• Home

Home > Medical Reference > Encyclopedia (English)

Toggle: English / Spanish

Enlarged prostate

• Overview
• Symptoms
• Treatment

Alternative Names:

BPH; Benign prostatic hypertrophy (hyperplasia); Prostate - enlarged

Treatment:

The choice of a treatment is based on the severity of your symptoms, the extent to which they affect your daily life, and the presence of any other medical conditions. Treatment options include "watchful waiting," lifestyle changes, medication, or surgery.

If you are over 60, you are more likely to have symptoms. But many men with an enlarged prostate have only minor symptoms. Self-care steps are often enough to make you feel better.

If you have BPH, you should have a yearly exam to monitor the progression of your symptoms and determine if any changes in treatment are necessary.

SELF-CARE

For mild symptoms:

• Urinate when you first get the urge. Also, go to the bathroom when you have the chance, even if you don't feel a need to urinate.
• Avoid alcohol and caffeine, especially after dinner.
• Don't drink a lot of fluid all at once. Spread out fluids throughout the day. Avoid drinking fluids within 2 hours of bedtime.
• Try NOT to take over-the-counter cold and sinus medications that contain decongestants or antihistamines. These medications can increase BPH symptoms.
• Keep warm and exercise regularly. Cold weather and lack of physical activity may worsen symptoms.
• Learn and perform Kegel exercises (pelvic strengthening exercises).
• Reduce stress. Nervousness and tension can lead to more frequent urination.

MEDICATIONS

• Finasteride lowers levels of hormones produced by the prostate, reduces the size of the prostate gland, increases urine flow rate, and decreases symptoms of BPH. It may take 3 to 6 months before you notice a significant improvement in your symptoms. Potential side effects related to use of finasteride include decreased sex drive and impotence .
• Alpha 1-Blockers (doxazosin, prazosin, tamsulosin, and terazosin) are a class of medications also used to treat high blood pressure. These medications relax the muscles of the bladder neck, allowing easier urination. Two thirds of the people treated with alpha 1-blocker medications report an improvement in symptoms.
• Antibiotics may be prescribed to treat chronic prostatitis (inflammation of the prostate), which may accompany BPH. Some men note relief of their BPH symptoms after a course of antibiotics.

SAW PALMETTO

Saw palmetto has been used by millions of men to ease BPH symptoms and is often recommended as an alternative to medication. Experts suggest a fat-soluble saw palmetto extract with 85-95% fatty acids and sterols. However, a well-conducted study published in the February 9, 2006 edition of the New England Journal of Medicine found that the popular herb was no better than a dummy pill in relieving the signs and symptoms of BPH. Further studies are needed. If you use saw palmetto and think it works, ask your doctor if you should still take it.

SURGERY

Prostate surgery may be recommended if you have:

• Incontinence
• Recurrent blood in the urine
• Urinary retention
• Recurrent urinary tract infections

The choice of a specific surgical procedure is usually based on the severity of your symptoms and the size and shape of your prostate gland.

• Transurethral resection of the prostate (TURP): This is the most common surgical treatment for BPH. The TURP is performed by inserting a scope through the penis and removing the prostate piece by piece.
• Transurethral incision of the prostate (TUIP): This procedure is similar to TURP, but is usually performed in men who have a relatively small prostate. This procedure is usually performed as an outpatient without need for a hospital stay. Like the TURP, a scope is inserted through the penis until the prostate is reached. Then, rather than removal of the prostate, a small incision is made in the prostatic tissue to enlarge the opening of the urethra and bladder outlet.
• Open Prostatectomy: An open prostatectomy is usually performed using general or spinal anesthesia. An incision is made through the abdomen or perineal area (i.e., through the pelvic floor, including the region from the scrotum to the anus). Then, the prostate is removed. This is a lengthy procedure, and it usually requires a hospital stay of 5 to 10 days.

The majority of men who have prostate surgery have improvement in urine flow rates and symptoms. Possible complications include impotence, urinary incontinence, retrograde ejaculation (semen flowing back into the bladder rather than out the penis), infertility, and urethral stricture (narrowing). Rates of these complications vary, depending on the surgical procedure that you and your doctor decide is best.

Various other procedures are available, such as those that destroy prostate tissue with heat generated by microwaves or lasers. Photoselective vaporization of the prostate (PVP), one of the newer laser technologies, is typically done as an outpatient procedure. The patient goes home on the same day. However, there is no long-term data for this procedure.

Robot-guided prostatectomy is another newer technique. However, the technology is not widely available, and surgeon experience should be taken into consideration. In addition, there are no long-term studies of this surgery.

Another form of treatment is prostatic stents .

For more information, see prostate surgery .

Support Groups:

Several national groups provide information on BPH. See BPH support groups .

Complications:

Men who have had long-standing BPH with a gradual increase in symptoms may develop:

• Sudden inability to urinate
• Urinary tract infections
• Urinary stones
• Damage to the kidneys
• Blood in the urine

Even after surgical treatment, a recurrence of BPH may develop over time.

Calling your health care provider:

Call your doctor right away if you have:

• Less urine than usual
• Fever or chills
• Back, side, or abdominal pain
• Blood or pus in your urine

Also call your doctor if:

• Your bladder does not feel completely empty after you urinate
• You take medications that may cause urinary problems, like diuretics, antihistamines, antidepressants, or sedatives. DO NOT stop or adjust your medications on your own without talking to your doctor
• You have taken self-care measures for 2 months without relief

References:

Hormone Foundation. Hormones & you. Patient information page. Benign prostatic hyperplasia (enlarged prostate). J Clin Endocrinol Metab . 2005; 90(10):2.

AUA Practice Guidelines Committee. AUA guideline on management of benign prostatic hyperplasia (2003). Chapter 1: Diagnosis and treatment recommendations. J Urol . 2003 Aug; 170:530-47.

Bent S, Kane C, Shinohara K, et. al. Saw Palmetto for Benign Prostatic Hyperplasia. NEJM . 2006; 354:557-566.

• Review Date: 2/9/2006
• Reviewed By: David R. Knowles, M.D., Advanced Urologic Surgeons, Mt. Vernon, IL. Reviewprovided by VeriMed Healthcare Network.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is the first of its kind, requiring compliance with 53 standards of quality and accountability, verified by independent audit. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial process . A.D.A.M. is also a founding member of Hi-Ethics (www.hiethics.com) and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 1997-2007 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.