Benign Prostatic Hyperplasia (BPH)

Last Updated: August 18, 2022

Benign prostatic hyperplasia (BPH) is a condition in which the prostate gland is enlarged and not cancerous. It often leads to lower urinary tract symptoms and is very common in older men (>50 years old).

Benign Prostatic Hyperplasia (BPH) falls under theMen’s HealthandKidney & Urinary Healthcategories.

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.

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  1. ^National Institute of Diabetes and Digestive and Kidney DiseasesProstate Enlargement (Benign Prostatic Hyperplasia(2014-09)
  2. ^Chughtai B, Forde JC, Thomas DD, Laor L, Hossack T, Woo HH, Te AE, Kaplan SABenign prostatic hyperplasia.Nat Rev Dis Primers.(2016-05-05)
  3. ^The content of this page was partially adapted from MedlinePlus of the National Library of Medicine
  4. ^Lerner LB, McVary KT, Barry MJ, Bixler BR, Dahm P, Das AK, Gandhi MC, Kaplan SA, Kohler TS, Martin L, Parsons JK, Roehrborn CG, Stoffel JT, Welliver C, Wilt TJManagement of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA GUIDELINE PART I-Initial Work-up and Medical Management.J Urol.(2021-10)
  5. ^Mitsunari K, Miyata Y, Matsuo T, Mukae Y, Otsubo A, Harada J, Kondo T, Matsuda T, Ohba K, Sakai HPharmacological Effects and Potential Clinical Usefulness of Polyphenols in Benign Prostatic Hyperplasia.Molecules.(2021-Jan-16)
  6. ^Homma Y, Gotoh M, Kawauchi A, Kojima Y, Masumori N, Nagai A, Saitoh T, Sakai H, Takahashi S, Ukimura O, Yamanishi T, Yokoyama O, Yoshida M, Maeda KClinical guidelines for male lower urinary tract symptoms and benign prostatic hyperplasia.Int J Urol.(2017-10)
  7. ^Zhang W, Ma L, Bauer BA, Liu Z, Lu YAcupuncture for benign prostatic hyperplasia: A systematic review and meta-analysis.PLoS One.(2017)
  8. ^Ng M, Baradhi KMBenign Prostatic HyperplasiaStatPearls.(2022-05)
  9. ^Sanda MG, Beaty TH, Stutzman RE, Childs B, Walsh PCGenetic susceptibility of benign prostatic hyperplasia.J Urol.(1994-Jul)
  10. ^Omran A, Leca BM, Oštarijaš E, Graham N, Da Silva AS, Zaïr ZM, Miras AD, le Roux CW, Vincent RP, Cardozo L, Dimitriadis GKMetabolic syndrome is associated with prostate enlargement: a systematic review, meta-analysis, and meta-regression on patients with lower urinary tract symptom factors.Ther Adv Endocrinol Metab.(2021)
  11. ^Roehrborn CGBenign prostatic hyperplasia: an overview.Rev Urol.(2005)
  12. ^National Institute of Diabetes and Digestive and Kidney DiseasesProstate Enlargement (Benign Prostatic Hyperplasia(2014-09)
  13. ^Middleton LW, Shen Z, Varma S, Pollack AS, Gong X, Zhu S, Zhu C, Foley JW, Vennam S, Sweeney RT, Tu K, Biscocho J, Eminaga O, Nolley R, Tibshirani R, Brooks JD, West RB, Pollack JRGenomic analysis of benign prostatic hyperplasia implicates cellular re-landscaping in disease pathogenesis.JCI Insight.(2019-05-16)
  14. ^Parsons JK, Sarma AV, McVary K, Wei JTObesity and benign prostatic hyperplasia: clinical connections, emerging etiological paradigms and future directions.J Urol.(2013-Jan)
  15. ^Eschely Mampa et al.The correlation between obesity and prostate volume in patients with benign prostatic hyperplasia at Charlotte Maxeke Johannesburg Academic Hospital
  16. ^Lu Yong et al. The Effect of Weight Losing to Benign Prostate Hyperplasia Patients with Metabolic Syndrome
  17. ^Parsons JK, Im RAlcohol consumption is associated with a decreased risk of benign prostatic hyperplasia.J Urol.(2009-Oct)
  18. ^Crispo A, Talamini R, Gallus S, Negri E, Gallo A, Bosetti C, La Vecchia C, Dal Maso L, Montella MAlcohol and the risk of prostate cancer and benign prostatic hyperplasia.Urology.(2004-Oct)
  19. ^Giorgio Ivan Russo, Giuseppe Broggi, Andrea Cocci, Paolo Capogrosso, Marco Falcone, Ioannis Sokolakis, Murat Gül, Rosario Caltabiano, Marina Di MauroRelationship between Dietary Patterns with Benign Prostatic Hyperplasia and Erectile Dysfunction: A Collaborative ReviewNutrients.(2021 Nov 19)
  20. ^Jalalinia SF, Raei M, Naseri-Salahshour V, Varaei SThe Effect of Pelvic Floor Muscle Strengthening Exercise on Urinary Incontinence and Quality of Life in Patients after Prostatectomy: a Randomized Clinical Trial.J Caring Sci.(2020-Mar)
Examine Database References
  1. Benign Prostatic Hyperplasia Symptoms - Wilt T, Ishani A, Mac Donald R, Rutks I, Stark GPygeum africanum for benign prostatic hyperplasiaCochrane Database Syst Rev.(2002)
  2. 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)
  3. 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)
  4. 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)
  5. 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)
  6. 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)
  7. 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)
  8. 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)
  9. 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.()