BPH: Symptoms, Diagnosis & Prevention!

Benign prostatic hyperplasia (BPH), also called prostate enlargement, is a noncancerous increase in size of the prostate gland. It is more frequently associated with older men.



  • Frequent urination
  • Nocturia i.e. waking up at night once or more to urinate.
  • Involuntary urination
  • Urinary urgency i.e. an immediate unstoppable urge to urinate, due to a sudden involuntary contraction of the muscular wall of the bladder.
  • Urge incontinence (urine leak following a strong sudden need to urinate)
  • Urinary hesitancy (a delay between trying to urinate and the flow actually beginning)
  • Involuntary interruption of voiding
  • Weak urinary stream
  • Straining to void, a sensation of incomplete emptying.
  • Uncontrollable leaking after the end of urination
  • Dysuria i.e. bladder pain or pain while urinating.


  • Urinary retention
  • Urinary tract infection
  • Bladder stones
  • Obstruction of the bladder
  • Damage to the bladder & its ducts
  • Kidney damage


Hormonal Causes

  • Androgens play a permissive role in the development of BPH.
  • As aging in men occurs enzymes like aromatase & 5-alpha reductase convert androgens to estrogen & DHT, due to an increased activity.
  • Increase in DHT is a contributing factor for prostate growth.

Diet & metabolic factors

  • Obesity
  • Impaired glucose metabolism/diabetes
  • High level of LDL
  • Hypertension.

Other factors

  • Fibrosis/Scarring & weakening of the muscular tissue of the prostate which is responsible for functionality of the prostate.
  • The muscle provides force & contraction for excretion of fluid.
  • Increasing age.


The clinical diagnosis of BPH is based on

  1. Digital rectal exam: The size of the prostate is checked manually by the doctor, the physical exam is also done to rule out prostate cancer.
  2. Urine Analysis: For detection of sugar level, protein level or any presence of infection causing agents.
  3. Blood test: Kidney function test for evaluation of kidney damage if any & detection of prostate cancer.
  4. Prostate-specific antigen (PSA) blood test: PSA is a substance produced in your prostate. PSA levels increase when you have an enlarged prostate, and it may indicate BPH. 
  5. Ultrasound of the prostate, testes, bladder & kidneys.
  6. Cystourethroscopy, a camera is used for examination of the prostate.



  • Various drugs that lead to urinary retention & should be avoided are, anticholinergics, antihistamines, decongestants, opioid drugs & TCA antidepressants on medical advise.
  • Voiding position when urinating may influence urinary flow rate.
  • Some drugs used for treatment & management of BPH are:
  1. Alpha blockers. Examples: Alfuzosin, doxazosin, silodosin. 
  2. 5α-Reductase inhibitors. Examples: Finasteride and dutasteride. 
  3. Phosphodiesterase-5 inhibitors like tadalafil 5mg. 
  4. Antimuscarinic drugs. 
  • Surgical methods:
  1. Transurethral resection of the prostate (TURP) 
  2. Open prostatectomy 
  3. Transurethral incision of the prostate (TUIP) 
  4. Photoselective (laser) vaporization of the prostate (PVP) 
  5. Prostatic artery embolization (PAE) 
  6. Transurethral microwave thermotherapy (TUMT)


  • Inhibition in alcohol intake
  • Cessation of smoking
  • Lower fluid intake before going to bed at night
  • Exercise
  • Low sodium diet
  • Low sugar diet
  • Less consumption of caffeine
  • Management of underlying conditions like hypertension & diabetes.