Understanding BPH: What Every Man Needs to Know for Better Prostate Health

By Dr. David Samadi

Benign Prostatic Hyperplasia (BPH), or an enlarged prostate, is one of the most common conditions affecting men, particularly as they age. By the time men reach their 50s, about half of them will experience symptoms of BPH, and the prevalence increases as they get older—affecting up to 90% of men over 80. Although BPH can lead to uncomfortable symptoms, it’s important to remember that it is a non-cancerous condition and will not increase the risk of prostate cancer.

If you’re a man over 40, understanding the basics of BPH and how to manage it can significantly improve your quality of life. Here’s a breakdown of key facts about BPH and helpful strategies for managing the condition.

What Is BPH, Really?

BPH is when the prostate gland can experience enlargement, typically as men age. A younger (age 35 or less) man’s prostate gland is about the size of a walnut. By the time a man reaches the age of 40, it may have grown to the size of a small apricot. This prostate growth will continue to enlarge with age so that older men may have a prostate the size of a lemon or bigger. 

For the majority of men, this enlargement will create urinary issues since the prostate surrounds the urethra, the tube that carries urine from the bladder. Prostate enlargement will put pressure on the urethra, leading to urinary symptoms often resulting in quality-of-life issues. 

“Benign” means the condition is not related to cancer, and while BPH and prostate cancer can share similar symptoms, BPH does not increase the risk of developing prostate cancer.

Why Does BPH Happen?

The cause of BPH remains unclear, has been shown to be linked to hormonal changes that occur with aging. Specifically, the balance of male hormones shifts over time. Men produce testosterone throughout their lives, but as they age, the active levels of testosterone decrease, while estrogen levels slightly increase. This hormonal change may trigger prostate cell growth, leading to prostate enlargement.

Another factor is dihydrotestosterone (DHT), a potent form of testosterone that stimulates prostate cell growth. Even though testosterone levels drop with age, DHT levels can remain high in the prostate, encouraging continued growth of the gland.

What Are the Symptoms of BPH?

BPH is associated with a range of urinary symptoms, including:

• Frequent or urgent need to urinate
• Weak or slow urine flow
• Difficulty starting urination
• Dribbling after urination
• Inability to fully empty the bladder
• Waking up multiple times at night to urinate

Not all men will experience all of these symptoms, and the severity depends on the extent of prostate enlargement. In many cases, BPH is considered a benign condition unless symptoms significantly affect daily life.

Can BPH Be Prevented?

While there is no guaranteed way to prevent BPH, maintaining a heart-healthy lifestyle can help protect your prostate. The same habits that promote good cardiovascular health—such as managing blood pressure, cholesterol, and blood sugar—can also support prostate health. Maintaining a healthy weight is particularly important, as research shows that overweight and obese men are at a higher risk of developing BPH.

The Role of Weight and Waist Size

Excess abdominal weight is particularly associated with an increased risk of BPH. To assess whether you have excess weight, you can calculate your Body Mass Index (BMI). Here’s how:

1. Multiply your weight in pounds by 703.
2. Multiply your height in inches by itself.
3. Divide the result from Step 1 by the result from Step 2.

For example, if you weigh 215 pounds and are 5’10” (70 inches tall):

• Step 1: 215 x 703 = 151,145
• Step 2: 70 x 70 = 4,900
• Step 3: 151,145 ÷ 4,900 = 30.8 (BMI of 31, which falls in the obese category).

Here’s a breakdown of BMI categories:

• Under 18.5 – Underweight
• 18.5 to 24.9 – Normal weight
• 25 to 29.9 – Overweight
• 30 or higher – Obese

Maintaining a healthy BMI and reducing waist size can help lower the risk of BPH and other health problems.

Tips for Managing BPH Symptoms

Even though there is no quick fix for BPH, there are several ways to manage symptoms and improve quality of life. Here are a few practical tips:

1. Relax and Take Your Time: Don’t rush when urinating. Try to relax and allow your bladder to fully empty.
2. Practice “Double Voiding”: After urinating, take a brief pause and try to go again to ensure your bladder is completely emptied.
3. Spread Fluid Intake Throughout the Day: Drink fluids consistently throughout the day, but limit the amount in the evening by stopping fluids at least 2-3 hours before bedtime to reduce nighttime trips to the bathroom.
4. Be Mindful of Medications: Certain medications, such as antihistamines, decongestants, or some pain medications, can worsen BPH symptoms. Talk to your doctor about the impact of any medications you’re taking.

Practical Lifestyle Changes for BPH Management

Managing BPH also requires healthy lifestyle choices, including:

• Maintain a Healthy Diet: Eat balanced meals rich in fiber, lean proteins, fruits, and vegetables. Aim for 25-30 grams of protein and at least 10 grams of fiber every meal.
• Watch Portion Sizes: Use the MyPlate method to guide meal portions: vegetables should fill half of the plate, one-quarter with lean protein, and the other with healthy grains.
• Limit Sugary Drinks: Swap sugary sodas or energy drinks for water or unsweetened tea.
• Reduce Alcohol Intake: Alcohol contributes to abdominal weight gain and can interfere with bladder function, so limit consumption.
• Exercise Regularly: Aim for at least 150 minutes of moderate activity each week. Exercise helps with weight management, particularly around the abdominal area.

Conclusion

BPH is a common condition for aging men, but with the right knowledge and healthy habits, its impact can be minimized. A couple of ways to achieve this is to reach and maintain a healthy weight, keep physically active, and practice good urinary habits, which can help reduce severe symptoms and improve overall prostate health. If you’re experiencing symptoms of BPH, don’t hesitate to discuss with your doctor treatment options and find the best path forward for your health. 

Dr. David Samadi is the Director of Men’s Health and Urologic Oncology at St. Francis Hospital in Long Island. He’s a renowned and highly successful board certified Urologic Oncologist Expert and Robotic Surgeon in New York City, regarded as one of the leading prostate surgeons in the U.S., with a vast expertise in prostate cancer treatment and Robotic-Assisted Laparoscopic Prostatectomy.  Dr. Samadi is a medical contributor to NewsMax TV and is also the author of two books, Prostate Cancer, Now What? A Practical Guide to Diagnosis, Treatment, and Recovery, and The Ultimate MANual, Dr. Samadi’s Guide to Men’s Health and Wellness, available online both on Amazon and Barnes & Noble. Visit Dr. Samadi’s websites at robotic oncology and prostate cancer 911.