What is BPH?
The prostate is a walnut-sized gland in the male reproductive system that sits just below the bladder and surrounds the upper part of the urethra (i.e., the tube that carries urine from the bladder) and makes fluid that is part of semen. Benign prostatic hyperplasia (BPH) is a condition in which the prostate gland is enlarged and not cancerous.[1] BPH commonly affects older men; it’s estimated that about 50% of men > 50 years of age have evidence of BPH, and the prevalence of BPH increases further with advancing age.[2]
What are the main signs and symptoms of BPH?
As the prostate gets bigger, it presses against and narrows the urethra. The bladder wall also becomes thicker, and over time, the bladder may weaken and lose the ability to fully void.[1] With that said, the correlation between prostate size and symptom severity is inconsistent; some men with substantially enlarged prostates experience few symptoms. The symptoms of BPH largely overlap with the early symptoms of prostate cancer and include:[3]
- A frequent and urgent need to urinate, especially at night
- Trouble starting a urine stream
- A weak or interrupted (i.e., stops and starts several times) urine stream
- Dribbling at the end of urination
- Incomplete urination
How is BPH diagnosed?
BPH is most often diagnosed based on the patient’s symptoms (typically assessed using the International Prostate Symptom Score questionnaire), their medical history (e.g., prior surgeries, medication use, sexual history, fluid consumption), and a digital (i.e., finger) rectal exam.[1] To differentiate BPH from other conditions that can cause lower urinary tract symptoms, a urinalysis is also commonly performed to detect material in the urine associated with metabolic disorders, renal dysfunction, or urinary tract infection.[4]
What are some of the main medical treatments for BPH?
The severity of symptoms determines the medical treatment selected. Treatment options include watchful waiting (i.e., lifestyle advice) and medications, which either relax the smooth muscles of the prostate and bladder neck to improve urine flow (i.e., alpha-blockers, phosphodiesterase-5 inhibitors) or block the conversion of testosterone to dihydrotestosterone (DHT) to prevent further enlargement of the prostate (i.e., 5-alpha reductase inhibitors). If the former treatments fail to improve symptoms, minimally invasive procedures or surgery to reduce prostate size and/or to widen the urethra may be indicated.[1]
Have any supplements been studied for BPH?
Because oxidative stress and inflammation are implicated in the development of BPH, research has mainly focused on the effect of different polyphenols (i.e., plant compounds with potent antioxidant and anti-inflammatory effects). With the exception of saw palmetto, most of the studies were conducted in rodents.[5]
How could diet affect BPH?
Obesity and metabolic-syndrome (a disorder characterized by a combination of insulin-resistance, abnormal blood lipids, high-blood-pressure, and elevated waist circumference) have been associated with an increased risk of BPH in observational studies,[2] so a healthy diet that facilitates weight loss is likely beneficial.[6] Additionally, reducing total liquid intake and the intake of caffeinated and alcoholic beverages, specifically, are commonly recommended to improve symptom management.[1]
Are there any other treatments for BPH?
Physical activity levels in accordance with the guidelines from the World Health Organization (i.e., 150–300 minutes of moderate-intensity or 75–150 minutes of vigorous-intensity aerobic exercise and two resistance exercise sessions per week) are recommended to improve cardiometabolic risk factors (e.g., high-blood-pressure, insulin-resistance) and reduce body fat, which are associated with an increased risk of BPH. Over-the-counter “decongestants" commonly used for common-cold and flu symptoms should be avoided because they can exacerbate lower urinary tract symptoms.[2] Limited evidence suggests acupuncture may also improve lower urinary tract symptoms.[7]
What causes BPH?
The precise causes of BPH are not well understood, but several factors — both modifiable and nonmodifiable — have been implicated, including hormones (i.e., dht, estrogen), genetics, dietary factors, inflammation, and oxidative stress.[8] According to some evidence, the risk of BPH is increased by four-fold in people with a first-degree relative with BPH.[9] Also, metabolic-syndrome is consistently associated with an increased risk of BPH,[10] so it may be involved in the development and progression of the condition.
Examine Database: Benign Prostatic Hyperplasia (BPH)
Research FeedRead all studies
In this randomized controlled trial in men with benign prostatic hyperplasia, supplementing with vitamin D might have improved lower urinary tract symptoms in men with low baseline serum vitamin D levels, and silymarin seemed to decrease prostate volume.
Frequently asked questions
The prostate is a walnut-sized gland in the male reproductive system that sits just below the bladder and surrounds the upper part of the urethra (i.e., the tube that carries urine from the bladder) and makes fluid that is part of semen. Benign prostatic hyperplasia (BPH) is a condition in which the prostate gland is enlarged and not cancerous.[1] BPH commonly affects older men; it’s estimated that about 50% of men > 50 years of age have evidence of BPH, and the prevalence of BPH increases further with advancing age.[2]
As the prostate gets bigger, it presses against and narrows the urethra. The bladder wall also becomes thicker, and over time, the bladder may weaken and lose the ability to fully void.[1] With that said, the correlation between prostate size and symptom severity is inconsistent; some men with substantially enlarged prostates experience few symptoms. The symptoms of BPH largely overlap with the early symptoms of prostate cancer and include:[3]
- A frequent and urgent need to urinate, especially at night
- Trouble starting a urine stream
- A weak or interrupted (i.e., stops and starts several times) urine stream
- Dribbling at the end of urination
- Incomplete urination
Aside from the main signs and symptoms, BPH does not cause other complications in most instances — which is great since it affects the majority of older men.[11] However, BPH can lead to urinary tract infections (UTIs), pain in the lower abdomen, blood in the urine or semen, bladder stones, or damage to the bladder or the kidneys. Consult a medical professional if these, or any other concerning issues come up. If left untreated, these complications can become serious.[12]
BPH and more severe conditions like prostatitis and prostate-cancer can share some symptoms. A prostate-specific antigen (PSA) test can help differentiate BPH from prostate cancer; whereas tests for the presence of an infection, another source of inflammation, or PSA can help rule out prostatitis.
BPH is most often diagnosed based on the patient’s symptoms (typically assessed using the International Prostate Symptom Score questionnaire), their medical history (e.g., prior surgeries, medication use, sexual history, fluid consumption), and a digital (i.e., finger) rectal exam.[1] To differentiate BPH from other conditions that can cause lower urinary tract symptoms, a urinalysis is also commonly performed to detect material in the urine associated with metabolic disorders, renal dysfunction, or urinary tract infection.[4]
The severity of symptoms determines the medical treatment selected. Treatment options include watchful waiting (i.e., lifestyle advice) and medications, which either relax the smooth muscles of the prostate and bladder neck to improve urine flow (i.e., alpha-blockers, phosphodiesterase-5 inhibitors) or block the conversion of testosterone to dihydrotestosterone (DHT) to prevent further enlargement of the prostate (i.e., 5-alpha reductase inhibitors). If the former treatments fail to improve symptoms, minimally invasive procedures or surgery to reduce prostate size and/or to widen the urethra may be indicated.[1]
Because oxidative stress and inflammation are implicated in the development of BPH, research has mainly focused on the effect of different polyphenols (i.e., plant compounds with potent antioxidant and anti-inflammatory effects). With the exception of saw palmetto, most of the studies were conducted in rodents.[5]
Obesity and metabolic-syndrome (a disorder characterized by a combination of insulin-resistance, abnormal blood lipids, high-blood-pressure, and elevated waist circumference) have been associated with an increased risk of BPH in observational studies,[2] so a healthy diet that facilitates weight loss is likely beneficial.[6] Additionally, reducing total liquid intake and the intake of caffeinated and alcoholic beverages, specifically, are commonly recommended to improve symptom management.[1]
Men with BPH or at risk of BPH are commonly advised to abstain from or limit their alcohol consumption for fear that it may enhance prostate growth and worsen lower-urinary-tract-symptoms. However, this advice may not be supported by the evidence. In fact, studies have suggested that men who consume alcohol may have a lower risk of BPH compared to men who do not drink.[17][18] This does not mean that you should take up drinking to prevent BPH, however, as there is no mechanistic evidence to explain how or why alcohol would reduce prostate growth.
The impact of dietary patterns on BPH is inconclusive, but the intake of certain foods has been proposed to contribute to a reduction in the risk of BPH and other prostate-related disorders. The Mediterranean diet seems to be associated with a lower risk of BPH, as does the intake of vegetables, fruits, nuts, fish, and legumes. On the other hand, a high intake of red meat and low vegetable and protein consumption have been linked to an increased risk of BPH.[19]
It should be noted that while these dietary patterns have been associated with BPH, there are a lack of randomized controlled trials looking at how the intake of specific foods affects prostate growth or BPH symptoms.
Physical activity levels in accordance with the guidelines from the World Health Organization (i.e., 150–300 minutes of moderate-intensity or 75–150 minutes of vigorous-intensity aerobic exercise and two resistance exercise sessions per week) are recommended to improve cardiometabolic risk factors (e.g., high-blood-pressure, insulin-resistance) and reduce body fat, which are associated with an increased risk of BPH. Over-the-counter “decongestants" commonly used for common-cold and flu symptoms should be avoided because they can exacerbate lower urinary tract symptoms.[2] Limited evidence suggests acupuncture may also improve lower urinary tract symptoms.[7]
Kegel exercises — which are designed to strengthen the pelvic floor muscles — are often recommended for women after childbirth but may have some utility for men experiencing symptoms of BPH. Unfortunately, Kegel exercises likely have no effect on the size and volume of the prostate, but some studies suggest that strengthening the pelvic floor muscles can improve symptoms of urinary incontinence in men following prostate surgery.[20]
Kegel exercises are simple and can be completed at home. Lie on the ground with your back and pelvis flat on the floor and knees bent and apart. Contract your pelvic floor muscles for 3 seconds, relax for 3 seconds, and repeat.
The precise causes of BPH are not well understood, but several factors — both modifiable and nonmodifiable — have been implicated, including hormones (i.e., dht, estrogen), genetics, dietary factors, inflammation, and oxidative stress.[8] According to some evidence, the risk of BPH is increased by four-fold in people with a first-degree relative with BPH.[9] Also, metabolic-syndrome is consistently associated with an increased risk of BPH,[10] so it may be involved in the development and progression of the condition.
Family history has been identified as a significant risk factor for developing BPH. The risk of BPH is increased 4-fold in men who have a relative with BPH, and this risk increases to 6-fold if their brother has BPH.[9] Recent genetic studies have identified a “genetic signature” of BPH in which two genes — BMP5 and CXCL13 — seem to play a role in the pathogenesis of BPH.[13]
There seems to be a connection between obesity and BPH, and increased body fatness is strongly correlated with prostate volume and prostate enlargement. Having overweight or obesity also increases the chances of undergoing medical treatment or surgery for BPH.[14]
The mechanisms by which obesity increases the risk of BPH have not been solidified, but may involve inflammation and oxidative stress, increased intra-abdominal pressure, microvascular dysfunction, and increased estrogen levels.[15]
Weight loss seems to improve BPH and BPH-related symptoms. In one study, prostate volume size was reduced after a 6-month weight loss intervention in men with metabolic syndrome and a clinical diagnosis of BPH.[16]
Exercise reduces the risk of BPH and a host of other diseases, but (perhaps mistakenly), bicycling has been suggested to aggravate or even cause prostate conditions — including BPH. While men with BPH may experience mild discomfort when spending too much time in the saddle, there is no evidence to suggest that riding a bike poses any risk for developing or worsening BPH. Riding with proper form and using the right gear when riding may help alleviate BPH symptoms, but again, there aren’t any studies that have investigated this topic.
References
Examine Database References
- Benign Prostatic Hyperplasia Symptoms - Wilt T, Ishani A, Mac Donald R, Rutks I, Stark GPygeum africanum for benign prostatic hyperplasiaCochrane Database Syst Rev.(2002)
- Benign Prostatic Hyperplasia Symptoms - Suter A, Saller R, Riedi E, Heinrich MImproving BPH symptoms and sexual dysfunctions with a saw palmetto preparation? Results from a pilot trialPhytother Res.(2013 Feb)
- Benign Prostatic Hyperplasia Symptoms - Bent S, Kane C, Shinohara K, Neuhaus J, Hudes ES, Goldberg H, Avins ALSaw palmetto for benign prostatic hyperplasiaN Engl J Med.(2006 Feb 9)
- Benign Prostatic Hyperplasia Symptoms - MacDonald R, Tacklind JW, Rutks I, Wilt TJSerenoa repens monotherapy for benign prostatic hyperplasia (BPH): an updated Cochrane systematic reviewBJU Int.(2012 Jun)
- Benign Prostatic Hyperplasia Symptoms - Barry MJ, Meleth S, Lee JY, Kreder KJ, Avins AL, Nickel JC, Roehrborn CG, Crawford ED, Foster HE Jr, Kaplan SA, McCullough A, Andriole GL, Naslund MJ, Williams OD, Kusek JW, Meyers CM, Betz JM, Cantor A, McVary KT, Complementary and Alternative Medicine for Urological Symptoms (CAMUS) Study GroupEffect of increasing doses of saw palmetto extract on lower urinary tract symptoms: a randomized trialJAMA.(2011 Sep 28)
- Benign Prostatic Hyperplasia Symptoms - Willetts KE, Clements MS, Champion S, Ehsman S, Eden JASerenoa repens extract for benign prostate hyperplasia: a randomized controlled trialBJU Int.(2003 Aug)
- Benign Prostatic Hyperplasia Symptoms - Bertaccini A, Giampaoli M, Cividini R, Gattoni GL, Sanseverino R, Realfonso T, Napodano G, Fandella A, Guidoni E, Prezioso D, Galasso R, Cicalese C, Scattoni V, Armenio A, Conti G, Corinti M, Spasciani R, Liguori G, Lampropoulou N, Martorana GObservational database serenoa repens (DOSSER): overview, analysis and results. A multicentric SIUrO (Italian Society of Oncological Urology) projectArch Ital Urol Androl.(2012 Sep)
- Benign Prostatic Hyperplasia Symptoms - Safarinejad MRUrtica dioica for treatment of benign prostatic hyperplasia: a prospective, randomized, double-blind, placebo-controlled, crossover studyJ Herb Pharmacother.(2005)
- Benign Prostatic Hyperplasia Symptoms - lker Durak, PhD, Erdal Yılmaz, MD, Erdinç Devrim, MD, Hakkı Perk, MD, Murat Kaçmaz, MDConsumption of aqueous garlic extract leads to significant improvement in patients with benign prostate hyperplasia and prostate cancerNutrition Research.()