Benign Prostatic Hyperplasia (BPH): Symptoms and Treatment
What is BPH | Symptoms | Causes | Diagnosis | BPH Treatments | Procedures for BPH |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.
Why do men get BPH?
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.
Can BPH be diagnosed clinically?
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 the top BPH treatments?
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. For some men, symptoms may ease. If prostate problems become bothersome, several medical and surgical treatments are available.
Which medications are used 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:
- 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. 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
- 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
- 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, or a phosphodiesterase 5 (PDE5) inhibitor and a 5-alpha-reductase inhibitor can be combined for patients who have more severe urinary symptoms and a larger prostate, or have not had success with single agents.
- Jalyn (dutasteride and tamsulosin) is a brand name 5-alpha-reductase inhibitor and alpha blocker combination. The product has been approved in generic form, too.
- Entadfi (finasteride and tadalafil), approved in Dec. 2021, is a 5-alpha-reductase inhibitor and phosphodiesterase 5 (PDE5) inhibitor combination used to treat symptoms of benign prostatic hyperplasia (BPH). A generic option for this combination is not yet available. Cialis (tadalafil) is not recommended for use in combination with alpha-blockers for the treatment of BPH.
- If preferred, these agents are available separately in generic form, which may be more cost effective. Your healthcare provider can help you determine which treatment is best for you.
How do you use Cialis for BPH?
Cialis (tadalafil), a phosphodiesterase inhibitor, is approved to treat both erectile dysfunction (ED) and the symptoms of benign prostatic hyperplasia (BPH) due to an enlarged prostate, with one daily pill. It can also be sued to treat either one individually.
What is the 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.
What is the Cialis dose for BPH and ED? The recommended dose of Cialis for BPH / ED is 5 mg, taken once daily at about the same time every day, without regard to timing of sexual activity. Do not use other ED medicines or ED treatments while taking Cialis.
- Cialis can be taken with or without food. Do not split or break Cialis tablets in half.
- Do not use this medicine if you take nitrate medicines, as it could dangerously lower your blood pressure.
- You may need a dose adjustment if you have kidney impairment.
- Do not drink too much alcohol when taking Cialis (for example, 5 glasses of wine or 5 shots of whiskey). Drinking too much alcohol can increase your chances of getting a headache or getting dizzy, increasing your heart rate, or lowering your blood pressure.
Related: Enlarged Prostate (BPH) Medications and Alcohol Interactions
Which surgical procedures work for BPH?
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. Your healthcare provider will help you decide which type of prostate procedure may work best for you.
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, or UroLift): 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.
- Water vapor therapy: In this minimally-invasive procedure, water vapor is delivered directly to the prostate, which leads to tissue destruction over a 3-month period. It is performed using a local nerve block in your doctor's office.
What kind of lifestyle changes are needed 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; consider 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.
- Ask your healthcare provider about pelvic floor muscle training.
Are there any natural treatments for BPH?
Alternative medicines for BPH are not approved by the FDA. Reliable studies with adequate evidence proving the effectiveness of natural medicines are not always available. Further clinical trials may be needed to confirm findings.
Mixed results have been seen with herbal treatments for BPH, such as:
For example, one study found that saw palmetto extract was as good as finasteride (Proscar) in relieving BPH symptoms, but other placebo-controlled studies found no evidence of this. Beta-sitosterol extracts, pygeum and rye grass have been suggested as helpful for reducing enlarged prostate symptoms. However, long-term data on safety and effectiveness is not known.
Always check with your doctor before using any herbal supplements for treatment of BPH symptoms, as products may be ineffective, lead to serious side effects, or have important drug interactions with prescription or OTC medicines.
- If you take any herbal remedies, tell your doctor. Certain herbal products might increase the risk of bleeding or interfere with other medications you're taking.
- 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 Drugs.com Drug Interactions Checker
What is the 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.
- Anticholinergic Drugs to Avoid in the Elderly
- Enlarged Prostate (BPH) Medications and Alcohol Interactions
Symptoms and treatments
Medicine.com guides (external)
- Prostate enlargement (Benign Prostatic Hyperplasia). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Accessed April 24, 2021 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 24, 2021 at https://www.icd10data.com/ICD10CM/Codes/N00-N99/N40-N53/N40-/N40.1
- Mayo Clinic. Benign prostatic hyperplasia (BPH). Accessed April 24, 2021 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 24, 2021.
- Cunningham G, O'Leary M, Givens J. Patient Education: Benign Prostatic hyperplasia (BPH). Beyond the Basics. Accessed April 19, 2019 at https://www.uptodate.com/contents/benign-prostatic-hyperplasia-bph-beyond-the-basics
- Cunningham G, O'Leary M, Givens J. Medical treatment of benign prostatic hyperplasia. Up to Date. Accessed April 24, 2021 at https://www.uptodate.com/contents/medical-treatment-of-benign-prostatic-hyperplasia
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