Benign Prostatic Hypertrophy (BPH): Symptoms and Treatment
Medically reviewed by L. Anderson, PharmD Last updated on Apr 23, 2019.
Benign prostatic hypertrophy, usually abbreviated as BPH, is a male condition where the prostate gland grows larger than normal. This condition can occur as men grow older. 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. As the prostate gland grows, it can squeeze the urethra, blocking the flow of urine and making urination difficult.
Men 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. BPH is not a form of prostate cancer but symptoms can be similar. 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.
The exact causes of BPH are not fully known. Age is certainly a BPH risk factor, and hormone imbalances may 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.
Your doctor will ask you questions about your symptoms, perform a physical exam, and run possible lab tests to diagnose BPH or rule out other conditions.
- Blood tests - A blood test that measures the prostate specific antigen (PSA), or a PSA test, may be done; if it is elevated, you may have BPH. Your doctor may also order blood tests to look for kidney disease.
- 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.
- Urine test - a lab test on a urine sample to rule out any infection.
- Cytoscopy - a cytoscope is a long tube, with a camera and a light, that allows a physician to see inside your bladder. The cytoscope is inserted through the urethra. A picture of the prostate or a tissue sample can be collected, if needed.
- Transrectal ultrasound (TRUS) - a probe is inserted in the rectum to look at the prostate, and a video image will appear on a monitor. A TRUS is painless but may be uncomfortable.
- Urinary void records - to measure urine flow, amount of bladder emptying, or to keep track of your urine output at night
- Biopsy - a piece of prostate tissue may be collected for lab testing. This may be done with the guidance of a TRUS.
There are several options for patients who are diagnosed with an enlarged prostate and BPH.
Patients with enlarged prostates but no or minimal symptoms typically do not require any treatment at all, and their symptoms can be monitored. However, if prostate problems become bothersome and affect quality of lifestyle, several medical and surgical treatments are available.
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 BPH 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 for BPH work by blocking the alpha-1a receptor in the prostate and the bladder. Alpha-blockers relax the muscles of the bladder neck and prostate and allow an easier urine flow.
Alpha-blockers are very effective in the treatment of BPH; roughly 50 percent of men see an improvement in symptoms within the first 48 hours to one week after therapy initiation. However, 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.
Examples of alpha-blockers used in the treatment of BPH include:
- Terazosin (Hytrin)
- Doxazosin (Cardura, Cardura XL)
- Alfuzosin (Uroxatral)
- Tamsulosin (Flomax)
- Silodosin (Rapaflo)
Side effects that may occur with alpha-blockers include:
- hypotension (low blood pressure), dizziness and possible fainting (terazosin and doxazosin, first dose 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
- 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 are another class of drugs that are used to treat an enlarged prostate and BPH. 5-alpha-reductase inhibitors work by blocking dihydrotestosterone to shrink the prostate and increase urine flow. 5-alpha-reductase inhibitors can take three to six months to begin working, and this may be a drawback for many patients. In a small percentage (4%) of patients, 5-alpha-reductase inhibitors can also lead to impotence. Common examples of 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
- gynecomastia (male breast enlargement)
- dizziness or lightheadedness
These side effects do not occur frequently. You should discuss the risk of these side effects with your doctor. If you have questions or think you have experienced a serious side effect, contact your doctor immediately.
Combination Drugs for BPH
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 your circumstance.
Cialis for BPH
Cialis (tadalafil) is often used to treat erectile dysfunction (ED) and is also approved to treat the symptoms of benign prostatic hypertrophy (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 Dosage 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.
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 the most 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 one to two hours, and may require an overnight stay. General or spinal anesthesia is typically used.
- Prostatic urethral lift (PUL): Stitches (sutures) 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.
- Simple prostatectomy: This is a major 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 two to four hours. You may require a few days in the hospital, and your activities will be limited for several weeks.
- BPH laser surgery: Laser surgery for an enlarged prostate is called Transurethral ultrasound-guided laser-induced prostatectomy (TULIP). During this procedure, the surgeon removes excessive prostate tissue using ultrasound imaging and a laser beam. A telescope may be used instead of ultrasound and is known as visualized laser assisted prostatectomy (VLAP).
- 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.
- Avoid caffeine and alcohol, which can worsen symptoms.
- Lose weight if needed, and exercise daily.
- Avoid drugs that have "anticholinergic" properties, such as decongestants like pseudoephedrine or phenylephrine, or first generation antihistamines like diphenhydramine (Benadryl). These drugs may prevent muscle relaxation in the prostate, worsen urinary symptoms, and lead to urinary retention.
Alternative medicines for BPH are not approved by the FDA and robust studies proving effectiveness may be lacking. 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.
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.
- Prostate enlargement (Benign Prostatic Hyperplasia). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Accessed April 23, 2019 at https://www.niddk.nih.gov/health-information/urologic-diseases/prostate-problems/prostate-enlargement-benign-prostatic-hyperplasia
- ICD-10 Data. 2019 ICD-10-CM Diagnosis Code N40.1. Benign prostatic hyperplasia with lower urinary tract symptoms. Accessed April 21, 2019 at https://www.icd10data.com/ICD10CM/Codes/N00-N99/N40-N53/N40-/N40.1
- Mayo Clinic. Benign prostatic hyperplasia (BPH). Accessed April 23, 2019 at https://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/symptoms-causes/syc-20370087
- Magistro G, et al. Emerging minimally invasive treatment options for male lower urinary tract symptoms. European Urology. 2017;72:986-97. Accessed April 22, 2019 at https://misuse.ncbi.nlm.nih.gov/error/abuse.shtml
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- Cunningham G, O'Leary M, Givens J. Medical treatment of benign prostatic hyperplasia. Up to Date. Accessed April 23, 2019 at https://www.uptodate.com/contents/medical-treatment-of-benign-prostatic-hyperplasia
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