What To Do When The Prostate Swells

Normally, the prostate gland is about the size of a walnut. It’s attached to the base of the bladder. The urethra, which is the tube that carries urine out of the body, goes right through the prostate gland. 

In most men, the prostate gland slowly grows with time. This type of growth is not cancer. It’s benign, meaning it is not life-threatening. The medical name for this condition is benign prostatic hyperplasia (BPH). “Hyperplasia” means tissue growth. More than half of men over age 60 have signs of BPH, and about 90% of men over age 70 have this condition.

Many men have an enlarged prostate and don’t know it, but sometimes the swelling causes problems. Because the prostate wraps around the urethra, as it grows, it can close like a fist, squeezing the urethra. This typically causes the bladder to fill up too much, while at the same time making it harder to empty the bladder fully. The most common consequence is frequent waking during the night to pee. 

That may sound like a minor problem, but it’s not. The frequent waking interrupts sleep, and as a nation, we’re sleep-deprived enough as it is. Sleep is one of the most important ingredients of a person’s overall health, so it’s important to treat BPH if it’s causing a problem.

The first thing to do is to visit your doctor to confirm that the problem is, in fact, BPH. A quick digital rectal exam will confirm an enlargement and, if there’s any doubt, other tests can be done to rule out cancer or other issues. If BPH is the culprit, you’ve got a number of options.

The simplest thing to try is limiting your intake of liquids—particularly alcoholic liquids—near bedtime. Alcohol stimulates urination and, of course, the extra liquid adds to the load of urine in your bladder.

If that doesn’t work, there are two types of medications that can help:

Alpha blockers relax the muscles in the prostate and bladder. This can improve urine flow. Alpha blockers do not usually reduce the size of the prostate. They are usually taken as pills once or twice a day, and work almost immediately. Side effects can include headaches, dizziness, light-headedness, fatigue, and changes in the way you ejaculate.  5-alpha-reductase inhibitors are pills that can improve urine flow and reduce the size of the prostate. It may take as long as six months to a year, however, for the drugs to work fully. Side effects can include erection problems, low sexual desire, and reduced semen release during ejaculation.

Sometimes the two types of medications can be used at the same time, which can give men quick relief of symptoms while the longer-acting drugs begin to shrink the prostate. Interestingly, some recent studies and shown that sildenafil (aka Viagra) can improve symptoms of BPH when taken daily. Although we know clearly why Viagra and similar drugs boost erections, it’s not clear how they improve BPH symptoms because the men who say it has helped them don’t show any evidence of improved urine flow. Before you try popping a daily Viagra, it would be wise to wait for more research... but it’s certainly an intriguing line of inquiry and suggests, at the very least, that if you’re already using Viagra, you may be helping any BPH symptoms you may be feeling.

The bottom line is that BPH may technically be “benign” but the consequences of the frequent nighttime waking are not, so it pays to get checked out sooner rather than later.