (like those containing antihistamines); and
- Men with BPH should avoid any medications for colds and allergies that contain decongestants, such as pseudoephedrine (Sudafed, generic). Such drugs, known as adrenergic, can worsen urinary symptoms by preventing muscles in the prostate and bladder neck from relaxing to allow urine to flow freely
There are a number of treatments available for prostate enlargement. The most suitable treatment can depend on how severe the symptoms are:
For mild symptoms, Medication is the most common treatment for mild to moderate symptoms of prostate enlargement. The options include:
- Alpha-blockers. These medications relax bladder neck muscles and muscle fibres in the prostate, making urination easier. Alpha-blockers include alfuzosin (Uroxatral), doxazosin (Cardura), tamsulosin (Flomax) and silodosin
- Rapaflo — usually, work quickly in men with relatively small prostates. Side effects might include dizziness and a harmless condition in which semen goes back into the bladder instead of out the tip of the penis (retrograde ejaculation).
- 5-alpha reductase inhibitors. These medications shrink your prostate by preventing hormonal changes that cause prostate growth. These medications — which include finasteride (Proscar) and dutasteride (Avodart) — might take up to six months to be effective. Side effects include retrograde ejaculation.
- Combination drug therapy. Your doctor might recommend taking an alpha-blocker and a 5-alpha reductase inhibitor at the same time if either medication alone isn't effective.
- Tadalafil (Cialis). Studies suggest this medication, which is often used to treat erectile dysfunction, can also treat prostate enlargement.
No treatment may be required if the symptoms are not interfering with your enjoyment of life;
For moderate symptoms
- Surgery may be an option to remove part of the prostate or relieve pressure on the urethra. There are several types of surgery which differ in how they are performed, their recovery times and their possible side effect
- Less invasive treatments – These usually use some form of heat – such as lasers or microwave beams – to reduce the size of the prostate and relieve the pressure on the urethra. Because they are less invasive, they require less time in hospital
There are several types of surgery available to treat prostate enlargement:
- Transurethral resection of the prostate (TURP) – A rigid tube is inserted into the urethra and a metal loop at its end is used to slice off some of the enlarged prostate tissue to reduce pressure on the urethra. TURP is the most common surgical procedure for an enlarged prostate. It is performed under anesthetic and involves a hospital stay of several days;
- Transurethral incision of the prostate (TUIP) – This procedure also relieves the pressure on the urethra but without removing any of the prostate. It may be used in cases where the enlargement is not severe;
- Open prostatectomy – This is not a common treatment and is usually only done when the prostate is very enlarged. An incision is made in the lower abdomen to remove part of the inside of the prostate
An enlarged prostate usually provides significant relief from symptoms and an improvement in the quality of life.
However, some types of prostate surgery can result in complications that may include bleeding after surgery, infections, problems with sexual function, infertility or leakage of urine. Talk to your doctor or surgeon about the risks associated with surgery.
Simple steps to relieve symptoms
- Don’t let your bladder get too full – urinate as soon as the urge arises, and try to relax when urinating. It may help to ‘double void’ – try emptying your bladder again after waiting a moment. Don’t strain or push.
- Reduce your intake of drinks containing caffeine and alcohol that can irritate the bladder.
- Restrict your intake of fluids before going to bed to reduce the need to get up during the night to urinate.
- Check with your doctor about whether any medicines you are taking might make your symptoms worse and whether there are other alternatives.
- Make sure other health conditions are under control (e.g. diabetes and high blood pressure).
- Do pelvic floor muscle exercises to help stop urine leaking from the bladder (a special nurse or a physiotherapist can teach you the exercises).
- Boost your fibre intake to avoid becoming constipated which can aggravate prostate and bladder symptoms.
- When taking long car trips, make frequent stops to urinate.
- Whenever possible, sit on a hard chair instead of a soft one.
- Lose weight if necessary.
- Quit smoking.
- Be more active