Why Men Get an Enlarged Prostate and How to Treat BPH Symptoms

Summary

In this episode of the Reena Malik MD podcast, Dr. Reena Malik, a urologist and pelvic surgeon, discusses Benign Prostatic Hyperplasia (BPH), a common condition affecting millions of men. She explains what BPH is, its symptoms, and the factors contributing to its development, including hormones, genetics, and inflammation. Dr. Malik also covers various treatment options, such as alpha blockers, 5-alpha reductase inhibitors, and lifestyle modifications, emphasizing the importance of managing BPH to improve quality of life.

Takeaways

• 😀 Benign Prostatic Hyperplasia (BPH) is a common condition where the prostate gland enlarges, affecting about 70% of men by age 60 and 80% by age 80.
• 💧 Symptoms of BPH include increased urinary frequency, urgency, nocturia (waking up to urinate), weak stream, hesitancy, intermittency, and post-void dribbling.
• 🚫 BPH is not cancer, and an enlarged prostate does not increase the risk of prostate cancer.
• 🔬 The causes of BPH are complex and can involve hormones like DHT, inflammation, genetics, and factors like metabolic syndrome and the sympathetic nervous system.
• 🏃‍♂️ Maintaining a healthy weight, staying active, and eating a diet rich in vegetables and lycopene can help reduce the risk of BPH.
• 💊 Supplements like saw palmetto, beta-sitosterol, and pygeum africanum have mixed evidence for effectiveness in treating BPH symptoms.
• 🚫 Certain medications, including antihistamines, decongestants, and some antidepressants, can worsen BPH symptoms.
• 💧 Behavioral changes such as monitoring fluid intake, reducing bladder irritants like caffeine and alcohol, and managing constipation can improve BPH symptoms.
• 💊 Medical treatments for BPH include alpha blockers (e.g., tamsulosin), 5-alpha reductase inhibitors (e.g., finasteride), and phosphodiesterase 5 inhibitors (e.g., tadalafil).
• ⚠️ Sexual side effects are a potential risk with 5-alpha reductase inhibitors, and they can also affect PSA levels used in prostate cancer screening.

Q & A

What is BPH and how common is it among men?

BPH, or benign prostatic hyperplasia, is an enlargement of the prostate gland. It is incredibly common, affecting about 70% of men by the age of 60 and 80% by the age of 80.

What are the typical symptoms of BPH?

Symptoms of BPH include increased urinary frequency, urgency, nocturia (waking up to urinate more than once at night), weak stream, hesitancy, intermittency, incomplete emptying, post-void dribbling, and sometimes urinary leakage.

Does an enlarged prostate always lead to symptoms, and how does the size correlate with symptom severity?

An enlarged prostate does not always result in symptoms, and the size of the enlargement does not always correlate with symptom severity. Some men may have a large prostate without bothersome symptoms, while others with a smaller prostate may experience significant symptoms.

How does BPH affect sleep and quality of life?

BPH can significantly impact sleep and quality of life, especially in patients who experience nocturia. Frequent nighttime urination can lead to fatigue and difficulty falling back asleep, which can affect daily functioning and overall well-being.

What is the role of hormones like DHT in the development of BPH?

DHT, or dihydrotestosterone, is a byproduct of testosterone that plays a significant role in prostate growth. Higher levels of DHT are often found in men with larger prostates, contributing to the development of BPH.

How does inflammation contribute to BPH?

Chronic low-grade inflammation in the prostate can promote growth by triggering the release of growth factors like epidermal growth factor, insulin-like growth factor, and transforming growth factor beta, leading to cell proliferation and prostate enlargement.

What is the relationship between genetics and the risk of developing BPH?

There is a hereditary component to BPH. Men with a close male relative, especially a father, who had BPH at a young age (before 60) may be at a higher risk of developing BPH themselves.

What lifestyle changes can help prevent or reduce the risk of BPH?

Maintaining a healthy weight, staying active, eating a diet rich in vegetables and lycopene-rich foods like tomatoes and watermelon, managing chronic conditions, and being mindful of medications that could worsen BPH symptoms can help prevent or reduce the risk of BPH.

What are some common supplements that are believed to help with BPH symptoms, and how effective are they?

Saw palmetto is the most studied supplement for BPH, but recent high-quality trials have not shown significant benefits over placebo. Other supplements like beta-sitosterol, Pygeum africanum, pumpkin seed extract, and stinging nettle have some evidence of symptom improvement, but the results are not consistent.

How do alpha blockers and 5-alpha reductase inhibitors work to treat BPH, and what are their potential side effects?

Alpha blockers, such as tamsulosin and alfuzosin, work by relaxing the prostate and bladder neck muscles to improve urine flow. 5-alpha reductase inhibitors, like finasteride and dutasteride, block the conversion of testosterone to DHT, shrinking the prostate. Side effects can include retrograde ejaculation, dizziness, and sexual side effects like decreased libido.

What is the role of phosphodiesterase 5 inhibitors in treating BPH, and how do they work?

Phosphodiesterase 5 inhibitors, such as tadalafil, work by relaxing smooth muscles to help with prostatic symptoms. They are particularly useful for men experiencing both erectile dysfunction and BPH, as they can help with both conditions.

Outlines

00:00

😀 Understanding BPH and Its Symptoms

Dr. Reena Malik introduces the topic of benign prostatic hyperplasia (BPH), a common condition affecting millions of men worldwide. She explains that BPH involves the enlargement of the prostate gland, which can lead to various urinary symptoms such as increased frequency, urgency, weak stream, and nocturia. Dr. Malik emphasizes that while BPH is common, especially among older men, it is not cancerous and does not increase the risk of prostate cancer. She also mentions that the severity of symptoms does not always correlate with the size of the prostate and that factors like inflammation and hormones play a role in its development.

05:03

🧬 The Science Behind BPH

This section delves into the scientific aspects of BPH, exploring the role of hormones, genetics, and inflammation in the condition's development. Dr. Malik discusses how hormones like DHT (dihydrotestosterone) and inflammation within the prostate can lead to the release of growth factors, promoting cell proliferation and enlargement of the prostate. She also touches on the hereditary component of BPH, noting that men with a family history of the condition may be at higher risk. Additionally, she mentions other factors such as metabolic syndrome and the sympathetic nervous system that can contribute to BPH.

10:04

🏋️‍♂️ Prevention and Management of BPH

Dr. Malik offers evidence-based advice on preventing BPH, emphasizing the importance of maintaining a healthy weight, staying active, and making dietary changes. She suggests limiting high-fat red meats and increasing vegetable intake, particularly foods rich in lycopene like tomatoes and watermelons. The doctor also advises managing chronic conditions to reduce inflammation and being cautious with certain medications that could exacerbate BPH symptoms. She invites patients to her practice for a comprehensive approach to healthcare, where she focuses on patient education and personalized treatment plans.

15:07

💊 Exploring BPH Treatment Options

In this segment, Dr. Malik discusses various medical treatments for BPH, including alpha blockers, 5-alpha reductase inhibitors, and phosphodiesterase 5 inhibitors. She explains how these medications work to alleviate symptoms by either relaxing muscles around the prostate or shrinking the prostate through hormonal regulation. She also addresses potential side effects of these treatments and the importance of discussing them with a healthcare provider. Dr. Malik mentions that a combination of medications can be more effective for severe cases and that she will be covering surgical options in a future podcast.

20:07

🚭 Lifestyle Changes and Supplements for BPH

Dr. Malik highlights the role of lifestyle changes in managing BPH symptoms, such as monitoring fluid intake, avoiding bladder irritants like caffeine and alcohol, and addressing constipation. She also discusses the effectiveness of certain supplements like saw palmetto, beta-sitosterol, and pumpkin seed extract, noting that while some show modest benefits, results can be inconsistent. The doctor stresses the importance of considering behavioral changes and supplements as part of a comprehensive approach to BPH management.

25:09

💪 Empowering Patients with BPH Knowledge

In the concluding part of the podcast, Dr. Malik encourages patients to take control of their health by understanding BPH and its management options. She invites listeners to engage with her content, share it with others, and subscribe to her podcast or YouTube channel for more in-depth discussions on surgical treatments and expert insights. Dr. Malik reiterates her commitment to providing free, high-quality educational content to empower individuals to make informed decisions about their health.

Keywords

💡Benign Prostatic Hyperplasia (BPH)

Benign Prostatic Hyperplasia (BPH) is a medical condition characterized by the enlargement of the prostate gland, which can obstruct the urinary tract. In the video, Dr. Reena Malik discusses BPH as a prevalent condition affecting millions of men, often leading to urinary symptoms such as frequency, urgency, and weak stream. The term is central to the podcast's theme of addressing a common yet under-discussed health issue among aging men.

💡Urinary Frequency

Urinary frequency refers to the need to urinate more often than normal, which is a common symptom of BPH. Dr. Malik mentions this symptom as one of the indicators that a man might have BPH, affecting the quality of life by causing inconvenience and sleep disturbances, such as nocturia, or waking up at night to urinate.

💡Nocturia

Nocturia is the need to wake up and urinate one or more times during the night, which is abnormal and can be indicative of BPH. In the script, nocturia is highlighted as a significant symptom that not only disrupts sleep but also poses a risk of falls and subsequent health complications in older patients.

💡Urinary Urgency

Urinary urgency is a sudden, strong desire to urinate that is difficult to defer. This term is used in the video to describe a symptom of BPH that can significantly impact a patient's daily life and is one of the factors that can lead to seeking medical attention.

💡Weak Stream

A weak stream, as mentioned by Dr. Malik, refers to a less forceful or slow urinary flow compared to what might be expected, often a sign of BPH. This symptom can be an indicator of an obstruction in the urinary tract caused by an enlarged prostate.

💡Hesitancy

Hesitancy is a medical term that describes difficulty starting urination. In the context of the video, it is one of the urinary symptoms associated with BPH, affecting the patient's ability to initiate the flow of urine, which can be frustrating and indicative of an underlying prostate issue.

💡Intermittency

Intermittency, in the context of BPH, refers to the stopping and starting of the urinary stream. Dr. Malik uses this term to describe a symptom where the flow of urine is not continuous, which can be another sign of an enlarged prostate affecting the urinary tract.

💡Inflammation

Inflammation is a biological response to harmful stimuli and is mentioned in the video as a contributing factor to BPH. Chronic low-grade inflammation in the prostate can trigger the release of growth factors, leading to cell proliferation and prostate enlargement. This concept is crucial for understanding the complex pathophysiology behind BPH.

💡Hormones

Hormones, particularly testosterone and its byproduct DHT (dihydrotestosterone), play a significant role in the development of BPH. The video explains that sensitivity to DHT influences prostate size, with some men having higher levels of DHT associated with larger prostates. Hormonal imbalances are discussed as a key factor in the pathogenesis of BPH.

💡Supplements

Supplements are discussed in the video as a potential over-the-counter treatment option for BPH symptoms. Dr. Malik reviews various supplements like saw palmetto, beta-sitosterol, and pumpkin seed extract, evaluating their effectiveness based on scientific studies. This section of the video addresses the common question of whether natural supplements can provide relief from BPH symptoms.

💡Medical Treatment

Medical treatment options for BPH are explored in the video, including alpha blockers and 5-alpha reductase inhibitors. These medications are designed to alleviate urinary symptoms by either relaxing the prostate and bladder neck muscles or shrinking the prostate through hormonal regulation. The discussion of medical treatments provides listeners with an understanding of the available pharmacological approaches to managing BPH.

Highlights

Benign prostatic hyperplasia (BPH) is an enlargement of the prostate gland, affecting millions of men worldwide.

By age 60, about 70% of men have BPH, and by age 80, this number increases to 80%.

BPH symptoms include increased urinary frequency, urgency, nocturia, weak stream, hesitancy, and intermittency.

An enlarged prostate does not necessarily correlate with symptom severity.

BPH is not cancer, and having an enlarged prostate does not increase the risk of prostate cancer.

Hormones, genetics, and inflammation are key factors in the development of BPH.

Inflammation in the prostate can trigger the release of growth factors, leading to cell proliferation and prostate enlargement.

A hereditary component exists for BPH, with a higher risk for those with a family history of the condition.

Metabolic syndrome, including diabetes and high blood pressure, is linked to a higher likelihood of BPH.

Maintaining a healthy weight, staying active, and a healthy diet can help reduce the risk of BPH.

Supplements like saw palmetto have mixed evidence for improving BPH symptoms.

Behavioral changes, such as fluid intake management and avoiding bladder irritants, can be effective in managing BPH symptoms.

Alpha blockers and 5-alpha reductase inhibitors are common medical treatments for BPH.

Combination therapy with alpha blockers and 5-alpha reductase inhibitors can be more effective for severe BPH symptoms.

Phosphodiesterase 5 inhibitors, typically used for erectile dysfunction, can also help with BPH symptoms.

Surgical options are available for BPH management and will be discussed in future episodes.

Transcripts

are you up all night urinating has your

stream slowed down are you going more

often or having to rush to the bathroom

then this podcast is for you welcome

back to the Reena Malik MD podcast your

source for evidence-based medical and

Sexual Health content I'm Dr Reena Malik

urologist and pelvic surgeon today we're

diving deep into a condition that

affects millions of men worldwide but n

prostatic hyperplasia or BPH we'll cover

what it is why it happens how you might

be able to prevent it the truth about

supplements and the various treatment

options that are available to you to

help manage these symptoms so let's

start off what is

BPH well BPH or benign prostatic

hyperplasia is an enlargement of the

prostate now the prostate is a walnut

sized gland located just below the

bladder surrounding the urethra and

that's the tube that carries urine out

of the body or I like to call the P tube

now BPH occurs when this gland gets

bigger now you may not know this but it

is incredibly common by the age of 60

about 70% of men have BPH let me say

that again by the time you're 60 7 out

of 10 men will suffer from BPH and by

the time you're 80 that number jumps to

8 80% but having an enlarged prostate

doesn't always mean that you're going to

have symptoms and the size of the

enlargement doesn't always correlate

sometimes you'll get an exam by your

doctor and they'll say well your

prostate is not that big but your

symptoms are really bothersome and so

it's more than just the size but very

often it's because there is some degree

of an enlargement now what sort of

symptoms are there when you do have

symptoms they're typically related to

your uration so here are the things you

might see increased urinary frequency

going to the bathroom more often more

than eight times a day urinary urgency

this sudden and strong desire to urinate

that you can't delay noctua waking up

more than one time at night to urinate

more than one time is considered

abnormal a weak stream having sort of a

less strong forceful stream compared to

what it was like when you were maybe in

your 20s

hesitancy which is essentially a

difficulty starting urination and

intermittency this stopping and starting

of your urinary stream you may also feel

what we call incomplete emptying or

feeling like you can't really fully

empty your bladder and sometimes this is

can also correlated with postvoid

dribbling meaning you urinate and you

think you're done and then right

afterwards you get a little bit of

dribble afterwards and sometimes you can

have leakage and you usually this is

leakage cuz you got to go got to go and

can't make it to the bathroom or

sometimes you get leakage because your

bladder gets so full that you have what

we call overflow incontinence and so

you're leaking because your bladder is

just too full and it can't hold any more

urine these symptoms can affect people

variably meaning that some people are

really not bothered but for others these

are really significantly impacting their

quality of life particularly in those

patients who wake up at night to urate

not only are they at risk for falling on

their way to the bathroom which is very

concerning particularly in older

patients because once you fall and you

go to the hospital because of that fall

over the next year your risk of dying

goes up to

20% these Falls are really serious so

that's really a a big issue for me and

then secondly you're not getting good

sleep you're waking up all the time

you're tired you can't fall back asleep

and this can really affect your quality

of life now the other important thing to

realize is that BPH is not cancer having

a large prostate does not mean that you

have cancer and it doesn't increase your

risk of prostate cancer so now why does

BPH occur let's get into the science

benine prosthetic hyperplasia is a

complex process and it can involve

issues with hormones genetics and

inflammation hormones do play a

significant role particularly in the

prostates so we know that the formation

of the prostate or the size of the

prostate is sensitive to what we call

DHT and this is a byproduct or

conversion product of testosterone so we

know that some men who have a large

prostate will have higher levels of DHT

but that's not everybody and we know

that it's not just due to testosterone

because if it was just due to

testosterone then we know that

testosterone decreases with age so

people's prostate wouldn't continue to

increase so this is where these other

factors come into play inflammation is a

big one so chronic lowgrade inflammation

in the prostate can promote growth and

this inflammation can be caused by a

variety of different things this can

include things like infections so you

may have bacterial or viral prostatitis

or infections you can have some hormonal

changes which are inflammatory or even

autoimmune changes and also changes in

the prostate microbiome interestingly

when you have inflammation it triggers

the release of certain growth factors

like the epidermal growth factor or the

insulin like growth factor and

transforming growth factor beta these

then send signals and stimulate cell

growth and division which then cause

what we call cell

proliferation and cause an enlargement

of the prostate now when you think about

BPH or any organ really there's a

balance between cells growing and cells

dying and so there's always new cells

being created for example in our skin

and cells being SLE off in BPH there's

an imbalance more cells are growing than

dying off and this leads to enlargement

the other thing that happens is as the

prostate grows it creates areas where

there's low levels of oxygen now these

areas of hypoxia trigger again more

inflammatory substances so we're getting

this vicious cycle of growth

inflammation low oxygen creating more

inflammation creating more growth

factors and then you continue to get

enlargement now another factor is

genetics so there's a hereditary

component to BPH if you have a close

male relative usually a father who's had

BPH at a young age meaning before 60

years of age you may be at higher risk

in fact we find that people who do have

a genetic component are more like ly to

get BPH symptoms as early as their 40s

compared to those who don't have a

genetic component are you sick of going

to the doctor only to have them talk at

you for 15 minutes and leave without

knowing exactly why they're prescribing

you this certain medication and what

exactly the next step is to take to

optimize your health wouldn't it be

great to finally find a doctor who

actually listens to you answers your

questions and doesn't rush you out the

door well at my practice Reena Malik MD

I aim to do just that I specialize in

taking care of patients who have issues

with their sex lives issues with their

bladder with their Hormone Health or are

having pain in their pelvic region or

with sex my goal is to give you the time

and attention you deserve so you can

leave with a clear understanding of your

condition as well as our treat treatment

plan that's optimized for your goals

during your visit I'm 100% present with

you for an entire hour and after you

leave you can reach me it is super easy

to send me a message through our secure

portal and I'll get back to you within

24 to 48 hours no questions asked no

hidden fees scheduling is easy just

visit our website Reena Malik md.com

slappointment we see patients in both

Irvine and Beverly Hills California and

I see patients virtually in California

Florida Illinois Maryland New York New

Jersey and Virginia oh and don't forget

Texas if you're outside these states

consider seeing me for an educational

visit I look forward to seeing you

another risk factor is what we call

metabolic syndrome so this is where

conditions like diabetes high blood

pressure obesity link to the higher

likelihood of having BPH in fact having

diabetes more than doubles your risk of

BPH another factor is the sympathetic

nervous system so when you have

increased activity of the sympathetic

nervous system this can cause an

increase in smooth muscle tone of the

prostate which can contribute to

symptoms so anything that's sort of

revving up your sympathetic nervous

system that fight ORF flight system may

make these symptoms worse now that we

know sort of what factors go

into creating an enlarged prostate we

can talk about prevention so we can't

control every risk factor right we can't

really control genetics we can't really

control aging but there are things that

we can do to reduce our risk that are

evidence-based first and foremost

maintain a healthy weight Studies have

shown that men with a BMI over 35 have

more than double the risk of developing

BPH compared to men with a BMI under 25

and a waist circumference if you have a

waist circumference of over 40 in this

increases the risk by about 50% so

maintaining a healthy body weight and

reducing body fat is very important for

reducing all this inflammation that then

begins that Cascade the next thing

number two is stay active regular

physical activity is very helpful even

light exercise has been shown to reduce

the BPH Risk by 30% now what's light

exercise that's 2 hours of walking a

week that's less than 20 minutes a day

so really even 20 minutes of walking a

day can help reduce your risk now if you

exercise regularly about six times a

week they've shown that these men have a

50% lower risk of

BPH next is diet so diet does play a

significant role you want to limit high

fat red meats so daily red meat

consumption and again these don't

control for the kind of red meat you're

eating but presumably really high fat

red meats increases your BPH Risk by

about 30% compared to eating it less

than once a week eat more vegetables in

your diet so four or more servings of

vegetables a day has been shown to

reduce Risk by about

30% the other thing you may consider

adding is lycopene rich foods so

Tomatoes especially cooked Tomatoes

contain like opine and lopine has been

studied and has been shown to help

potentially prevent BPH watermelon is

another thing that has a lot of loped in

it so what they found in studies is that

high fat intake which is more than 38%

of your total energy intake through

calories increases BPH Risk by

31% and lastly you want to manage your

chronic conditions because these all

increase inflammation so keeping

conditions like diabetes high blood

pressure high cholesterol keeping them

under control is not only good for

obviously overall health for your heart

it's also good for your prostate and

lastly be mindful of medications this is

one you probably haven't heard of before

some over-the-counter medications can

actually worsen your BPH symptoms and

one of these very commonly is

antihistamines these can relax the

bladder making it harder to empty

another one is decongestion like psea

fet or psea fed these can actually

tighten the smooth muscles making

urination much more difficult some

anti-depressants also particularly those

called tricyclic

anti-depressants can negatively also

negatively affect bladder function now

it's important if you're on

antihistamines for allergies or you need

some of these medications talk to your

doctor if you find that you're

experiencing urinary symptoms and say is

there something I can use instead quick

break from this episode to let you know

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creating content online to empower

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malik. supercast docomo to see you there

now let's move on to supplements

everyone always wants to know what can I

take over the counter to help improve my

symptoms I'm going to start with the

most studied supplement for BP and

that's called saw palmetto early studies

were really promising but more recent

highquality trials have been done and

have not shown significant benefits in

comparison to Placebo so in one large

study where they had over 3,000 men they

found that saw palmetto showed really no

difference in comparison to Placebo in

terms of improving urinary symptoms even

at high doses now remember Placebo is

just a sugar pill or something that you

take that you think is going to improve

your symptoms but doesn't I still find

that some patients do benefit from

trying saw palmetto so I will suggest if

you're going to try one it may be one

that you want to consider however we do

have again very strong highquality

studies about saw paletto that don't

show a benefit in large patient

populations next is beta cytool now this

has less data some Studies have shown

some improvements in urinary symptoms

and flow rates mean that your flow is

faster but it's missing a lot of

long-term data next one is Pidge

africanum now this also has a Cochran

review so a Cochran review is

essentially a very high quality

metaanalysis that's done in systematic

review of all the data and they did that

for sa paletto and they also did it for

Pidge and it found that there was some

evidence of symptom Improvement but

unfortunately the studies were all

shortterm and a VAR quality pumpkin seed

extract is another interesting one um

again some Studies have shown some

modest benefits in symptom scores but

the results are not consistent so

sometimes you see a benefit and

sometimes you don't stinging nettle is

actually not really often times study by

itself but it's usually combined with

saw paletto and in those studies where

it's been combined with saw paletto they

have seen some improvement in symptoms

over a long period of time 96 weeks and

last lopine so I mentioned dietary

lycopene like tomatoes and watermelon

has shown benefit supplement data on

lopine is less robust so I'd rather you

eat your lopine than take a supplement

now I think it's really important to

remember that supplements can really

vary in quality quite significantly to

give you an example one study looked at

27 saw palmetto products and what they

found is that there was huge variability

in the amount of active ingredient

content and so only 7 of those 27 met

criteria for a proper salt Palmetto

supplement so 10 of them didn't and you

always have to remember that natural

doesn't always mean safe or effective I

like to say Botox is natural you can

find it in the environment but large of

the botox will kill you and so you want

to be thoughtful before you take a

supplement because we don't always know

there's there's very little regulation

on supplements we don't always know

what's on the bottle is actually in the

bottle make sure if you're taking

supplements mention them to your doctor

before starting them and also review the

ingredients sometimes you may not

realize that you're taking a whole bunch

of supplements and you're taking more

than you think of each individual

ingredient so before you even start

taking a supplement I would argue that

behavioral changes can be just as

effective if not more so one is I always

tell people to look at how much they're

drinking if you are drinking enough

fluid your urine should be about a light

y yellow lemonade color if you're

drinking too little it's going to be

darker than that and if you're drinking

a lot it's going to be clear like water

now clear like water once in a while is

not a big deal but if it's always clear

like that you are definitely over

drinking so you want to make sure you're

drinking enough some people think oh I

should drink less then my urinary

symptoms will be less but in fact if you

drink too little your urine will get

very concentrated and if it gets very

concentrated it starts irritating the

bladder lining which gives you even

worse symptoms next thing I generally

recommend is looking at what you're

putting in your body so if you're

drinking or eating things that can

irritate the bladder lining it may be

useful to try taking them out of your

diet for just a couple days now this is

not like a GI problem where you have to

do an Elimination Diet and take

something out for several weeks even a

couple days will allow you to see a

difference so the one big offender is

caffeine and caffeine is not just coffee

and tea although those are the most

common ones and I will tell you I see

patients who drink so much caffeine I

mean they drink like six cups of coffee

a day of course your bladder is going to

be irritated if you're drinking that

much caffeine but caffeine can also be

in chocolate it can be in ice cream it

can be in a whole host of other things

that you may not even realize you're

taking in those Celsius drinks those

other Sparkling Waters a lot of them

have caffeine so that's one another one

is alcohol certainly we know that people

will urinate more when they drink

alcohol because it's a diuretic but also

it can irritate the bladder lining so if

you're having a glass of wine at dinner

every night that may be contributing to

how much you wake up at night other

things that can irritate the bladder are

citrusy fruits and juices sometimes

tomato based products so lopine while we

say it's great sometimes it can irritate

the bladder lining so you sort of have

to be thoughtful about that other things

could be spicy foods for some people

artificial sweeteners and even

carbonated beverages I've made a whole

video on bladder irritants on my YouTube

channel so check that one out if you

want to review a little more detail

about these the other thing is

specifically at dinner what are you

drinking at dinner if you're waking up

at night a lot that would be where I

would start versus if your symptoms are

more during the day then I would look at

what you're drinking throughout the day

also how much are you drinking before

bedtime if you're drinking a lot before

bedtime like within the last 2 hours

before bed you're definitely going to

wake up more so I'll tell patients to

try to limit how much they're drinking

before bed so that they can see if

there's a difference the next thing is

constipation a lot of people don't

realize that constipation will actually

make their bladder symptoms worse

because when you're constipated the

stool is filling up the rectum which is

right behind the bladder and it pushes

against the bladder making it more

sensitive and making its symptoms much

much worse so making sure you're not

constipated is very helpful I've made

some content on my YouTube channel about

a bow recipe that I often use you can

also try mirx over the counter um or

natural regimen like prunes can be very

helpful in reducing constipation and as

we've already mentioned weight loss can

be helpful in fact reducing even 8% of

your body weight can significantly

improve your urinary symptoms and lastly

if you are smoking quit smoking smoking

is a huge bladder irritant so please

consider stopping smoking for not just

your prostate but for your bladder for

your lungs for all the areas of your

body that are being affected by the

chemical in smoking now if you've tried

conservative management if you've tried

to prevent enlargement if you've tried a

supplement what can you do next let's

talk about medical treatment so in this

podcast I'm not going to cover surgical

treatments because there are so many new

treatments and I want to make sure I

give that topic the time it deserves so

I'm going to do a whole episode on

surgical treatment of BP if you're

interested in learning about a specific

surgical option make sure you comment in

the YouTube comment or leave a comment

on Spotify where I can see it and make

sure that I cover all the different

types of surgical interventions so the

most common medical treatment is called

alpha blockers these are often known as

telosin or brand named Flomax or

alfuzosin these work by relaxing the

prostate and bladder neck muscles this

then makes urination easier because the

urine can flow better across those

relaxed smooth muscles now these work

quite well usually takes about a month

to see full effect but very often they

can work even sooner than that sometimes

they do have some side effects the one

that I always caution my patients about

is retrograde ejaculation now tamsulosin

which is the most commonly prescribed

one has a very high rate of retrograde

ejaculation and what that means is that

when you ejaculate you will have a lower

volume or no volume because it will be

going back into the bladder rather than

going out towards the opening

fortunately we do have other options

like alfuzosin which has a lower risk of

retrograde jaculation and so that is a

risk the other one is that some people

can get dizzy when they stand up too

quickly so they stand up quickly and

they get um a little dizzy and then they

have to sit back down also if you have

to have surgery on your eyes it can

cause cause what we call floppy Iris

syndrome so if you're about to have any

surgery on your eyes make sure to tell

your urologist they don't prescribe this

because otherwise it can make that

surgery much more difficult for the

opthalmologist are you feeling in a rut

in the bedroom wishing you had the kind

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of medication is called a five Alpha

reductase Inhibitors these are

medications called finasteride or

dutasteride and how they work is they

block the conversion of testosterone to

DHT and remember the pro at is very

sensitive to DHT and then this works by

shrinking the prostate these can take a

long time to work sometimes it can go as

early as 3 months sometimes it can take

as long as 9 months to see a benefit

these medications in lower doses are

also used for hair loss so that may be a

nice side effect however there's two

other major side effects I want you to

know about one is that a small subset of

people have sexual side effects that are

very bothersome in terms of affecting

libido

and that can be very serious because it

can take a long time to go away and I've

talked about these in more detail on a

YouTube video about finasteride and

tamsulosin so I'll link that here the

other side effect to know about is that

it doesn't cause prostate cancer however

if you're taking these medications they

reduce your PSA which is a screening

test for prostate cancer by half and

what we found in the data is that when

you're taking these medications if you

get prostate cancer you are more likely

to have a higher grade prostate cancer

than if you weren't taking the

medication now it doesn't mean again

that it causes prostate cancer but there

is this risk and I I suspect that part

of it is due to the fact that it's

having your PSA and so when you look at

that number in your mind in your

doctor's mind it should be doubled for

screening purposes now the last

medication that many people don't

actually talk about is phosphodiesterase

5 Inhibitors and these are essentially

tadalfil which is the medication we we

use for erections but at low doses it

works by relaxing again the smooth

muscle to help with prostatic symptoms

it's actually a great medication

particularly if you're having both

erectile dysfunction and BPH because you

take one medication it will help with

both side effects can be sort of having

head cold symptoms um stuffiness or

congestion uh or muscle aches but

usually at the low dose I find that most

people do pretty well now you can use

combination you can take both alpha

blockers and five Alpha reduce

Inhibitors most commonly Flomax and

finasteride and they've shown in very

good solid trials that this is even

better for large prostates and those who

have more severe symptoms and so talk to

your doctor make sure you're maximizing

your medical therapy if you want to

avoid having surgery because we can do

higher doses of the medication or take

more than one medication at a time to

see if we can improve your symptoms

without needing surgery now the good

news is we now have so many options for

BPH whether they're procedures or

surgeries that can help you achieve

symptom relief so if you're sick of

taking medications or you don't want to

take medications it's a great option to

consider and be on the lookout if you

like this podcast make sure to subscribe

or follow my podcast on whatever podcast

platform you're using or subscribe to my

YouTube channel because I will be doing

a deep dive into all the surgical

options I'll be reviewing the data and

telling you exactly what to expect after

each of these options and I may even

have some guests on who are World

experts in some of these newer options

that we can talk about what you can

expect from the mouth of someone who's

done hundreds if not thousands of these

operations okay guys thank you so much

for joining me on today's episode of the

Reena Malik MD podcast if you found this

episode helpful do me a solid favor tag

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to make the accurate evidence-based

decisions for their bodies and as always

we going to take care of yourself

because you're worth it