It’s perfectly normal for a man’s prostate to grow throughout his adult life. For some men, this doesn’t bring about any serious symptoms, but for others, an enlarged prostate can lead to issues that affect not just prostate health, but their quality of life.
An enlarged prostate affects one in five men between the ages of 50 and 60, and it’s even more common in older men. The symptoms can certainly be bothersome, and they can even cause problems in your personal life or at work because you can’t sleep. Turning to medication or surgery can make matters worse in some cases, especially when it isn’t entirely necessary, but there are some lifestyle and diet changes that can make a difference when it comes to an enlarged prostate.
What Is an Enlarged Prostate?
The prostate, a gland in the male reproductive system, is located just below the bladder, between the rectum and the base of the penis. Because the prostate wraps around part of the urethra, where urine passes through, an enlarged prostate may cause issues with urination.
When the prostate grows, it may push against the bladder and urethra, making you feel like you need to urinate even though your bladder is not full and preventing the urine from flowing out naturally. This feeling becomes stronger when the muscles at the bottom of the bladder begin contracting, even when only a small amount of urine is present. Over time, this constant pressure can weaken the bladder muscles, and as a result the bladder will no longer be able to empty itself properly, always leaving some urine behind. (1)
The medical term for an enlarged prostate is benign prostatic hyperplasia (BPH). The word benign means that the growth is not cancerous, and the word hyperplasia means enlargement, or the abnormal increase in cells. BPH is the most common noncancerous form of cell growth in men, and it does not lead to prostate cancer.
When the prostate is enlarged, it pushes against the bladder and urinary tract. This can lead to issues, such as:
- frequent urination, especially at night
- difficulty postponing urination
- it taking longer for urine to start flowing (despite the urgency to urinate)
- straining when urinating
- weaker urine flow and taking longer to finish urinating
- dripping and leaking after urination
- feeling like the bladder is not empty after urinating
There is not always a direct relationship between the size of the prostate and the symptoms. Men with very enlarged prostates may not experience symptoms, while others who don’t have very enlarged prostates may have a lot of problems.
About a third of men with an enlarged prostate have lower urinary tract symptoms (LUTS) that can interfere with their quality of life. Symptoms of LUTS include filling symptoms, such as frequent urination, especially at night, and voiding symptoms, such as poor stream, incomplete urination and dribbling after urination. For some men, the symptoms subside over time, while for others they remain the same or deteriorate over time, which may require surgical treatment.
Occasionally, men with enlarged prostate may suddenly have difficulty urinating, or they cannot urinate at all. This is a condition called acute urinary retention (AUR), and it requires immediate medical attention in order to relieve the severe discomfort. AUR is an uncomfortable and potentially dangerous conditions. It commonly occurs in men with underlying benign prostatic hyperplasia, and often there is a precipitating event, such as exposure to cold weather, ingestion of a medication that doesn’t allow the bladder to contract or excessive alcohol consumption. Other factors may cause AUR, such as invasive procedures done to treat BHP, acute bacterial prostatitis and viral infections. (2)
It’s perfectly normal for the prostate to grow during puberty, until it’s about the size of a walnut. Around the age of 25, the prostate begins to very slowly grow again. Prostate growth is not the same for every man; for some, it grows a lot more than in others.
The changes that occur with male sex hormones as part of the aging process appear to play a role in the enlargement of the prostate. Androgens, like testosterone, affect prostate growth. The prostate converts testosterone into dihydrotestosterone (DHT), another powerful androgen, and DHT stimulates cell growth in the tissue that lines the prostate gland. This is the major cause of an enlarged prostate, and it commonly occurs between puberty and young adulthood. The estrogen present in men may also play a role in prostate enlargement. As men age and testosterone levels drop, the proportion of estrogen increases and may trigger prostate growth. (3)
Age is a major risk factor for an enlarged prostate. According to an overview on benign prostatic hyperplasia published in Reviews in Urology, the actual enlargement of the prostate gland develops as a strictly age-related phenomenon in nearly all men, starting at approximately 40 years of age. Data from autopsy studies around the world suggests that the prevalence of BPH is approximately 10 percent for men in their 30s, 20 percent for men in their 40s, reaches 50 percent to 60 percent for men in their 60s, and is 80 percent to 90 percent for men in their 70s and 80s. Researchers conclude that there’s no doubt that men who live long enough will develop some features consistent with BPH. (4)
Research conducted by the Mayo Clinic and Foundation found that of the 2,119 men involved in the study, 440 (21 percent) reported a family history of enlarged prostate. The age-adjusted odds of having moderate or severe urinary symptoms were elevated among those with a family history compared to those without. These findings suggest that men with a family history of enlarged prostate may be at increased risk of development of symptoms and signs of BPH, and this risk is greater in men with relatives diagnosed at a younger age. (5)
An alarming study published in the International Journal of Cardiology suggests that patients with BPH and lower urinary tract symptoms have a considerably higher prevalence of cardiovascular disease than the general population in old age. The underlying reasons for this correlation aren’t exactly clear, but researchers speculate that by causing sleep disturbances, blood pressure variability and increased cortisol levels, an enlarged prostate may be a risk factor for cardiovascular disease. (6)
Conventional Treatment for an Enlarged Prostate
Treatment for an enlarged prostate depends on the severity of symptoms and the risk of complications, such as urinary retention. Most men with enlarged prostate experience mild to moderate symptoms, and they’re able to cope with them without relying on serious treatment plans, like medications. But for some men, the symptoms can be extremely bothersome or even painful, and they can get worse over time, so a treatment plan in needed.
A strategy called “watchful waiting” is becoming more common among United States physicians. (7) This is when patients are monitored to see if their conditions get worse before turning to any form of treatment. Watchful waiting has become common practice because treatments for an enlarged prostate or prostate cancer, such as surgery or radiation, can lead to serious long-term side effects, such as incontinence and impotence. Watchful waiting involves looking out for changes in symptoms instead of undergoing frequent tests and turning to treatment too soon.
A study that began between 1989 and 1999, and was published in the New England Journal of Medicine, involved 695 men with early prostate cancer who were assigned to watchful waiting or radical prostatectomy (removal of prostate gland) and were followed through the end of 2012. The results, over 23 years of follow-up, showed a substantial reduction in mortality after surgery, especially when surgery was based on age at diagnosis and tumor risk. And a large proportion of long-term survivors in the watchful waiting group have not required any specialized treatment. According to this study and many others like it, watchful waiting is beneficial for low-risk patients, and it allows them to hold off on invasive or harmful treatments that aren’t necessary. (8)
If the symptoms of an enlarged prostate are ongoing or become more serious over time, the main conventional treatment options include:
Most men with an enlarged prostate will either watch and wait to see how their symptoms develop or take medication. Alpha blockers, such as terazosin, are used to relieve BPH symptoms within a few weeks, but they don’t stop the prostate from continuing to grow. 5-alpha reductase inhibitors (such as Avodart or Proscar) are used to reduce an enlarged prostate, but they may take up to six months or more to show any effect on symptoms. Sometimes a combination of alpha blockers and 5-alpha reductase inhibitors is used. When taking medications, it’s important to be aware of the possible interactions between medications. For instance, if a man takes alpha blockers, he should not use drugs for impotence treatment as well because both of these medications have a blood-pressure-lowing effect. (9)
There are surgical techniques that are used to remove or destroy prostate tissue. Surgery is only necessary when there are complications or the symptoms of an enlarged prostate have become severe, and there is no other way to relieve the discomfort. Transurethral resection of the prostate (TURP) is the most common surgery for an enlarged prostate. In the United States, about 150,000 men have TURPs each year. The surgery involves removing obstructing prostate tissue with electric current or laser light.
In a 2011 study, 40 patients who, due to BPH, were treated with TURP were analyzed. The participants were under the age 0f 80, and the weight of their BPH tissue was between 30–80 grams. After collecting data from the participants after surgery, researchers found that the quality of life had significantly improved because of the TURP method and impact on quality of life was not related to age. (10)
Natural Treatments for an Enlarged Prostate
1. Lifestyle and Diet Changes
Certain lifestyle changes may help relieve symptoms of an enlarged prostate. For those who wish to wait before choosing drug therapy or surgery, trying these recommendations may be beneficial:
- limit or avoid alcohol and caffeine
- limit drinking fluids in the evening
- try to urinate at least once every three hours
- engage in physical activity
- maintain a healthy weight
- increase intake of healthy fats (such as omega-3 foods)
2. Pelvic Floor Training
Pelvic floor training, also known as kegel exercises, can help men strengthen the muscles of the pelvic diaphragm, improving involuntary or abnormal urine loss for men with enlarged prostate. Performing these exercises, which involve contracting and then releasing the muscle, help support the bladder and close the sphincter. Because it can be hard to locate this muscle, try practicing while urinating. Contract the muscle, letting urine slow until it slows down and then stopping the urination for 20 seconds. In general, it’s recommended that men practice pelvic floor training three to five times daily. (11)
3. Herbal Supplements
The following herbs can also help with BPH:
Saw palmetto has been widely used as a therapeutic remedy for urinary dysfunction due to BPH. Research shows that saw palmetto helps improve urinary dysfunction and an overactive bladder in patients with BPH. It’s also known to be a safe means of treatment, even with long-term intake. (12)
Stinging Nettle Root
A study conducted in Japan found that stinging nettle has hydrophobic constituents, such as steroids, that may inhibit the membrane tissue activity of the prostate, which may subsequently suppress prostate-cell metabolism and growth. (13)
Pumpkin Seed Oil
Research published in Nutrition Research and Practice found that pumpkin seed oil was able to reduce symptoms of an enlarged prostate within three months. Maximal urinary flow rate was gradually improved significantly after six months. (14)
Enlarged Prostate Precautions
Men with enlarged prostate should talk to their health care providers before taking any over-the-counter medicines, such as decongestants and antihistamines. These drugs, which are usually taken for colds and allergies, may worsen urinary symptoms by preventing muscles in the prostate and bladder neck from relaxing and allowing urine to flow freely. (15)
Diuretics, which increase urination, can also make enlarged prostate symptoms worse, so men taking these drugs should speak to their health care providers about alternatives.
Final Thoughts on Enlarged Prostate
- An enlarged prostate affects one in five men between the ages of 50 and 60, and it’s even more common in older men.
- When the prostate is enlarged, it pushes against the bladder and urinary tract. This can cause issues with urination, such as frequent urination, feeling the need to urinate even though your bladder is empty, being unable to empty your bladder completely and dripping after urination.
- Age is the biggest risk factor for an enlarged prostate, or BPH. Men who live long enough will develop some features consistent with BPH.
- It’s becoming more popular to practice watchful waiting before turning to medications or surgery to relieve enlarged prostate symptoms. For men who experience severe, ongoing symptoms, a combination of alpha blockers and 5-alpha reductase inhibitors seems to be effective but does have side effects.
- Lifestyle changes can help relieve the symptoms of an enlarged prostate. Limiting fluid intake is helpful, and physical exercise and maintaining a healthy weight may also be beneficial. Pelvic floor exercises help strengthen the pelvic muscles and can control urination. Herbal supplements, such as saw palmetto, stinging nettle root and pumpkin seed oil, may also reduce discomfort.