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Benign Prostatic Hyperplasia (BPH): Symptoms and Treatment

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on April 24, 2021.

What is BPH | Symptoms | Causes | Diagnosis | BPH Treatments | Lifestyle Changes | Natural Treatments | ICD-10 Code

What is BPH or an enlarged prostate?

Benign prostatic hyperplasia, usually abbreviated as BPH, is a male condition where the prostate gland grows larger than normal. This condition can occur as men grow older. As the prostate gland grows, it can squeeze the urethra, blocking the flow of urine and making urination difficult. Benign prostatic hyperplasia is also sometimes called benign prostatic hypertrophy.

The prostate gland is part of the male reproductive tract. It produces a fluid that mixes with sperm to make semen, and is located below the bladder, in front of the rectum, and wraps around the urethra. The urethra is the tube that carries urine through the penis and out of the body. 

What are BPH symptoms?

Men with BPH may experience these symptoms:

  • frequent need to urinate
  • feeling that the bladder is not fully emptied
  • difficulty in starting a urine stream
  • frequent nighttime urination (nocturia)
  • weak urine stream
  • blood in the urine
  • urinary tract infections

When the prostate enlarges, not all men have significant symptoms. Several different conditions can lead to symptoms comparable to an enlarged prostate, such as inflammation of the prostate (prostatitis), kidney or bladder stones, prostate cancer, or narrowing of the urethra. If you experience any of these symptoms, be sure to consult with your doctor.

BPH is not a form of prostate cancer but symptoms can be similar. Having BPH does not increase your risk for prostate cancer, but they can occur at the same time.

BPH causes

The exact causes of BPH are not fully known, but age is certainly a BPH risk factor, and hormone imbalances may also be a cause. As men age past 45 years of age, the prostate gland typically grows larger and may squeeze the urethra, blocking the flow of urine and making urination difficult. Symptoms may become bothersome enough to require treatment by the age of 60, on average.

If serious BPH is not addressed, urine may back up into the bladder and lead to urinary infections or kidney damage.

A history of a vasectomy and the frequency of sex do not increase the risk of developing BPH. 

BPH diagnosis

Your doctor will ask you questions about your symptoms, perform a physical exam, and run common lab tests to diagnose BPH or rule out other conditions.

  • Digital rectal exam - allows a physician to feel the size of the prostate to determine if it is enlarged. Your doctor may perform this during your physical exam.
  • Blood tests - A blood test that measures the prostate specific antigen (PSA) may be done. PSA is a protein produced by prostate cells. If it is elevated, you may have BPH.  Your doctor may also order blood tests to look for kidney disease.
  • Urine test - a lab test on a urine sample to rule out a bladder infection.

Other tests or a biopsy may be performed, if needed.

What are BPH treatments?

There are several options for patients who are diagnosed with an enlarged prostate and BPH.

Careful Observation

Patients with enlarged prostates but no or minimal symptoms typically do not require any treatment at all, and their symptoms can be monitored. For some men, symptoms may ease. If prostate problems become bothersome, several medical and surgical treatments are available.

Medications to treat BPH

Medications are frequently used for the treatment of symptoms of BPH. BPH drug treatment is typically long-term and continued until symptoms are no longer controlled with medications; at that time surgery may be needed.

Drug treatment combinations may also be more effective for some patients than use of a single drug.

Common medications used for treatment of BPH

Alpha-blockers: Alpha-blockers are a class of drugs considered to be first-line treatment for BPH. Alpha-blockers work by blocking the alpha-1a receptor in the prostate and the bladder. They relax the muscles of the bladder neck and prostate and allow an easier urine flow. They can work well in men with small prostates and mild to moderate symptoms.

Alpha-blockers are very effective in the treatment of BPH. Roughly 50% of men see an improvement in symptoms within the first 48 hours to one week after therapy initiation. Patients may only retain symptom relief for up to 4 years, and alpha-blockers do not shrink the prostate or slow down BPH progression. Alpha-blockers are also used to treat high blood pressure.

Alpha-blockers used in the treatment of BPH include:

Side effects that may occur with alpha-blockers include:

  • hypotension (low blood pressure), dizziness and possible fainting. You may be instructed to take your dose at bedtime due to this side effect.
  • heart fibrillation (fast heartbeats or fluttering in your chest) or chest pain
  • floppy iris syndrome (eye complication during cataract surgery)
  • abnormal ejaculation
  • penis erection that is painful or lasts 4 hours or longer (priapism)
  • fatigue or weakness
  • swelling in hands, ankles or feet
  • headache
  • nausea, upset stomach
  • allergic reactions

Alpha-blockers are usually well-tolerated by most patients. If you should experience a serious side effect, contact your doctor immediately. Also, if you are scheduled to have eye surgery while using an alpha-blocker, be sure to tell all of your doctors.

5-alpha-reductase inhibitors: 5-alpha-reductase inhibitors work by blocking dihydrotestosterone (DHT) to shrink larger prostates and increase urine flow. 5-alpha-reductase inhibitors can take 3 to 6 months to begin working, and this may be a drawback for many patients. 

5-alpha-reductase inhibitors used in the treatment of BPH include:

Side effects that may occur with 5-alpha-reductase inhibitors include:

  • allergic reactions
  • breast or high-grade prostate cancer
  • decreased sexual drive
  • abnormal ejaculation
  • impotence
  • gynecomastia (male breast enlargement)
  • dizziness or lightheadedness

These side effects do not occur frequently. In a small percentage of patients, 5-alpha-reductase inhibitors can also lead to a lowered sex drive, impotence, or depression, but these effects are reversible if these medicine is stopped. 

You should discuss the risk of these side effects with your doctor. Do not stop medications without speaking to your doctor first. If you have questions or think you have experienced a serious side effect, contact your healthcare provider or call 911.

Combination drugs for BPH

Alpha-blockers and 5-alpha-reductase inhibitors can be combined for patients who have more severe urinary symptoms and a larger prostate, and have not had success with single agents.

A combination medication, Jalyn, is available commercially, or alpha-blockers and 5-alpha-reductase inhibitors can be taken individually which may be more cost effective if generics are selected. Your healthcare provider can help you determine which treatment is best for you. Newer brands may not be covered by health insurance.

  • dutasteride and tamsulosin (Jalyn) - dutasteride, a 5-alpha-reductase inhibitor, and tamsulosin, an alpha blocker, are found in this combination treatment.

How do you use Cialis for BPH?

Cialis (tadalafil), a phosphodiesterase inhibitor, is often used to treat erectile dysfunction (ED) and is also approved to treat the symptoms of benign prostatic hyperplasia (BPH) due to an enlarged prostate. Quite often, this one drug will be prescribed to treat both BPH and ED at the same time.

  • Cialis dose for BPH - The dose of Cialis when used only for treatment of BPH is 5 mg once daily, taken at roughly the same time every day; the dose is the same when used for both BPH and ED, taken without regard for sexual activity. Do not use this medicine if you take nitrate medicines.

RelatedEnlarged Prostate (BPH) Medications and Alcohol Interactions

BPH surgery or minimally invasive treatments

Several types of procedures are available if medications are no longer effective or drug treatment is not an option. Surgical procedures, some of which may be minimally invasive, will usually improve urine flow rates and other symptoms. Examples of surgical options for an enlarged prostate include:

  • Transurethral resection of the prostate (TURP): This is a common procedure for BPH. In TURP, a telescoping instrument is inserted through the urethra to reach the prostate gland. An electrical current burns away prostate tissue and creates a larger urethral passage for urine. This surgery takes roughly 1 to 2 hours, and may require an overnight stay. General or spinal anesthesia is typically used.
  • Prostatic urethral lift (PUL): Stitches (sutures) or a device are added to lift the side of the prostate away from the urethra to improve urine flow. This minimally-invasive procedure may have a smaller effect on sexual dysfunction than TURP. A local anesthetic is typically used.
  • Transurethral incision of the prostate (TUIP): This procedure is used in men with smaller prostates. In this procedure, a telescoping instrument is inserted through the urethra to reach the prostate gland, as with TURP. A small cut is made in the bladder opening rather than in the prostate gland to widen the urethra opening. No overnight hospital stay is required.
  • Transurethral microwave thermotherapy (TUMT): Microwave heat is used to destroy extra tissue on the prostate. This procedure does not require an overnight stay, and although it is a less-invasive procedure, men may need surgery again after five or ten years. It helps to improve symptoms of urgency and slow urine flow.
  • BPH laser surgery: During laser surgery for an enlarged prostate the surgeon removes excessive prostate tissue using ultrasound imaging and a laser beam. Laser surgery can relieve symptoms right away and may be a safer option for some high risk patients, for example, those who take blood thinners. 
  • Prostatectomy: This is a surgical procedure for more complicated cases and may be robot-assisted. The inside of the prostate gland is removed through an incision through the lower abdomen. General or spinal anesthesia is required, and the surgery may take 2 to 4 hours. You may require a few days in the hospital, and your activities will be limited for several weeks. Recovery can be quicker with robot-assisted procedures.

Lifestyle changes for BPH

  • Limit the amount of fluids you drink in the evening, 1 to 2 hours before bed, to help avoid frequent nighttime urination.
  • Urinate when you need to and schedule regular bathroom breaks; double voiding (empty bladder, wait a few minutes, then empty again).
  • Limit caffeine and alcohol, which can worsen symptoms.
  • Lose weight if needed, and exercise daily. Obesity is associated with BPH.
  • Avoid drugs that have "anticholinergic" properties, such as decongestants (pseudoephedrine or phenylephrine), or first generation antihistamines like diphenhydramine (Benadryl). These drugs may prevent muscle relaxation in the prostate, worsen urinary symptoms, and can make it harder to urinate.
  • Stay warm: Cold temperatures can cause you to retain urine and increase frequent urination.
  • Pelvic floor muscle training

Natural BPH treatment

Alternative medicines for BPH are not approved by the FDA. Reliable studies proving effectiveness are not always available. Mixed results have been seen with herbal treatments for BPH, such as:

Always check with your doctor before using any herbal supplements for treatment of BPH, as products may be ineffective, lead to serious side effects, or have drug interactions.

When you start or stop prescription or over-the-counter medicines, be sure to tell your doctors, pharmacists or other healthcare providers, so a drug interaction screen can be checked. This includes vitamins and herbal products, too.

Related: Use the Drug Interactions Checker

ICD 10 Code for BPH

N40.1 is the BPH ICD 10 code (Benign prostatic hyperplasia (BPH) with lower urinary tract symptoms).

What is ICD 10?

ICD-10 is an abbreviation for International Statistical Classification of Diseases and Related Health Problems, 10th Revision. ICD 10 codes are published and updated by the World Health Organization (WHO). These codes are used by health care providers, Medicare and health insurance for reimbursement for specific medical conditions. Government, public health agencies, and research groups may also use these numbers to identify diseases and track statistics.

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Further information

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