How Is Yale Medicines Approach To Treating Enlarged Prostate Unique
Urologists at Yale Medicine can give you a personalized approach to prostate care for both benign and malignant conditions, says Dr. Honig.
Doctors at Yale Medicine work closely with specialists across all disciplines at Yale New Haven Hospital. Our doctors are dedicated to providing the latest treatmentsall personalized to meet the needs of each patient. This collaboration between different departments and teams sets Yale Medicine apart in its standard of care.
What Should I Watch Out For
Symptoms of BPH fall into 2 categories. Those caused by pressure on your urethra are called obstructive. The others start in your bladder.
Some of the obstructive symptoms include:
- Trouble starting to urinate
- You have to stop and restart several times
- Pee dribbles out at the end
If BPH causes changes in your bladder, it may include these signs:
- You suddenly feel a strong need to urinate. Doctors call this âurgency.â
- You have to pee more than 8 times a day. This is called âfrequency.â
- Even after you go, you feel as though your bladder is not empty.
- You wake up often in the night to relieve yourself. This is called ânocturia.â
What Is Your Prostate And What Does It Do
Your prostate is a small gland that lives inside your body, just below your bladder. It sits around the urethra, which is the tube that carries pee from your bladder through your penis. Only men have a prostate.
Your prostate produces some of the fluids contained in your semen, the liquid that transports sperm. This liquid contains special enzymes and hormones that help your sperm cells function properly, which means the prostate plays a key part in your fertility. The muscles in your prostate also help push semen through your urethra when you ejaculate.
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What Medications Are Used To In The Treatment Of Bph
Several types of medications have been approved for treatment of urinary symptoms secondary to prostate enlargement. Men with severe symptoms may require treatment with a combination of these medications. Your doctor will determine the optimal combination for your condition:
Alpha-blockers, such as terazosin , prazosin , or doxazosin , relax the muscles in the prostate and thus may relieve symptoms. Newer alpha-blockers, such as tamsulosin , alfuzosin , and silodosin, are more commonly prescribed because they may have fewer side effects.
Finasteride or dutasteride can cause the prostate to shrink. As a result, the urinary symptoms may improve. These drugs are most helpful in men who have at least moderate enlargement of the prostate.
Tadalafil has recently been approved for the treatment of BPH.
Bladder calming medications that help with the symptoms related to bladder irritability from prostate blockage: oxybutynin , solifenacin , darifenacin , trospium , and mirabegron .
Once your doctor has given you a medical plan, you should stick to it and follow up as recommended. Sometimes men need follow-up with a urologist.
Medications For An Enlarged Prostate
Several drugs are FDA-approved to relieve common symptoms of an enlarged prostate. Each works differently, says Westney. They either shrink the enlarged prostate or stop the prostate cell growth, she explains. “For many men, medications are very effective,” Westney tells WebMD. “They have a significant change in symptoms, and side effects are very uncommon ⦠so medications are an attractive treatment.”
Doctors use the BPH Index to gauge how the patient responds to medication, Westney adds. “We see how symptoms are progressing ⦠if they’ve stabilized or not.”
Alpha blockers: These drugs don’t reduce the size of the prostate, but they are very effective at relieving symptoms. They work by relaxing the muscles around the prostate and bladder neck, so urine can flow more easily. These drugs work quickly, so symptoms improve within a day or two. They are most effective for men with normal to moderately enlarged prostate glands.
The drugs: Flomax , Uroxatral , Hytrin , Cardura , and Rapaflo .
Alpha blockers were originally created to treat high blood pressure dizziness is the most common side effect other side effects are generally mild and controllable. Possible side effects include headache, stomach irritation, and stuffy nose. These drugs are not for men with significant urine retention and frequent urinary tract infections.
The drugs: Proscar and Avodart .
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What The Prostate Gland Does
Deep within your groin area, a gland the size of a pingpong ball rests just below your bladder. In fact, your urethra, the small tube that carries urine from your bladder through and out of your penis, runs through the middle of your prostate gland.
If your prostate changes shape or size, it squeezes the urethra and hinders the flow of urine. Here are some of the other signs you might notice if your prostate becomes enlarged, also called benign prostatic hyperplasia .
Diagnosing Benign Prostate Enlargement
You might have several different tests to find out if you have an enlarged prostate.
A GP may do some of these tests, such as a urine test, but others might need to be done at a hospital.
Some tests may be needed to rule out other conditions that cause similar symptoms to BPE, such as prostate cancer.
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What Is Prostate Cancer
Prostate cancer is common among American men. Your chance of getting prostate cancer may be affected by your:
- Age. Men age 50 and older run a greater risk.
- Race. Prostate cancer is most common among African-American men.
- Family history. If your father or brother has had prostate cancer, you are more likely to have it, too.
- Diet. Eating high-fat food with few fruits and vegetables may raise your risk.
Treatment For Benign Prostate Hyperplasia
Treatment for benign prostate hyperplasia can involve:
- Lifestyle changes, such as limiting a night-time consumption of liquids, avoiding caffeine and alcohol, avoiding medication such as diuretics, decongestants and antihistamines and getting more exercise, as well as dietary improvements, such as eating more fibre, avoiding artificial sweeteners and sweetened beverages.
- Medication, such as alpha-blockers or 5-alpha-reductase inhibitors.
- Interventions, such as the Urolift]® system, a non-surgical proprietary device that uses tiny implants to lift the prostate away from the urethra and thereby relieve BPH symptoms that result from pressure on the urethra.
- Surgical procedures, such as a prostatectomy , transurethral microwave thermotherapy , prostate laser, and Transurethral Resection of the Prostate .
- Herbal prostate treatments, such as saw palmetto extract. Saw palmetto extract is made from the fruit of the saw palmetto, which is native to the southeast and Gulf coasts of North America and may potentially assist in reducing urinary frequency and increasing urinary flow.
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What Are The Symptoms Of Benign Prostatic Hyperplasia
Lower urinary tract symptoms suggestive of benign prostatic hyperplasia may include
- urinary frequencyurination eight or more times a day
- urinary urgencythe inability to delay urination
- trouble starting a urine stream
- a weak or an interrupted urine stream
- dribbling at the end of urination
- nocturiafrequent urination during periods of sleep
- urinary incontinencethe accidental loss of urine
- pain after ejaculation or during urination
- urine that has an unusual color or smell
Symptoms of benign prostatic hyperplasia most often come from
- a blocked urethra
- a bladder that is overworked from trying to pass urine through the blockage
The size of the prostate does not always determine the severity of the blockage or symptoms. Some men with greatly enlarged prostates have little blockage and few symptoms, while other men who have minimally enlarged prostates have greater blockage and more symptoms. Less than half of all men with benign prostatic hyperplasia have lower urinary tract symptoms.3
Do Prostatitis And Bph Cause Pain
Both BPH and prostatitis may cause pain. However, if BPH causes pain, it usually occurs with urination .
Prostatitis may cause painful urination, painful ejaculations, and generalized groin/abdominal pain. Prostatitis pain may be more constant and may be due to the inflammation of the prostatic tissue and/or adjacent tissues. Experts point out that often the source of pain from prostatitis is unclear.
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Diagnosing An Enlarged Prostate
As with all incontinence conditions, a thorough diagnosis must be developed before action can be taken. You may have heard of some of these exams. And if you havent, now is a good time to familiarize yourself with them. Not only is knowledge power, but it also eliminates surprises.
Because those with BPH can experience symptoms from mild to severe, the treatment options featured here are organized from least invasive to more intense.
If You Are Diagnosed With Bph
Taken together, these tests will help your doctor determine whether you have BPH and if you do, how severe it is. If you have BPH, your doctor should provide you with information on whether simply monitoring your symptoms is a reasonable option, or whether treatment is a better option.
BPH can be treated medically or surgically in some cases.
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When To Seek Medical Advice
See a GP if you have any of the symptoms of an enlarged prostate .
Even if the symptoms are mild, they could be caused by a condition that needs to be investigated.
Any blood in your urine must be investigated by a GP to rule out other more serious conditions.
Page last reviewed: 10 February 2020 Next review due: 10 February 2023
What An Enlarged Prostate Gland Feels Like
The symptoms that come with an enlarged prostate vary from man to man, but they usually start out mild and get worse over time. Here are a few of the signs you might notice.
- An urgent need to urinate
- Frequent need to urinate
- The need to urinate frequently through the night
- A weak urine stream
- Urination that starts and stops
- Trouble starting to urinate
- Trouble emptying your bladder completely
- Dribbling
While these are the most common signs of BPH and are more annoying than medically problematic, a few symptoms require immediate attention, including the inability to urinate and blood in your urine.
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What Are The Symptoms Of Enlarged Prostate
When the prostate becomes enlarged, it can block the urethra and impair bladder function. Symptoms that may indicate this is happening include:
- Urinating many times a day and being unable to hold off urination
- Problems starting a urine stream or a weak or interrupted stream, followed by dribbling at the end
- Waking at night to urinate and accidental loss of urine
How Is Bph Diagnosed And Evaluated
Early diagnosis of BPH is important because if left untreated it can lead to urinary tract infections, bladder or kidney damage, bladder stones and incontinence. Distinguishing BPH from more serious diseases like prostate cancer is important.
Tests vary from patient to patient, but the following are the most common:
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What Causes An Enlarged Prostate
We still dont really know all the things that cause the prostate to grow. But we do know about two risk factors that can increase your risk of having an enlarged prostate.
Age
Your risk of having an enlarged prostate increases as you get older. Many men aged 50 or over have an enlarged prostate, but they dont all get symptoms. And some men have symptoms that don’t bother them.
Hormone levels
The balance of hormones in your body changes as you get older. This may cause your prostate to grow.
Other factors
Some studies show that obese men and men who have diabetes may be more likely to develop an enlarged prostate. Regular exercise may help to reduce your risk of urinary symptoms. But we still need more studies into the causes of enlarged prostate to know for certain if, and how, we can prevent it.
There is also some research that suggests you may be more at risk of developing an enlarged prostate if your father or brother has one. Again, further studies are needed to confirm this.
Are The Treatments For Prostatitis And Bph Different
The treatment for an enlarged prostate and prostatitis are very different.
BPH treatment may include an interactive questionnaire to determine the extent of your symptoms. The results of the questionnaire may influence what medications or other treatments you may need. Drugs used to treat BPH include:
- Alpha receptor blockers
- Phosphodiesterase inhibitors
- Anticholinergic agents
Some patients with more severe prostatic enlargement may need surgery. A transurethral resection of the prostate is the usual procedure to reduce pressure on the urethra by reducing the size of the prostate.
Treatment for prostatitis depends on the type.
- Bacteria acute and chronic prostatitis are typically treated and cured with antibiotics like fluoroquinolones or trimethoprim. These infections typically take longer to cure so you may have to take antibiotics for as long as 4-8 weeks. Some infections of the prostate gland are resistant or unresponsive to treatment so antibiotics like gentamicin or doxycycline may need to be injected directly into the gland.
- Type III, chronic bacterial prostatitis and pelvic pain syndrome, is treated similarly with antibiotics, however, alpha-blockers and NSAIDs , for example, aspirin, ibuprofen , naproxen also are used.
- Type IV, asymptomatic inflammatory prostatitis, in most patients requires no treatment. However, some doctors prescribe antibiotics and NSAIDs for this condition.
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How To Tell If It Is Hemorrhoids Or Enlarged Prostate
If you have never experienced either condition then it may have difficulty when trying how to tell if it is hemorrhoids or enlarged prostate. Hemorrhoids are actually enlarged veins in the lower rectum and anus and tend to clear up after a few days. There are two types of hemorrhoids. External hemorrhoids occur outside the anal opening and internal hemorrhoids are inside the lower rectum and anus.
It is possible to have both at the same time.Though hemorrhoids do clear up after a few days the symptom can be quite disruptive and can cause bleeding and excruciating pain. Over 75% of individuals over 30 will experience hemorrhoids. However men tend to develop hemorrhoids that require medical treatment. Hemorrhoids are usually discovered as they can be felt as lumps or bleeding is noticed. An enlarged prostate occurs in men and tends to occur after the age of 40. The prostate actually surrounds the urethra which delivers urine from the bladder to the penis. An enlarged prostate tends to make urination difficult or painful.
Some common symptoms include repeated urinary tract infections, sensitive bladder, acute urinary retention, dribbling of urine, leaking urine and even kidney damage. However some men also have no symptoms with an enlarged prostate.So the two conditions hemorrhoids and an enlarged prostrate are quite different as they affect a different part of your body. Hemorrhoids can happen to anyone and occur in and outside the lower rectum and anus.
How Common Is Benign Prostatic Hyperplasia
Benign prostatic hyperplasia is the most common prostate problem for men older than age 50. In 2010, as many as 14 million men in the United States had lower urinary tract symptoms suggestive of benign prostatic hyperplasia.1 Although benign prostatic hyperplasia rarely causes symptoms before age 40, the occurrence and symptoms increase with age. Benign prostatic hyperplasia affects about 50 percent of men between the ages of 51 and 60 and up to 90 percent of men older than 80.2
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Sign : Hesitancy To Start Urinating
It sometimes happens. You go to urinate, and nothing comes out immediately. However, if it occurs regularly, something might be amiss.
When the prostate pushes too much against the urethra, the narrowed tube can prevent you from even starting. You stand there ready, yet it takes a while to get going. This is particularly frustrating if it has happened when youve urgently wanted to go.
What Else Can Cause These Symptoms
As men get older their prostate gland enlarges. It isn’t normally cancer. But instead a condition called benign prostatic hyperplasia . BPH is when the prostate gland grows and presses on the urethra. The urethra is the tube that empties out urine from the bladder.
BPH does not develop into cancer. But you can have an enlarged prostate at the same time as having areas in the prostate gland that contain cancer cells.
See your doctor if you have any of the changes described here.
The changes don’t mean that you have cancer but it is important to get them checked so your doctor can help with you cope with them.
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Treating Benign Prostate Enlargement
Treatment for an enlarged prostate is determined by the severity of your symptoms.
If you have mild to moderate symptoms, you wonât receive any immediate medical treatment, but youâll have regular check-ups to carefully monitor your prostate.
Youâll probably also be advised to make lifestyle changes, such as limiting your caffeine and alcohol intake, and exercising regularly, to see if they improve your symptoms.
As well as lifestyle changes, medication is usually recommended to treat moderate to severe symptoms of benign prostate enlargement. Finasteride and dutasteride are medications that are commonly used. They block the effects of a hormone called dihydrotestosterone on the prostate gland, which can reduce the size of the prostate and improve associated symptoms.
Alpha blockers may also be prescribed. They help to relax your bladder muscles, making it easier to pass urine. Tamsulosin and alfuzosin are two alpha blockers commonly used to treat benign prostate enlargement.
Surgery is usually only recommended for moderate to severe symptoms of benign prostate enlargement that have failed to respond to medication.
How Can I Tell The Difference Between Prostatitis And Bph
If you do not have any symptoms of BPH or any of the types of prostatitis, which can be the situation for some men, you may not be able to tell if you have either problem. However, a doctor or other health care professional can detect enlargement of the prostate with a digital rectal exam , even if you dont have any symptoms.
If you do have symptoms, they are related to the increase in size of your prostate gland. When the gland enlarges, it can constrict the urethra and produce one or more of these symptoms.
- The need to urinate frequently during the day or night
- The sudden urgent need to urinate
- Difficulty initiating urinary stream
- Feeling like you still need to urinate even though you recently urinated
- Feeling like you need to push or strain to empty your bladder
- A decrease in the force of the urine stream
- Loss of small amounts of urine
The symptoms of prostatitis depend upon the type of prostatitis.
Acute bacterial prostatitis symptoms
Asymptomatic inflammatory prostatitis
Some men may have some of these symptoms with both BPH and prostatitis. If you are over age 50, it is more likely BPH than prostatitis, and if you are under age 35, acute bacterial prostatitis is more likely than BPH. In some patients, prostatitis may be recurrent .
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