Benign Prostatic Hyperplasia (BPH): Causes, Symptoms, Diagnosis, and Treatment

Evidence Based Article 📄
This article has been based on relevant and up-to-date scientific studies. Our writers are unbiased and objective and present the facts as they are known. Numbers in brackets within the article refer to sources included in the reference list at the end of the article.

Benign prostatic hyperplasia (BPH) is an enlargement of the prostate that happens when the cells of the prostate gland start to multiply.

The majority of men start suffering from prostate gland enlargement after their 50s due to the changes in hormonal balance.

In rare cases, men begin to notice the symptoms of BPH in their early 30s.

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BPH has nothing to do with prostate cancer and it doesn’t trigger cancer at all. Prostate cancer grows on the outer part of the prostate and it tends to grow outward, while the prostate tissue growth related to BPH focuses around the inner prostate – a ring of the tissue around the urethra – and keeps growing inward.

However, BPH does require serious medical treatment and lifestyle changes. Below are the symptoms, causes, and treatments of an enlargement of the prostate to help you detect the problem as early as possible.

What are the major causes of BPH?

The causes of BPH are still not clear and a growing number of studies have been conducted to figure out the triggers.

Many researchers believe that androgens, including testosterone and other related hormones, play an important role in the development and growth of BPH.

Although experts haven’t proved that androgens directly cause the condition, they suppose the hormones can trigger an enlargement of the prostate.

Age is the most critical factor and most experts call BPH an age-related condition. They believe that a development of BPH is a consequence of fibrosis and/or weakening of the prostate’s muscular tissue.

Men who have had one or both testicles removed when they were young have a lower or no risk of developing BPH. The family history of any prostate issues or/and abnormalities with the testicles may increase your risk of benign prostatic hyperplasia.

Diet can also trigger the development of BPH, albeit more research is required to confirm this fact. Experts believe that consuming too much of protein, particularly animal sources, can cause a development of BPH.

Excess alcohol consumption can also be a great factor. Moreover, there’s epidemiological evidence that links an enlargement of the prostate with a metabolic syndrome (obesity, diabetes and impaired glucose metabolism, high levels of low-density cholesterol, high triglyceride levels, and high blood pressure.)

To sum up, the main risk factors are:

  • Sedentary lifestyle and unhealthy eating.
  • Heart disease and diabetes. The usage of beta blockers can boost the risk of BPH.
  • Men over 60-80 years old are more likely to experience the symptoms of BPH than those under 40 years old.
  • Family history. If a father or brothers have or had prostate problems, you’re at risk as well.

What are the major symptoms of BPH?

The severity of BPH symptoms varies and it depends on how healthy you are, but the symptoms can worsen over time, especially if you don’t treat them.

The prostate’s size doesn’t necessarily identify the severity of BPH symptoms. Men with a slightly enlarged prostate can experience more severe symptoms than those with a highly enlarged prostate and otherwise.

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In some men, the symptoms might stabilize over time if men stick to a healthy lifestyle. The most common symptoms of BPH are:

  • Difficulty to fully empty the bladder;
  • Dribbling at the end of urination;
  • A stream that stops and begins or completely weak urine stream;
  • Difficulty or inability to start urination;
  • Nocturia or an increased frequency of urination during the nighttime;
  • Urgent or frequent need to urinate;
  • Blood in the urine;
  • Urinary tract infection;
  • Painful urination;
  • Leakage of urine.

However, these symptoms are very similar to those of UTIs, bladder cancer, prostate cancer, kidney or bladder stones, scarring in the bladder neck, urethral stricture or narrowing of the urethra, and prostatitis or inflammation of the prostate. That’s why it’s vital to consult a doctor who will make the correct diagnosis.

How’s BPH diagnosed?

The physical exam is required at first and includes a rectal examination, which helps your doctor to determine the shape and size of your prostate. Depending on these two factors, you may need to do the following tests:

  • PSA test: The prostate specific antigen blood test that checks for a cancer risk of the prostate.
  • Urodynamic test. This is a measurement of the pressure of the bladder during urination by filling it with liquid via a catheter.
  • Prostatic biopsy. This test is rare and involves a removal of a little amount of prostate tissue for detecting any abnormalities.
  • The most common test that involves checking your urine for bacteria and blood.
  • Urography or intravenous pyelography. This is a CT scan or X-ray exam done after injecting a dye into the body. This special dye helps to highlight the whole urinary system on the images done by the CT or X-ray.
  • The full examination of both bladder and urethra with a help of a little lighted scope that’s inserted into the urethra.
  • Post-void residual. It helps to determine the amount of urine that remained in the bladder after urination.

If you take any medications, such as sedatives, antihistamines, diuretics, or antidepressants, let your doctor know since they can affect the urinary system.

What are the complications of BPH?

If left untreated, BPH might cause the following complications:

  • Kidney damage. The pressure from urinary retention in the bladder can negatively affect the kidneys and/or let bladder infections reach them.
  • Bladder damage. A regularly half emptied bladder can gradually stretch and weaken. This can lead to the poor contraction of the muscular wall of the bladder, making it difficult to completely empty the bladder.
  • Bladder stones. An inability to fully empty the bladder can cause the bladder stone formation. Bladder stones trigger bladder irritation, infections, obstruction of urine flow, or/and blood in the urine.
  • Urinary tract infections. Inability or difficulty to empty the bladder boosts your risk of infections in your urinary tract. When you don’t treat it properly, a surgery might be needed in order to remove a part of the prostate and ease the symptoms.
  • Urinary retention. It involves a frequent usage of the catheter to drain the urine. Sometimes, a surgery is required to fix the problem.
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How to treat BPH

Just like with any health issue, there are two ways to treat BPH – with a help of medications and natural remedies. In severe cases, a surgery may needed. The treatment of BPH is usually started with lifestyle, diet, and habit changes that can fix the early signs of BPH. These are:

1.Saw palmetto

Perhaps, the most popular herbal treatment of BPH, saw palmetto has been proven to treat the majority of prostate problems, including an enlargement of the prostate.

Men who have the feelings of needing to urinate several times per hour or who have weak urine flow can reap some powerful benefits from this herb. Talk to your doctor about saw palmetto supplementation before taking any.

2.Boost zinc intake

Apart from boasting powerful immune strengthening properties, zinc is found in the prostate’s cells where it plays a strongly protective role in reducing inflammation.

Consuming foods rich in this essential trace mineral, such as cashews, yogurt, and beans, can fight inflammation and relieve the symptoms of BPH. The zinc supplementation is possible too, but only an expert can determine your daily dosage.

3.Kegel exercises

Women perform kegel exercises in order to strengthen pelvic, and men can do it too. Kegel exercises have recently been shown to help relieve some symptoms of BPH.

After emptying your bladder, lie on the floor mat with your knees apart and bent. Start with tightening your pelvic muscles for a count of 5, and relaxing for a count of 5 to 8. Perform this exercise 10 to 20 times at least 3 times each day.

4.Resistance and aerobic exercises

Even a few minutes of daily exercise, such as weight training, swimming, calisthenics, or walking, can help you relieve the urinary issues caused by BPH.

If you can’t do it each day, aim to exercise 20 to 30 minutes two times per week. Doing aerobic exercises like dancing or jogging 5 days per week can significantly improve your men’s health as well.

5.Reconsider your diet

Sticking to a healthy diet, especially a meat-free one, has been proven to reduce and control the symptoms of BPH.

Incorporate more vegetables, especially cauliflower, broccoli, red bell peppers, kale, and Brussels sprouts into your daily meal plan, reduce your meat consumption or try going vegan, avoid caffeine and alcohol, consume healthy fats (avocado, fish, nuts, etc.) and add some soy based products to your weekly meal plan.

Moreover, munch on tomatoes, which are an excellent source of lycopene, a powerful antioxidant that can help to decrease the level of a prostate specific antigen that is guilty of inflammation in the prostate. Regular tomato consumption has been proven to reduce the bladder pressure, warding off the prostate.


Quercetin is a potent flavonoid abundantly found in capers, onions, apples, and many other veggies.

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This flavonoid helps to suppress the growth of prostate cancer cells and is good for men with chronic prostatitis.

7.Sitz bath

When it comes to treating an enlarged prostate in a natural way, a sitz bath can’t be missed.

The warm bath aids in relaxing the pelvic muscles and promoting the healing while the cold bath aids in relieving the pain and reducing the swelling. Add half a cup of Epsom salt to the bathtub filled with warm water.

Take another container, preferably a baby’s bathtub if you have, and fill it with cold water. Add 2 to 3 drops of organic lavender essential oil to it. Sit in the warm water for 3 minutes and then in the cold water for a minute. Repeat 2 to 3 times, ending with cold water. Do it 3 to 4 times a week to reduce the BPH symptoms.

When natural treatments don’t help, a doctor may prescribe certain medications that help both relieve the symptoms of BPH and treat it itself. The most widely used medications are:

  • They’re prescribed to treat chronically inflamed prostate. Antibiotics help to treat bacterial prostatitis by combating chronic inflammation.
  • Hormone reduction medications. Finasteride and dutasteride are usually prescribed to decrease the hormone levels produced by the prostate gland. Oftentimes, reducing the testosterone levels helps to reduce the size of the prostate and improve the urine flow. Low sex drive is the biggest drawback, though.
  • Alpha-1 blockers. These ones help to relax the muscles of the prostate and bladder, making it easy for urine to flow. Tamsulosin, terazosin, alfuzosin, prazosin, and doxazosin are commonly used alpha-1 blockers.

When medications aren’t effective, surgery might be required. There are several kinds of surgical procedures that help to treat BPH. Some of them are:

  • Outpatient procedures. They involve inserting a special instrument into the prostate gland and urethra. These procedures include high-intensity focused ultrasonography, water-induced thermotherapy, transurethral microwave therapy, and transurethral needle ablation.
  • Inpatient procedures. If you regularly see the blood in the urine, you can’t empty the bladder, or you have urine incontinence, recurrent urinary tract infections, bladder stones, or kidney failure, you might urgently need inpatient procedures. They include transurethral incision of the prostate, simple prostatectomy, and transurethral resection of the prostate.

Benign prostatic hyperplasia doesn’t always require surgery or harsh medical treatment. So, never take any supplements or medications without your doctor’s permission. Oftentimes, it’s enough to change your lifestyle habits, especially the way you eat.

However, it’s crucial to visit your doctor regularly and prevent the symptoms of BPH as earlier as possible in order to avoid the complications and surgical procedures. The regular doctor checkups will help you monitor the size of your prostate and the progress of your symptoms. And remember, it’s best to prevent BPH by living a healthy life than treat it with medications and surgery that have more side effects than benefits.