Benign Prostatic Hyperplasia & Urinary Incontinence

This piece has been medically reviewed by Susie Gronski, PT, DPT, Medical Advisor to Aeroflow Urology.

Benign prostatic hyperplasia is a condition that can interrupt men’s daily lives and also cause incontinence, but there are ways to manage symptoms of both conditions.

This post will explain benign prostatic hyperplasia and tell you how it relates to incontinence.

We’ll also give some helpful tips on managing your symptoms and show you how to get free incontinence supplies through Aeroflow Urology.

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The Prostate

The prostate, a part of the male reproductive system, is usually the size of a walnut and is located underneath the bladder and urethra, below the penis and rectum.

The prostate’s main job is to aid in reproduction and release sperm and seminal fluids to help protect your sperm.

What Is Benign Prostatic Hyperplasia?

Benign prostatic hyperplasia (BPH), also known as benign prostatic hypertrophy, occurs when glandular tissue, smooth muscle cells, and connective tissue change within the transition zone (located in the center around the prostatic urethra) of the prostate gland.

BPH describes the biological tissue changes that occur which may or may not lead to prostate enlargement and/or lower urinary tract symptoms. If you have BPH, your prostate volume can grow past its typical size of a walnut to the size of a tennis ball.

Enlarged prostates usually occur in men as they age; about 90% of men over 80 are diagnosed with the condition. BPH can interrupt your quality of life by causing lower urinary tract symptoms, such as urinary retention, urinary tract infections (UTIs), different types of urinary incontinence, worsened sexual function, and kidney and bladder problems.

The term benign prostatic hyperplasia (BPH) is often misunderstood. Firstly, it’s important to note that prostate cancer is not BPH, as indicated in the word “benign,” meaning not cancerous. Secondly, BPH in and of itself is not a medical concern.

Diagram of male anatomyDiagram of male anatomy

Symptoms 

While not all men with BPH will develop lower urinary tract or incontinence symptoms, some symptoms of BPH include:

  • Urinary retention (being unable to pee) and inability to empty the bladder fully.
  • Blood in urine.
  • Retrograde ejaculation.
  • Post-void dribbling.
  • Increase in frequency of urination.
  • Urinary dribbling.
  • Poor urine flow.
  • Urinary tract infection (UTI).
  • Intense urge to urinate.

 There has been no clear correlation between the size of the prostate gland and symptom severity.

Causes

The exact cause of BPH is unknown. It has been considered a complex symphony of biological and environmental influences. Some postulated reasons why BPH/BPE may develop include aging and hormonal influences (e.g., testosterone, dihydrotestosterone), upregulated local and/or systemic immune responses, insulin resistance, diminished circulation to bladder and prostate tissues, obesity, race (African Americans have a greater propensity for BPH), excessive alcohol consumption, and physical inactivity.

It is normal to see histological prostate changes (BPH) as men age. BPH has been reported to begin before 30 years old with an increase in evidence of these changes commonly observed around 40-45 years old and increases in prevalence with age thereafter. These changes may or may not lead to symptomatic prostate enlargement. The rate and onset of these changes is highly variable and unique to the individual. Interestingly, some researchers have documented a decrease in prostate size in some men as they age.

Risk Factors

Risk factors of BPH can increase men’s probability of developing the condition. These factors include:

  • Obesity or low levels of physical activity.
  • Genetic predisposition to BPH.
  • Aging (being over 50 years old).
  • Erectile dysfunction (ED).
  • Diabetes
  • Heart disease.

How Is BPH Diagnosed?

The diagnosis for BPH happens through a healthcare provider and usually consists of the following urodynamic tests:

  • Urinalysis (urine test).
  • Digital rectal exam.
  • Uroflowmetry tests.
  • Urinary flow test.
  • Post-void residual volume test.
  • Monitoring
  • Prostate-specific antigen (PSA level) blood test.
Old man at the doctor for BPH symptomsOld man at the doctor for BPH symptoms

How Are BPH & Incontinence Related?

Urinary Incontinence is described as a loss of bladder control resulting in an unintentional loss of urine.

Urinary incontinence in men who have BPH occurs due to the prostate growth squeezing the urethra. In addition, the bladder wall lining also thickens during this growth process. These symptoms cause the bladder muscles to weaken, leading to different types of urinary incontinence.

Your urethral tubes extend out of the bladder and through the prostate and the penis. Usually, when your brain receives signals that it’s time to urinate, your bladder muscles contract and urine flows through the path of the urethral tube and exits out of your penis.

But, when you have BPH, your enlarged prostate irritates your bladder and can block urine from passing through your urethra. This can create painful urination, urinary retention, and other incontinence symptoms, such as urinary leakage.

Prostatic enlargement may be accompanied by lower urinary tract symptoms (LUTS) side effects and different types of urinary incontinence, such as:

  • Urge incontinence: Increased urinary frequency and intense urge to urinate often.
  • Stress incontinence: Leaking urine when sneezing, coughing, laughing, lifting heavy objects, or exercising.
  • Overactive bladder (OAB): Urinating more frequently than usual.
  • Overflow incontinence: Not being able to empty the bladder fully, leading to dribbling urine.
  • Nocturia: Bedwetting or urinating at night.
  • Post-void dribbling: Dribbling urine after uriniating.
  • Acute urinary retention: Not being able to urinate or empty the bladder fully.

The most common types of urinary incontinence in men with BPH are stress urinary incontinence, post-void dribbling, and urge incontinence.

Treatment & Management for BPH & Incontinence

While incontinence and BPH can interrupt your daily lifestyle, there are ways you can manage and treat your symptoms. 

Although our biology is quite complex and constantly changing, the solutions to our health can be rather simple. Being proactive with lifestyle factors such as sleep, nutrition, physical activity, and mental health can optimize prostate health and reduce the risk factors associated with BPH/BPE and urinary incontinence.

Management of benign prostatic hyperplasia can be achieved by following these tips. You should also speak with your healthcare provider about the following treatment options.

How to manage BPH & Incontinence chartHow to manage BPH & Incontinence chart

Incontinence Products

Male incontinence products, such as incontinence shields, male guards, and adult briefs or pull-ons, can help you resume the activities you love while keeping you confident and protected from urinary leakage.

Incontinence Shield: Best for light urinary incontinence.

Male Guard: Made for light to moderate incontinence.

Adult Brief for Men: Made for moderate to heavy incontinence.

Adult Pull-on: Best for moderate to heavy incontinence.

Aeroflow Urology may be able to supply you with free incontinence products through your Medicaid or other private insurance plan.

To see if you qualify, fill out our eligibility form. If you’re eligible, one of our Continence Care Specialists will reach out to give you all the information you need to complete the process. After that, your products will be sent to your front door in unmarked packaging for discreet delivery.

Watchful Waiting

One of the first steps your healthcare provider or urologist may take in treating BPH and incontinence is monitoring your symptoms.

This can help you and your provider understand the severity of symptoms and determine what type of incontinence your BPH is causing. Your healthcare provider may use the International Prostate Symptom score chart to diagnose your severity. You may also undergo yearly physical exams with your provider to monitor the progress of your benign prostatic enlargement.

If you have more severe symptoms, your healthcare provider may skip the monitoring phase and suggest immediate medical therapies.

Medications for treating benign prostatic hyperplasiaMedications for treating benign prostatic hyperplasia

Medications

Certain medications can help relieve incontinence symptoms, such as:

  • Alpha-blockers, such as Doxazosin, Silodosin, Alfuzosin, and Tamsulosin, work to relax your bladder and prostate muscles.
  • 5-Alpha reductase inhibitors, such as Dutasteride and Finasteride, block Dihydrotestosterone (DHT) to help shrink the prostate and help you urinate.
  • Phosphodiesterase-5 inhibitors (PDE5Is) relax the bladder and prostate’s smooth muscle fibers to help decrease chronic inflammation of the prostate.
  • Combination therapy that consits of using different types of medications to lessen symptoms.

Surgical Treatments

If your symptoms are more severe or if you have frequent UTIs or bladder stones, your healthcare provider may recommend one of the following types of surgery. Some of these surgeries can be done as an outpatient and some treatments may require hospital stays.

  • Transurethral Resection of the Prostate (TURP): Your provider will remove tissue inside the prostate, allowing urine to flow normally.
  • Water Vapor Thermal Therapy: Healthcare professionals will use steam to destroy the cells of the prostate, shrinking the size of the prostate.
  • Transurethral Incision of the Prostate (TUIP): Small incisions are made in your bladder neck (the area where the bladder, prostate, and urethra connect) to lessen pressure and increase urine flow rate.
Man speaking with doctor about incontinence symptomsMan speaking with doctor about incontinence symptoms
  • Catheterization: A catheter is inserted into your urethra and bladder to help expel urine. You can get low-cost catheter supplies shipped to your home through Aeroflow Urology and your insurance if you’re eligible. Find out if you qualify today.
  • Laser Therapy: Laser therapy, such as ablation, use lasers to destroy prostate tissue that causes bladder outlet obstructions, clearing the path for urine to exit.
  • Prostatectomy / Prostate Surgery: The prostate is completely removed from the body.

For further information on treatments for BPH, read the American Urological Association’s list of procedures and medical treatments and see the AUA Guidelines.

Other treatments for BPH include:

  • Pelvic floor exercises.
  • Regular physical exercise.
  • Adequate sleep (7-8 hours per night).
  • Eating more plant-based foods.
  • Stress reduction, such as meditation.

How Aeroflow Urology Can Help

Managing BPH and incontinence symptoms can be challenging at times. Let Aeroflow Urology help you find and receive the perfect incontinence or catheter products at little to no cost through your Medicaid or other private insurance plan to make your life a little easier.

All you need to do to get started is put your information into our Qualify Form.

If you’re approved, our team will help you gather the necessary prescription from your doctor. We’ll also help you understand our incontinence products and send you free samples before deciding which ones are right for your lifestyle.

Once you’ve chosen your products, they’ll be delivered right to your doorstep each month. In addition, we’ll send you text or email reminders to let you know when to restock products so you’ll never run out.

References:

Urology Care Foundation. (2019, May). Benign Prostatic Hyperplasia (BPH): Symptoms, Diagnosis & Treatment - Urology Care Foundation. Www.urologyhealth.org. https://www.urologyhealth.org/urology-a-z/b/benign-prostatic-hyperplasia-(bph)

Benign Prostatic Hyperplasia (BPH) Guideline - American Urological Association. (n.d.). Www.auanet.org. https://www.auanet.org/guidelines/guidelines/benign-prostatic-hyperplasia-(bph)-guideline

‌International Prostate Symptom Score (IPSS). (n.d.). Reference.medscape.com. https://reference.medscape.com/calculator/338/international-prostate-symptom-score-ipss


Dr. Susie Gronski, PT, DPT

Specializing in men’s pelvic and sexual health, Susie Gronski, PT, DPT is a Medical Advisor and Writer for Aeroflow Urology and a licensed doctor of physical therapy, certified pelvic rehabilitation practitioner, Michigan-trained sex counselor and educator, international teacher, and author of "Pelvic Pain The Ultimate Cock Block: A No-bullshit Guide for Men Navigating Through Pelvic Pain." Learn more at www.drsusieg.com

Disclaimer

Information provided on the Aeroflow Urology blog is not intended as a substitute for medical advice or care from a healthcare professional. Aeroflow recommends consulting your healthcare provider if you are experiencing medical issues relating to incontinence.

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