Can BPH be treated?
Yes it can. There are a number of options:
Maybe your symptoms are just an inconvenience and don't trouble you too much. In this case, you may feel you're happy enough living with the symptoms once you've had your BPH diagnosed. That's fine. You should still keep an eye on things though and have regular check-ups. This is often referred to as "watchful waiting".
If, like many men, the symptoms of BPH are spoiling your enjoyment of life, there's no need to put up with them. There are several drugs available to help, including:
Symptoms can usually be relieved with a type of medicine called 'alpha-blockers'. They work by relaxing the muscle in the bladder and around the prostate so that pee can flow more freely in the urethra. These are often the first choice of treatment if your symptoms are bothering you, especially as they work quickly.
Somewhere between six and nine out of ten men find that alpha-blockers help them. They can improve your International Prostate Symptom Score (IPSS) by 30-40% and urine flow rate by 16-25%. Alpha–blockers can effective symptomatic relief within one week of treatment (Narayan et al, 1998) and they are available to buy OTC or on a prescription.11
There are different types of alpha-blockers available and they act or work in a similar way, although they may have slightly different side-effects.9 If one doesn't work for you, it's unlikely that a different one will work any better. If you get side effects with one kind, such as low blood pressure, dizziness, drowsiness or headaches, you could try changing to another kind to reduce the side effects that you get..
5-alpha reductase inhibitors
Another option is a type of medicine called '5-alpha reductase inhibitors', which can slow the growth or even shrink the prostate over time. These work by stopping an enzyme (called 5-alpha reductase) from converting the male hormone testosterone into the more potent dihydrotestosterone. High levels of dihydrotestosterone are linked to growth of the prostate.9
These drugs can shrink the prostate by 20-30%, thereby improving flow rate and reducing obstructive symptoms.12 Your IPSS symptom score might improve by up to 15%.10
You should notice an improvement in your symptoms in three to six months.9
Since 5-alpha reductase inhibitors work by reducing a potent form of testosterone, side-effects can include reduced sex drive, erectile problems and slight breast enlargement or tenderness.9 You can take 5-alpha reductase inhibitors together with an alpha-blocker if either drug is not helping on its own. Or you can take a 5-alpha reductase inhibitor on its own if you find that you suffer troublesome side effects with an alphablocker.9
Surgery is an option if medicines are not suitable for you, if your prostate has enlarged so much that medicines won't help, or if you have developed complications (see What happens if I don't treat it?).
The most common operation for BPH is called 'transurethral resection of the prostate', or TURP. This involves removing the excess prostate tissue from within the urethra, a bit like coring an apple. The operation is carried out under a general anaesthetic or a spinal anaesthetic and usually takes about an hour. Having a TURP used to mean a hospital stay of 2-3 days13, but now you might only need to stay in for one day.
You will need to have a catheter in place after the operation for a day or two. You might notice blood in your urine for a few days afterwards.13
TURP is usually very successful at treating the symptoms of BPH; improving IPSS by 15–20%, and increasing the urine flow rate by 10ml/s. However, approximately 1–2% of operations per year don't work and need to be repeated.
Other surgical procedures
There are new alternatives to TURP on offer in some hospitals, which might be suitable for you. You should talk to your doctor if you want to find out more about them. They are minimally invasive procedures, which usually mean a shorter hospital visit, sometimes just a day, and fewer after-effects, such as bleeding.
What happens if I don't treat it?
It is essential that you speak to a healthcare professional if you have urinary symptoms or think you might be suffering from BPH. Although some men find that nothing happens if their BPH is not treated, many find their symptoms get worse which increasingly affects their quality of life.16
BPH can also lead to urinary tract infections, such as bladder infection, or pyelonephritis (kidney infection).
There is the possibility that you could also find you eventually suffer from a serious condition known as acute urinary retention. This happens when you can't pee at all and the bladder fills up. It can be painful and needs urgent medical treatment. You'll need to have a catheter (a fine tube) put in to empty the bladder.4 Sometimes acute urinary retention is triggered by an unrelated operation under general anaesthetic, a new medicine, or a urinary tract infection.
In some men where BPH has been a long-standing untreated condition, chronic (long-term) urinary retention develops.9 This means the bladder is always full, becomes extremely distended and causes pressure to build up towards the kidneys. This can cause the kidneys to stop functioning properly.