Since an enlarged prostate puts pressure on the urethra and irritates the bladder, typical symptoms include difficulty urinating and holding urine.

The enlarging prostate gland narrows the urethra which causes the urine flow to become weak and often intermittent. Men have to therefore exert much more effort when urinating. After urinating, men often have a feeling of not having completely emptied the bladder, due to a body forming around the prostate area and putting pressure on the bladder. Behind the body, a pocket forms which gradually accumulates urine that cannot overcome this obstacle. This is also associated with a more frequent urge to urinate, accompanied by an urgent need to urinate as quickly as possible or in some cases, spontaneous leakage of urine (incontinence).

Other symptoms of an enlarged prostate include nocturia, a frequent need to urinate at night that wakes the patient from sleep. A frequent sign is also post-void dribbling where there is still a small leakage of urine after voiding the bladder (usually right after leaving the bathroom). An enlarged prostate can sometimes cause a urinary tract infection, which manifests as burning and sharp pain when urinating.

Typical signs of BPH:

• Delayed onset when urinating.
• A weak or intermittent stream of urine.
• Frequent dripping of urine.
• Feeling of incomplete emptying.
• Constant urge to urinate.
• Frequent urination during the day and night.

These symptoms can significantly impair patients' quality of life and often force them to change their day to day habits. For example, men avoid drinking liquids before bedtime, shy away from public events or are conscious to always have a bathroom present somewhere near them. In addition, the problems escalate over time and may later lead to urinary retention, where the patient cannot urinate at all.

There are nerves and blood vessels around the prostate gland that are responsible for erection. For this reason, some patients with an enlarged prostate may experience various types of other difficulties which include:

• Erectile dysfunction.
• Painful ejaculation.
• Presence of blood in the ejaculate.

It is recommended you see a doctor if you experience the problems described above. Only they can make a diagnosis and rule out more serious diseases that show similar symptoms in early stages. To assess your problems, it is recommended to complete the International Prostate Symptom Score (I-PSS). You can take the test here.

If you are over 50 years old, or over 40 years old with family history of prostate cancer, get preventive screenings at intervals recommended by your doctor, usually every one to two years.

Do not defer seeing your doctor if:

• You discover blood in your urine or semen.
• You have pain in your lower abdomen or lower back.
• You cannot hold your urine.
• You stop urinating altogether.

If your symptoms are mild or do not bother you significantly, your doctor will probably recommend monitoring and regular check-ups. Symptoms of BPH may lessen over time, without the need for medication.

It is advisable to make lifestyle adjustments, such as limiting smoking (nicotine irritates the bladder), limiting drinking coffee, alcohol, strong tea, and avoid large amounts of fluids at night. However, total daily fluid intake should not fall below 1.5 litres. It is also recommended to prevent constipation.

For more advanced forms of BPH (with moderate symptoms), your doctor will prescribe medicine to help ease the course of the disease. There are two main types of drugs:

• Alpha blockers - relax the tension of the smooth muscles of the prostate and bladder neck, thus improving the outflow of urine, the effect takes about 1-2 weeks
• 5 - alpha reductase inhibitors - these affect the production of sex hormones, especially testosterone, which suppress excessive growth of prostate cells.

The two groups of drugs can sometimes be combined or used together with herbal preparations. However, these drugs may also present side effects, including changes in the patient’s sex life such as erectile dysfunction, ejaculatory dysfunction and loss of libido.For cases where symptoms do not subside after taking the medication or the enlarged prostate is causing significant discomfort, the doctor will recommend alternative possible solutions:

• A modern treatment option for BPH is the Rezūm™ Water Vapor Therapy – sterile water vapor is released throughout the enlarged prostate tissue to destroy excess cells. When the steam comes into contact with the prostate tissue, it liquifies and all the stored energy kills the affected cells of the excess tissue. The Rezūm treatment is suitable for prostate swelling of 30 to 80 ml in size. Its main advantages are quick results while protecting erectile function.
• Another conservative method used for the treatment of enlarged prostate symptoms or chronic inflammation is shockwave therapy. In this non-invasive procedure, the tissue of the human body is exposed to short sound pulses. As a result, it promotes regeneration of the affected tissue, as well as growth and remodelling of new blood vessels. The new blood vessels improve blood flow and oxygenation, leading to faster healing of the tissue.

In cases where conservative treatment is not effective, the doctor will suggest a surgical solution:

• • Transurethral resection of the prostate (TURP), i.e. removing part of the prostate through the urethra – performed on small prostates (under 30 ml) or in younger patients.
  • Transurethral incision of the prostate (TUIP) – incision of the bladder neck - for prostates of 30-80 ml.
  • Open surgery, prostatectomy – the affected part of the prostate is removed through an incision, most often through the lower abdomen - for prostates with a significantly large volume over 80 ml.

Herbal remedies for the treatment of BPH are relatively safe and well tolerated, however their effect has not been sufficiently proven amidst clinical studies. Thus, many unanswered questions remain regarding the specific composition, extraction, quantification as well as the mechanisms regarding the effect of these substances.

These include:

• Stinging nettle root
• Calendula
• Lesser celandine
• African plum
• Purple coneflower
• Narrow-leaved fritillary
• Pumpkin seeds
• Dwarf palm (Saw Palmetto)

The use of herbal remedies is not universally recommended because of their uncertain effect. However, if you have mild symptoms of BPH and would like to try an alternative therapy, talk to your pharmacist or doctor about whether this treatment is suitable for you and what products are recommended.