Benign Prostatic Hyperplasia: Treatment Options

benign prostatic hyperplasia

Benign prostatic hyperplasia is a progressive condition in aging men and if treatment is not received, the symptoms may grow worse over time, leading to urologic problems like increased frequency of urination, nocturia, urgency, hesitancy and weak urine stream. Timely recognizing and addressing those symptoms can help avoid problems and complications later.

A wide variety of treatment options are available for enlarged prostate depending on its size, discomfort it brings, the age and overall health of the patient. Recent advances include:

Watchful waiting

If symptoms are not too bothersome, it is possible to start treatment with lifestyle changes, such as becoming more physically active; drinking less liquids before bedtime and consuming less caffeinated and alcoholic drinks in general; learning about BPH treatment but taking no further action until symptoms change. However it is necessary to watch for:

  • Needing to urinate more often
  • Urgent need to urinate
  • Trouble starting urination
  • Weak stream or dribbling at the end of urination
  • Urine leakage
  • Feeling the bladder is full after voiding.

Some men remain at this level of prostate health care for a rather long period of time and even report their mild symptoms ease with watchful waiting. Nevertheless it is necessary to see urologist once a year or sooner if symptoms start to change or worsen.

Medical treatment

If symptoms change for the worse or are initially moderate to severe, active treatment is necessary. Medical BPH treatment options include:

  • Alpha blockers, which help the muscles of the prostate and bladder neck relax and thus alleviate urinary problems, making urination easier.
  • 5-alpha reductase inhibitors, which help shrink the prostate and prevent its additional growth due to hormonal changes.
  • PDE5 inhibitors, which help relieve BPH symptoms by regulating smooth muscle tone in the prostate.
  • Combination therapy, if either medication alone isn’t effective, taking more than one drug at the same time may be effective for men with very enlarged prostates to reduce symptoms and postpone surgery.


If lifestyle changes and medications do not help, the next treatment level presupposes surgery. It can be either:

  • a minimally invasive procedure, like transurethral resection or incision to widen urethra and increase the urine flow, which warrant less pain and scarring, as well as faster recovery, or
  • open surgery, if the prostate is very large and there are complicating factors like cancer or bladder damage, prostatectomy may be the option.

Natural remedies

Although supplements and natural remedies are not as closely regulated as medications your doctor prescribes, some of them have shown promises for treating BPH and improving men’s health. Among them are:

  • Prunus Africana has shown to decrease urine frequency and increase urine flow.
  • Saw palmetto has anti-inflammatory effects and inhibits growth factor and prolactin-induced cell proliferation in BPH patients. It improves UT symptoms and flow measures by influencing androgen metabolism.
  • Vitamin D intake from dietary supplements has shown to decrease prostate size and slow prostate growth in PBH patients.
  • Green tea contains specific polyphenols that have been found to improve urinary symptoms associated with BPH.

Given the wide range of treatment options available, doctors must choose the right treatment for each patient  and patients should work closely with their urologist to ensure they manage the condition effectively and use the most appropriate for them form of treatment.