Aug 17, 2021 1:00 PM

Sometime in your 40s or 50s, you might notice that you wake up a lot more at night to go to the bathroom. It’s something that happens to men when their prostate enlarges. And according to experts, like University of Utah Health urologist Stephen Summers, MD, it’s not a problem that goes away on its own. It's largely genetic.

About 50 percent of men have significant BPH symptoms by age 50.

Stephen Summers, MD

Benign prostatic hyperplasia (BPH) is the medical term for when the prostate gland grows inward, pinches the urethra, and obstructs the urinary system. There’s no one cause for BPH, but Summers says you’re more likely to have the problem if your father or brothers do.

Other contributing factors include obesity, high blood sugar, and high intake of caffeine and alcohol which can irritate the bladder.

BPH is Common Among Men

Urinary health in men is an issue worth attention. About 50 percent of men have significant BPH symptoms by age 50, and it increases with each decade of life. Summers says some men even experience symptoms in their 30s. Those symptoms include:

  • A slow stream of urine
  • Starting and stopping while urinating
  • Inability to empty your bladder completely
  • Bladder irritation or discomfort
  • Feeling an urgency to urinate
  • Waking up multiple times at night to urinate
  • Urinary incontinence (an inability to control your bladder)

Urinary health is something some men find difficult to talk about. “A lot of patients have that concern, that this is something private," says Summers. “But it's something very regular that we see all the time.”

BPH Treatment Options

Treatment with medications can give you a 25 to 30 percent reduction in prostate volume, but they’re slow to work, and some are associated with erectile dysfunction (ED). On the flip side, one of the most common surgical procedures called Urolift offers immediate relief, and it’s done in office.  

It's kind of like you're in a mine shaft, and it's collapsing, so you're putting up struts to support it.

Stephen Summers, MD

A typical range of BPH treatment options includes:

  • Lifestyle changes including weight and blood sugar management, reducing alcohol and caffeine intake, and urinating at regular intervals.
  • Flomax or Tamsulosin alpha blockers that relax smooth muscle (first line therapy).
  • Dutastaride or Finasteride block the effects of testosterone to limit prostate growth (second line therapy).
  • Cialis Phosphodiesterase inhibitors are approved to treat both ED and BPH (third line therapy).
  • Urolift surgery is a small implant that holds back prostate tissue.
  • Rezum procedure is steam or water vapor targeted to kill prostate cells.

There are also multiple BPH surgery types, which the patient should discuss with their provider, and determine what options they're a candidate for.

“Most patients would prefer to trial medications before moving on to surgery,” says Summers. “But there are some that don't want to take a pill the rest of their life and rather move right on to surgery.’”

BPH’s Relation to Prostate Cancer

Summers says BPH is not a precursor to prostate cancer, though his patients often worry about that. “Prostate cancer may have no symptoms at all, but we do screening for prostate cancer during any workup for BPH,” he says. Part of that cancer screening is checking prostate specific antigen (PSA) levels. Of note, both prostate cancer and BPH can cause an elevated PSA. 

When to Seek Help

Seek treatment when symptoms arise. When you work harder to push urine out, you're putting pressure on your bladder. This may lead to bladder abnormalities or other issues. “It's better to intervene earlier," Summers says. "If you delay too long, your bladder undergoes irreversible changes. Patients can end up in renal failure because they've neglected their urinary symptoms. That's one reason to stay on top of this.”

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