When the prostate makes urination difficult
Benign prostatic hyperplasia (BPH), which is the benign enlargement of the prostate, affects more than one in two men over 50. As men age, the prostate slowly grows, which can lead to urinary problems and other uncomfortable symptoms. Even though it is a non-cancerous change, it can significantly impair quality of life.
However, if detected early, BPH can be treated well, for example through lifestyle changes, herbal remedies, or medically supervised therapies.
What is benign prostatic hyperplasia?
The prostate is located below the bladder and surrounds the urethra. With age, certain cells in the so-called periurethral zone (around the urethra) begin to multiply. The result: The organ enlarges, which can mechanically obstruct urine flow.
Important: BPH is not a precursor to prostate cancer, but both can cause similar symptoms. Therefore, medical clarification is crucial.
Who is particularly affected?
- Men from 45 years of age
- With a family history
- With an unfavorable hormone profile (e.g., elevated DHT, estradiol)
- In cases of obesity and chronic silent inflammation
- Decreasing testosterone levels can increase the risk of BPH
What symptoms occur with BPH?
Not all men with an enlarged prostate experience symptoms, but many notice typical changes in urination:
- Weakened urinary stream
- Post-void dribbling
- Frequent urge to urinate, even at night (nocturia)
- Feeling of incomplete bladder emptying
- Difficulty starting urination
- Occasionally: urge to urinate without success ("urge without stream")
- Rarely: bladder infections or urinary retention
These symptoms arise because the urethra is increasingly constricted from the outside.
How is BPH diagnosed?
An experienced urologist can determine whether BPH is present and how severe it is with a few targeted examinations.
Typical diagnostics:
- Anamnesis and IPSS questionnaire (standardized)
- Digital rectal examination (DRE): Palpation of the prostate
- Ultrasound of the prostate (residual urine, volume determination)
- PSA value in the blood
- If necessary, hormone status: Testosterone, DHT, estradiol
👉 View PSA test at Adon Health here
What role do hormones play in BPH?
An imbalance in the male hormone balance can promote prostate growth:
- Dihydrotestosterone (DHT): Formed from testosterone, stimulates prostate growth
- Estrogens (especially estradiol): Promote cell proliferation in the prostate
- Decreasing testosterone (with age) changes the balance; the relative influence of DHT and estradiol increases
A hormone analysis can help identify causes, especially in cases of simultaneous loss of libido, erectile dysfunction, or lack of drive.
What treatment options are available?
The therapy depends on the extent of the symptoms, lifestyle, and personal preference.
Conservative measures:
- "Watchful waiting" for mild cases
- Adjusting lifestyle (e.g., weight reduction, less alcohol/caffeine)
- Reducing fluid intake in the evening
- Targeted pelvic floor training
- Anti-inflammatory diet
Herbal therapies (for mild/moderate symptoms):
- Saw palmetto (Serenoa repens)
- Nettle root
- Pumpkin seed extract
- Pygeum africanum
These preparations can alleviate symptoms and improve quality of life, but they are not sufficient for everyone.
Medications:
- Alpha-blockers: Relax the muscles of the urinary tract
- 5-alpha-reductase inhibitors (e.g., finasteride): Inhibit DHT production
- Combination of both approaches is also possible
Surgical procedures:
- TURP (transurethral resection of the prostate)
- Laser therapy, microwaves, or water vapor ablation, minimally invasive procedures
These are usually necessary for severely pronounced BPH or complications.
What can men do themselves?
- Regularly check PSA levels (detect changes early)
- Reduce overweight: Lowers aromatase activity and hormonal pressure
- Support liver function: For better hormone breakdown
- Exercise and moderate strength training: Regulate hormones
- Visit a urologist 1-2 times a year (especially from 45 years of age)
Conclusion
Benign prostatic enlargement is not uncommon, but an age-related, hormonally driven development that can be observed in many men. It is important not to ignore symptoms and to take early countermeasures.
With a conscious lifestyle, early diagnosis (e.g., via PSA test from Adon Health) and, if necessary, therapeutic support, you can maintain your quality of life and avoid more serious complications.