24:00 – Why daily tadalafil works for BPH, erections & heart health
30:00 – The pros and cons of alpha-blockers & 5-AR inhibitors
02:30 – Meet Dr. Robert Caruso: 25 years in urology and robotic surgery
What if an enlarged prostate didn’t have to mean surgery, catheters, and a long recovery? In this episode, Dr. Geo sits down with Dr. Robert Caruso, board-certified urologist and surgeon at RWJ Barnabas Health, to discuss modern BPH treatments that combine medical precision with a holistic mindset. From vapor therapy to lifestyle changes, learn what really restores a man’s comfort, sleep, and confidence.
Episode Summary:
Dr. Geo and Dr. Caruso go beyond “just the prostate” to explain why urinary symptoms can stem from your spine, sleep, metabolism, and lifestyle—not only gland size. You’ll hear how Dr. Caruso’s Italian “blue zone” roots and 98-year-old mother inspired his whole-body approach to men’s health. They cover everything from tadalafil’s triple benefit (for BPH, erections, and heart health) to when surgical options like bipolar TURP, UroLift, Rezūm, or iTind make sense.If you’re considering treatment for an enlarged prostate—or want to understand your options before surgery—this episode breaks it all down clearly.
CHAPTERS
00:00 – Introduction: The truth about enlarged prostate and surgery
02:30 – Meet Dr. Robert Caruso: 25 years in urology and robotic surgery
05:00 – Italian roots, family garden & the “blue zone” lifestyle
07:00 – Lessons from his 98-year-old mother (and her showdown with a bear)
10:00 – How lifestyle, diet, and movement affect prostate health
13:00 – Not all urinary problems are from the prostate
15:30 – Hidden factors: spine, constipation, and sleep apnea
20:00 – Case study: Dr. Caruso’s mom, AFib & oxygen connection
24:00 – Why daily tadalafil works for BPH, erections & heart health
30:00 – The pros and cons of alpha-blockers & 5-AR inhibitors
33:00 – Natural support: saw palmetto, M-Enatium, and anti-inflammatory herbs
37:30 – TURP explained: what “bipolar” really means and why it’s safer
42:00 – UroLift: the 5-minute in-office “curtain holder” procedure
46:00 – Rezūm steam therapy: how it works and who benefits
50:00 – iTind: the temporary stent with long-term relief
53:00 – Final thoughts: choosing the right approach for your BPH
If you're waking up three, four, or five times a night to use the bathroom, you're not alone. Thousands of men deal with enlarged prostate problems every single day. The good news? You don't have to live with this frustration anymore. Modern medicine has come a long way, and there are way more options available now than just surgery. In fact, there are several treatments that can help you feel like yourself again without the long recovery times your dad might have had to deal with.
This guide breaks down everything you need to know about BPH treatment—from simple lifestyle changes to advanced medical options. Whether you're looking for natural approaches or ready to explore surgical solutions, we'll help you understand what's really going on with your body and what your actual choices are.
BPH stands for benign prostatic hyperplasia. That fancy term just means your prostate gland has gotten bigger. Your prostate is a small walnut-sized gland that sits below your bladder. As men get older, this gland naturally tends to grow. For some guys, it gets so big that it squeezes the tube you pee through, making urination difficult.
Here's something important that a lot of men don't know: a bigger prostate doesn't always mean you'll have problems. Some men have enormous prostates the size of oranges and never have a single urinary symptom. Meanwhile, other men with smaller prostates can have serious urinary issues. This tells us that prostate size alone isn't the whole story. That's why your doctor needs to understand what's actually bothering you, not just how big your prostate is.
The symptoms of BPH can vary from guy to guy. Some men experience mild annoyances, while others find their symptoms seriously impact their quality of life. Common signs include:
Nighttime Issues - Getting up multiple times during the night to urinate is one of the most common complaints. Some men find themselves waking up three, four, even five times a night. This constant sleep interruption can make you exhausted during the day.
Daytime Frequency - You might find yourself heading to the bathroom every hour or two, even when you haven't drunk much fluid. This can be embarrassing at work or make it hard to enjoy activities with family.
Weak Stream - The strength of your urine stream might decrease. Instead of a strong flow, you get a weaker stream that takes longer to finish.
Urgency - You might feel like you need to go right now, even when your bladder isn't that full. This urgent feeling can interrupt what you're doing.
Hesitation - Sometimes there's a delay when you start urinating, or you might have trouble getting started at all.
Incomplete Emptying - You might feel like you haven't fully emptied your bladder even after using the bathroom.
Before jumping to medications or procedures, it's worth knowing that lifestyle factors play a bigger role than many men realize. A board-certified urologist and men's health expert explains that his approach always starts with understanding the whole picture of a patient's life.
What You Drink Matters - One of the first questions your doctor should ask is what you're drinking throughout the day. If you're consuming a lot of caffeine—coffee, tea, energy drinks, or soda—you're working against yourself. Caffeine acts as a diuretic, which means it makes your body produce more urine. That's the last thing you need when you're already dealing with urinary frequency. The same goes for sugary drinks and excessive alcohol.
Pay attention to how much water you're actually drinking, too. Many men don't realize they're consuming way more fluid than they think, which naturally increases bathroom trips. Your doctor can help you figure out the right balance.
Back and Neck Pain Can Make Things Worse - This might sound strange, but back problems can actually contribute to urinary frequency and urgency. If you have chronic lower back pain or a herniated disc, the nerve irritation from those issues can send signals to your bladder to contract more often. Even neck pain can play a role because of how the nerves connect to your bladder from your brain stem.
If this applies to you, your doctor might recommend good posture, lumbar support when sitting, a firm mattress, and most importantly, building core strength. Stronger core muscles brace your spine, reduce daily compression of the nerves, and can actually decrease urinary frequency and urgency.
Constipation Is Connected to Your Bladder - Most guys don't think about this, but your bowels and bladder are neighbors. When your colon is full and constipated, it puts direct pressure against your bladder. Plus, there's a neurological connection between your bowel and bladder through the same nerve pathways. A high-fiber diet with both soluble and insoluble fiber can improve your digestion and take pressure off your bladder.
Sleep Apnea Might Be the Real Culprit - Here's one that catches a lot of men off guard: if you're getting up multiple times every night to urinate, especially if you're producing large amounts of urine rather than just frequent small amounts, sleep apnea could be the real problem. Sleep apnea means you stop breathing briefly during sleep, which reduces oxygen to your brain. Your body responds by raising blood pressure to get more blood to your brain. That high blood pressure triggers your body to release natural diuretics, which makes you produce more urine.
If you're tired during the day, wake up with headaches, have high blood pressure, or experience memory issues, talk to your doctor about getting a sleep study. Treating sleep apnea can sometimes solve the nighttime urination problem without ever treating the prostate.
Eat Fresh, Local Food When You Can - This might sound simple, but it really works. Food that comes from your local farmer's market or, even better, from your own garden, is more nutrient-dense than produce that's been shipped across the country. That apple from New Zealand that's been picked before it's ripe and lost its nutrients during shipping isn't as helpful to your body as an apple from your local orchard. Eating well supports your overall health and can reduce inflammation throughout your body, including in your prostate.
Get a Little Sun and Stay Active - Just 10 minutes of sun exposure does tremendous things for your body. It's not just about vitamin D production (though that's important). Sunlight helps regulate your circadian rhythm and supports your overall health. Being active outside, moving your body, and getting regular exercise all support prostate health and general wellness.
If lifestyle changes aren't enough to manage your symptoms, there are excellent medications available. Your doctor can help determine which one makes sense for your specific situation.
Tadalafil: The Multi-Purpose Medication - Tadalafil is a medication that many men recognize by the brand name Cialis. But here's something surprising: low-dose tadalafil (5 milligrams daily) is actually approved for treating BPH symptoms, not just erectile dysfunction. At this low dose, it's remarkably safe and effective.
What makes tadalafil special is that it can address multiple problems at the same time. For men with BPH symptoms, it relaxes the muscles in the prostate and bladder, making urination easier. For men with erectile dysfunction, it helps improve blood flow. For men with sleep apnea, it dilates the pulmonary arteries and improves blood flow to the heart during sleep. Some research suggests it may even offer cardiovascular benefits.
Many men who take 5 milligrams of tadalafil daily experience few or no side effects. Some might notice mild headaches or slight reflux, but these are uncommon. If you're concerned about using a medication, remember that when a doctor recommends a pharmaceutical option as a game-changer, it's worth considering. You can always discuss concerns with your healthcare provider.
Alpha Blockers: Opening Up the Channel - Alpha blockers are medications like tamsulosin (Flomax) and doxazosin (Cardura). These drugs work by relaxing the muscles in the prostate and bladder neck, making it easier for urine to flow through. They work relatively quickly—often providing relief within days or weeks.
Alpha blockers have minimal side effects for most men. The main downside to know about is that some men experience retrograde ejaculation, which means semen goes backward into the bladder instead of out through the urethra during orgasm. This doesn't hurt, but it does mean there's no ejaculate, which matters if you're planning to have children or if sexual function is important to your quality of life.
5-Alpha Reductase Inhibitors: Shrinking the Prostate - Medications like finasteride (Proscar) and dutasteride (Avodart) work differently than alpha blockers. These drugs actually shrink the prostate by blocking a hormone called DHT (dihydrotestosterone). Over time, the prostate can shrink by 20-30 percent.
However, there are some important things to know. These medications take longer to work than alpha blockers—you won't see real improvement for at least three to six months, sometimes longer. And they don't work for everyone. Shrinking the prostate doesn't always mean your urinary symptoms go away, especially if your real problem isn't obstruction but something else entirely.
These medications are best for older men with very large prostates who are concerned about urine retention or blood in the urine. If you're younger and concerned about your sex drive or erectile function, this probably isn't your first choice. These drugs can affect sexual function more than alpha blockers do.
Combination Therapy - Sometimes your doctor might recommend using both an alpha blocker and a 5-alpha reductase inhibitor together, especially if you have a very large prostate and significant symptoms. The alpha blocker provides quick relief while the 5-alpha reductase inhibitor works over time to shrink the prostate further.
Saw Palmetto and Natural Supplements - Some men prefer natural approaches before trying prescription medications. Saw palmetto is an herb that some studies suggest can help with mild to moderate BPH symptoms. The quality matters tremendously, though. Look for brands that extract the active ingredients from ripe berries rather than ground-up green berries.
Other supplements that may help reduce inflammation and support prostate health include quercetin, curcumin, and boswellia (an Indian herb used traditionally for joint inflammation but with good systemic anti-inflammatory benefits for the prostate). If you're interested in supplements, talk to your doctor or a qualified herbalist about which combination might work for you.
When medications aren't working well enough or you want a more permanent solution, several surgical options are available. The good news is that modern procedures are far less invasive than the surgeries of previous generations. Many can be done in an office setting with minimal recovery time.
Understanding Your Surgical Options - The truth is that all the modern BPH treatment options work well for improving urinary function. Whether you choose one procedure or another often depends on your personal priorities, your prostate size, and what kind of recovery you're willing to deal with. Your doctor can help match the best procedure to your specific situation.
Bipolar TURP: The Gold Standard for Large Prostates - TURP stands for transurethral resection of the prostate. It's been around for decades and remains one of the most effective treatments for large prostates. The word "bipolar" refers to the type of energy used during the procedure.
Here's how it works: Your doctor uses a camera and specialized instruments inserted through your urethra (the tube you pee through) to remove pieces of prostate tissue that are blocking urine flow. There's no external incision—everything is done through the natural opening.
The bipolar version is safer than older monopolar TURP techniques because it uses different technology that reduces bleeding and allows for faster recovery. Most patients can go home the same day. About 90 percent of men are dry enough to leave the hospital on the day of surgery.
The procedure works great for prostates of any size—some urologists have successfully treated prostates weighing 300-400 grams. It might take a couple of hours for a very large prostate, but the results are excellent. The main tradeoff is that some men experience retrograde ejaculation afterward (the same issue possible with alpha blockers).
UroLift: Five-Minute Office Procedure - UroLift is one of the newest options available, and it's remarkably simple. The entire procedure takes about five minutes in an office setting with just local anesthesia and a bit of sedation.
Here's what happens: Your doctor inserts a tiny camera through your urethra and deploys small titanium clips attached to permanent sutures. These clips act like "curtain holders," physically opening up the compressed prostate tissue and holding it open. Depending on your prostate size and shape, you might need anywhere from two to six implants.
The benefits are significant: minimal pain, no external incisions, quick recovery, and very low rates of sexual dysfunction (less than 1 percent experience loss of ejaculation). About two-thirds of men don't need a catheter afterward, and those who do only need it for a few days.
The main limitation is that UroLift works best on smaller to medium-sized prostates (up to about 80 grams, though some experienced surgeons push this limit slightly). If your prostate is very large or if you have a big middle lobe growing into the bladder, UroLift might not be the best choice.
Rezum: Steam Technology for BPH Treatment - Rezum is another minimally invasive option that uses steam to destroy excess prostate tissue. Each treatment spot takes only 9 seconds. The procedure is done through your urethra with local anesthesia.
The way Rezum works is fascinating. Your doctor infuses saline through a needle into the prostate tissue and then delivers radio frequency energy. The saline acts as a conductor, allowing the energy to treat a larger area of tissue than would be possible otherwise. As the treated tissue heals over time, the prostate opens up and relieves the obstruction.
Like UroLift, Rezum is indicated for smaller to medium prostates (up to about 80 grams). Most men only need a catheter for two or three days after the procedure. By 10 days after surgery, most men are urinating better than before. By two to three months, improvement continues as the prostate continues to heal and open up.
Rezum works well for men with a posterior lobe (the back of the prostate) or a moderate-sized middle lobe. Like UroLift, it preserves sexual function in most cases.
iTind: The Temporary Stent Option - iTind is a newer device that represents a different approach. It's a temporary stent that expands the prostate tissue mechanically, creating a spring-like action that opens up the compressed areas. You leave it in place for one week. A string hangs out that you use (with a special device) to pull the stent back out after seven days.
The beauty of iTind is its simplicity and its data. Studies show that five to ten percent of men need to go back on medications within four to seven years—meaning the majority stay symptom-free for years after just one week of having the device in place.
This option is particularly appealing for men who are hesitant about any procedure. It's one of the least invasive options available, yet the results are comparable to more invasive surgeries. It's especially good for tight bladder necks and works well in office-based settings.
Here's the most important thing to understand: there's no one "best" BPH treatment that works for everyone. The right choice depends on several factors:
Your Prostate Size - Very large prostates (over 100 grams) are best treated with bipolar TURP because it can handle any size. Smaller to medium prostates have more options available, including UroLift and Rezum.
Your Priorities - If preserving sexual function (particularly ejaculation) is important to you, UroLift and Rezum have better profiles than bipolar TURP. If you want a permanent solution and don't mind potential sexual side effects, bipolar TURP is highly effective. If you want the absolute minimal approach, iTind might appeal to you.
Your Age and Overall Health - Younger men often prefer to avoid long-term medications, making a minimally invasive procedure attractive. Older men might be fine taking a medication for a few more years.
How Bothered You Are - If your symptoms are mild and lifestyle changes help, medications might be all you need. If your symptoms are severe or you're in urinary retention, you might need a procedure.
Your Doctor's Experience - Having several treatment options available is great, but your specific doctor's expertise with each procedure matters. A surgeon who does bipolar TURP hundreds of times might get better results than someone just learning the technique. Ask your doctor which procedures they perform most frequently and what their outcomes are.
Some men reach a point where they absolutely need medical intervention. If you're unable to urinate at all (acute urinary retention), you need immediate care—usually a temporary catheter while you figure out your treatment plan. If you're experiencing repeated urinary tract infections, kidney problems, or blood in your urine because of your enlarged prostate, medical treatment becomes more urgent.
The good news? Most men who get appropriate BPH treatment report dramatic improvements. They go from waking up multiple times each night to sleeping through. They go from constant daytime urgency to normal bathroom habits. Many say they feel like they got their quality of life back.
If you're experiencing BPH symptoms, the first step is talking to a urologist who takes a comprehensive approach—someone interested in your lifestyle, your full health picture, and all your available options. Don't just accept that surgery is your only choice, and don't assume you have to live with these symptoms forever.
Start with these steps:
First, keep track of your symptoms for a week or two. Write down how many times you get up at night, how often you go during the day, and what's bothering you most. This information will help your doctor understand what's really going on.
Second, think about your lifestyle. Are you drinking too much caffeine? Do you have back pain that could be contributing? Are you experiencing signs of sleep apnea? Making changes in these areas might solve your problem without any medication at all.
Third, schedule an appointment with a urologist who will take time to understand your situation. Don't just accept the first recommendation—ask questions. Ask about your prostate size. Ask what's actually causing your symptoms. Ask about all your options, not just the one your doctor mentions first.
Remember that your urologist's time is valuable, so come prepared with your symptom information and stay focused on your specific concerns. But also know that good urologists understand that taking time to understand the whole picture often leads to better outcomes.
Having an enlarged prostate doesn't mean you're broken or that you have to accept a lower quality of life. Modern medicine offers excellent options, from simple lifestyle modifications to sophisticated minimally invasive procedures. The key is finding an approach that matches your specific situation, your priorities, and your goals.
Whether you choose to start with lifestyle changes and medications or jump to a minimally invasive procedure, know that you have options. You don't have to wake up multiple times each night. You don't have to deal with constant urinary urgency. And you definitely don't have to assume that surgery means weeks of recovery and permanent sexual side effects.
Take action. Talk to your doctor. Explore your options. Get your quality of life back.
Dr. Robert Caruso is a board-certified urologist and surgeon with over 25 years of clinical experience. Based in Bloomfield, New Jersey, and affiliated with Clara Maass Medical Center and Newark Beth Israel Medical Center, Dr. Caruso trained at NYU and completed a fellowship in robotic and laparoscopic urologic surgery.
Dr. Caruso specializes in prostate health, minimally invasive BPH treatment techniques, laser surgery, and bladder and kidney conditions. He's published extensively on prostate cancer, urologic conditions, and advanced surgical techniques. Beyond his clinical work, Dr. Caruso is co-founder of MedPro Wellness and has volunteered worldwide providing surgical care.
Dr. Caruso's approach to urology combines advanced surgical expertise with a deep interest in whole-person health, functional medicine, and preventive care. He's known for taking time with patients to understand their complete health picture before recommending treatment.
Contact Information:
Main Office Locations:
Phone: 973-743-4450
Website: ehurology.com
Insurance: Essex Hudson Urology is now part of RWJ Barnabas Health and accepts most major insurance plans.
Note: New patient wait times can be up to two months, but the office works to fit patients in sooner when cancellations occur. Mentioning you heard about Dr. Caruso on the prostate health podcast may help with scheduling.
This article is for informational and educational purposes only and should not be considered medical advice. The information presented is based on a discussion between healthcare professionals and is meant to help you understand BPH and available treatment options. It is not a substitute for professional medical advice, diagnosis, or treatment.
Every person's situation is unique. What works for one man may not work for another. Before starting any new treatment—whether lifestyle-based, supplement-based, or medical—talk to your healthcare provider. Your doctor knows your complete medical history and can make personalized recommendations based on your specific health situation.
If you're experiencing severe urinary symptoms, blood in your urine, or inability to urinate, seek immediate medical attention.
Always discuss any concerns about your prostate health with a qualified urologist or healthcare professional.
Ready to Take Control of Your Prostate Health?
If you're experiencing symptoms of an enlarged prostate, don't wait. Talk to your urologist about which BPH treatment option makes sense for your situation. Whether you start with lifestyle changes, medications, or a minimally invasive procedure, taking action now can significantly improve your quality of life. Your doctor can help you explore all your options and find the approach that's right for you. Schedule your appointment today and get back to the life you want—including sleeping through the night.
30:00 – The pros and cons of alpha-blockers & 5-AR inhibitors
02:30 – Meet Dr. Robert Caruso: 25 years in urology and robotic surgery
What if an enlarged prostate didn’t have to mean surgery, catheters, and a long recovery? In this episode, Dr. Geo sits down with Dr. Robert Caruso, board-certified urologist and surgeon at RWJ Barnabas Health, to discuss modern BPH treatments that combine medical precision with a holistic mindset. From vapor therapy to lifestyle changes, learn what really restores a man’s comfort, sleep, and confidence.
Episode Summary:
Dr. Geo and Dr. Caruso go beyond “just the prostate” to explain why urinary symptoms can stem from your spine, sleep, metabolism, and lifestyle—not only gland size. You’ll hear how Dr. Caruso’s Italian “blue zone” roots and 98-year-old mother inspired his whole-body approach to men’s health. They cover everything from tadalafil’s triple benefit (for BPH, erections, and heart health) to when surgical options like bipolar TURP, UroLift, Rezūm, or iTind make sense.If you’re considering treatment for an enlarged prostate—or want to understand your options before surgery—this episode breaks it all down clearly.
CHAPTERS
00:00 – Introduction: The truth about enlarged prostate and surgery
02:30 – Meet Dr. Robert Caruso: 25 years in urology and robotic surgery
05:00 – Italian roots, family garden & the “blue zone” lifestyle
07:00 – Lessons from his 98-year-old mother (and her showdown with a bear)
10:00 – How lifestyle, diet, and movement affect prostate health
13:00 – Not all urinary problems are from the prostate
15:30 – Hidden factors: spine, constipation, and sleep apnea
20:00 – Case study: Dr. Caruso’s mom, AFib & oxygen connection
24:00 – Why daily tadalafil works for BPH, erections & heart health
30:00 – The pros and cons of alpha-blockers & 5-AR inhibitors
33:00 – Natural support: saw palmetto, M-Enatium, and anti-inflammatory herbs
37:30 – TURP explained: what “bipolar” really means and why it’s safer
42:00 – UroLift: the 5-minute in-office “curtain holder” procedure
46:00 – Rezūm steam therapy: how it works and who benefits
50:00 – iTind: the temporary stent with long-term relief
53:00 – Final thoughts: choosing the right approach for your BPH
BPH Treatment Options: Your Guide to Enlarged Prostate Relief Without Surgery Hassles
If you're waking up three, four, or five times a night to use the bathroom, you're not alone. Thousands of men deal with enlarged prostate problems every single day. The good news? You don't have to live with this frustration anymore. Modern medicine has come a long way, and there are way more options available now than just surgery. In fact, there are several treatments that can help you feel like yourself again without the long recovery times your dad might have had to deal with.
This guide breaks down everything you need to know about BPH treatment—from simple lifestyle changes to advanced medical options. Whether you're looking for natural approaches or ready to explore surgical solutions, we'll help you understand what's really going on with your body and what your actual choices are.
What Is BPH, Really?
BPH stands for benign prostatic hyperplasia. That fancy term just means your prostate gland has gotten bigger. Your prostate is a small walnut-sized gland that sits below your bladder. As men get older, this gland naturally tends to grow. For some guys, it gets so big that it squeezes the tube you pee through, making urination difficult.
Here's something important that a lot of men don't know: a bigger prostate doesn't always mean you'll have problems. Some men have enormous prostates the size of oranges and never have a single urinary symptom. Meanwhile, other men with smaller prostates can have serious urinary issues. This tells us that prostate size alone isn't the whole story. That's why your doctor needs to understand what's actually bothering you, not just how big your prostate is.
Understanding Your Symptoms
The symptoms of BPH can vary from guy to guy. Some men experience mild annoyances, while others find their symptoms seriously impact their quality of life. Common signs include:
Nighttime Issues - Getting up multiple times during the night to urinate is one of the most common complaints. Some men find themselves waking up three, four, even five times a night. This constant sleep interruption can make you exhausted during the day.
Daytime Frequency - You might find yourself heading to the bathroom every hour or two, even when you haven't drunk much fluid. This can be embarrassing at work or make it hard to enjoy activities with family.
Weak Stream - The strength of your urine stream might decrease. Instead of a strong flow, you get a weaker stream that takes longer to finish.
Urgency - You might feel like you need to go right now, even when your bladder isn't that full. This urgent feeling can interrupt what you're doing.
Hesitation - Sometimes there's a delay when you start urinating, or you might have trouble getting started at all.
Incomplete Emptying - You might feel like you haven't fully emptied your bladder even after using the bathroom.
The Holistic Prostate Health Approach: Start Here First
Before jumping to medications or procedures, it's worth knowing that lifestyle factors play a bigger role than many men realize. A board-certified urologist and men's health expert explains that his approach always starts with understanding the whole picture of a patient's life.
What You Drink Matters - One of the first questions your doctor should ask is what you're drinking throughout the day. If you're consuming a lot of caffeine—coffee, tea, energy drinks, or soda—you're working against yourself. Caffeine acts as a diuretic, which means it makes your body produce more urine. That's the last thing you need when you're already dealing with urinary frequency. The same goes for sugary drinks and excessive alcohol.
Pay attention to how much water you're actually drinking, too. Many men don't realize they're consuming way more fluid than they think, which naturally increases bathroom trips. Your doctor can help you figure out the right balance.
Back and Neck Pain Can Make Things Worse - This might sound strange, but back problems can actually contribute to urinary frequency and urgency. If you have chronic lower back pain or a herniated disc, the nerve irritation from those issues can send signals to your bladder to contract more often. Even neck pain can play a role because of how the nerves connect to your bladder from your brain stem.
If this applies to you, your doctor might recommend good posture, lumbar support when sitting, a firm mattress, and most importantly, building core strength. Stronger core muscles brace your spine, reduce daily compression of the nerves, and can actually decrease urinary frequency and urgency.
Constipation Is Connected to Your Bladder - Most guys don't think about this, but your bowels and bladder are neighbors. When your colon is full and constipated, it puts direct pressure against your bladder. Plus, there's a neurological connection between your bowel and bladder through the same nerve pathways. A high-fiber diet with both soluble and insoluble fiber can improve your digestion and take pressure off your bladder.
Sleep Apnea Might Be the Real Culprit - Here's one that catches a lot of men off guard: if you're getting up multiple times every night to urinate, especially if you're producing large amounts of urine rather than just frequent small amounts, sleep apnea could be the real problem. Sleep apnea means you stop breathing briefly during sleep, which reduces oxygen to your brain. Your body responds by raising blood pressure to get more blood to your brain. That high blood pressure triggers your body to release natural diuretics, which makes you produce more urine.
If you're tired during the day, wake up with headaches, have high blood pressure, or experience memory issues, talk to your doctor about getting a sleep study. Treating sleep apnea can sometimes solve the nighttime urination problem without ever treating the prostate.
Eat Fresh, Local Food When You Can - This might sound simple, but it really works. Food that comes from your local farmer's market or, even better, from your own garden, is more nutrient-dense than produce that's been shipped across the country. That apple from New Zealand that's been picked before it's ripe and lost its nutrients during shipping isn't as helpful to your body as an apple from your local orchard. Eating well supports your overall health and can reduce inflammation throughout your body, including in your prostate.
Get a Little Sun and Stay Active - Just 10 minutes of sun exposure does tremendous things for your body. It's not just about vitamin D production (though that's important). Sunlight helps regulate your circadian rhythm and supports your overall health. Being active outside, moving your body, and getting regular exercise all support prostate health and general wellness.
Medical Treatments for Enlarged Prostate
If lifestyle changes aren't enough to manage your symptoms, there are excellent medications available. Your doctor can help determine which one makes sense for your specific situation.
Tadalafil: The Multi-Purpose Medication - Tadalafil is a medication that many men recognize by the brand name Cialis. But here's something surprising: low-dose tadalafil (5 milligrams daily) is actually approved for treating BPH symptoms, not just erectile dysfunction. At this low dose, it's remarkably safe and effective.
What makes tadalafil special is that it can address multiple problems at the same time. For men with BPH symptoms, it relaxes the muscles in the prostate and bladder, making urination easier. For men with erectile dysfunction, it helps improve blood flow. For men with sleep apnea, it dilates the pulmonary arteries and improves blood flow to the heart during sleep. Some research suggests it may even offer cardiovascular benefits.
Many men who take 5 milligrams of tadalafil daily experience few or no side effects. Some might notice mild headaches or slight reflux, but these are uncommon. If you're concerned about using a medication, remember that when a doctor recommends a pharmaceutical option as a game-changer, it's worth considering. You can always discuss concerns with your healthcare provider.
Alpha Blockers: Opening Up the Channel - Alpha blockers are medications like tamsulosin (Flomax) and doxazosin (Cardura). These drugs work by relaxing the muscles in the prostate and bladder neck, making it easier for urine to flow through. They work relatively quickly—often providing relief within days or weeks.
Alpha blockers have minimal side effects for most men. The main downside to know about is that some men experience retrograde ejaculation, which means semen goes backward into the bladder instead of out through the urethra during orgasm. This doesn't hurt, but it does mean there's no ejaculate, which matters if you're planning to have children or if sexual function is important to your quality of life.
5-Alpha Reductase Inhibitors: Shrinking the Prostate - Medications like finasteride (Proscar) and dutasteride (Avodart) work differently than alpha blockers. These drugs actually shrink the prostate by blocking a hormone called DHT (dihydrotestosterone). Over time, the prostate can shrink by 20-30 percent.
However, there are some important things to know. These medications take longer to work than alpha blockers—you won't see real improvement for at least three to six months, sometimes longer. And they don't work for everyone. Shrinking the prostate doesn't always mean your urinary symptoms go away, especially if your real problem isn't obstruction but something else entirely.
These medications are best for older men with very large prostates who are concerned about urine retention or blood in the urine. If you're younger and concerned about your sex drive or erectile function, this probably isn't your first choice. These drugs can affect sexual function more than alpha blockers do.
Combination Therapy - Sometimes your doctor might recommend using both an alpha blocker and a 5-alpha reductase inhibitor together, especially if you have a very large prostate and significant symptoms. The alpha blocker provides quick relief while the 5-alpha reductase inhibitor works over time to shrink the prostate further.
Saw Palmetto and Natural Supplements - Some men prefer natural approaches before trying prescription medications. Saw palmetto is an herb that some studies suggest can help with mild to moderate BPH symptoms. The quality matters tremendously, though. Look for brands that extract the active ingredients from ripe berries rather than ground-up green berries.
Other supplements that may help reduce inflammation and support prostate health include quercetin, curcumin, and boswellia (an Indian herb used traditionally for joint inflammation but with good systemic anti-inflammatory benefits for the prostate). If you're interested in supplements, talk to your doctor or a qualified herbalist about which combination might work for you.
Surgical and Minimally Invasive Treatment Options for Enlarged Prostate
When medications aren't working well enough or you want a more permanent solution, several surgical options are available. The good news is that modern procedures are far less invasive than the surgeries of previous generations. Many can be done in an office setting with minimal recovery time.
Understanding Your Surgical Options - The truth is that all the modern BPH treatment options work well for improving urinary function. Whether you choose one procedure or another often depends on your personal priorities, your prostate size, and what kind of recovery you're willing to deal with. Your doctor can help match the best procedure to your specific situation.
Bipolar TURP: The Gold Standard for Large Prostates - TURP stands for transurethral resection of the prostate. It's been around for decades and remains one of the most effective treatments for large prostates. The word "bipolar" refers to the type of energy used during the procedure.
Here's how it works: Your doctor uses a camera and specialized instruments inserted through your urethra (the tube you pee through) to remove pieces of prostate tissue that are blocking urine flow. There's no external incision—everything is done through the natural opening.
The bipolar version is safer than older monopolar TURP techniques because it uses different technology that reduces bleeding and allows for faster recovery. Most patients can go home the same day. About 90 percent of men are dry enough to leave the hospital on the day of surgery.
The procedure works great for prostates of any size—some urologists have successfully treated prostates weighing 300-400 grams. It might take a couple of hours for a very large prostate, but the results are excellent. The main tradeoff is that some men experience retrograde ejaculation afterward (the same issue possible with alpha blockers).
UroLift: Five-Minute Office Procedure - UroLift is one of the newest options available, and it's remarkably simple. The entire procedure takes about five minutes in an office setting with just local anesthesia and a bit of sedation.
Here's what happens: Your doctor inserts a tiny camera through your urethra and deploys small titanium clips attached to permanent sutures. These clips act like "curtain holders," physically opening up the compressed prostate tissue and holding it open. Depending on your prostate size and shape, you might need anywhere from two to six implants.
The benefits are significant: minimal pain, no external incisions, quick recovery, and very low rates of sexual dysfunction (less than 1 percent experience loss of ejaculation). About two-thirds of men don't need a catheter afterward, and those who do only need it for a few days.
The main limitation is that UroLift works best on smaller to medium-sized prostates (up to about 80 grams, though some experienced surgeons push this limit slightly). If your prostate is very large or if you have a big middle lobe growing into the bladder, UroLift might not be the best choice.
Rezum: Steam Technology for BPH Treatment - Rezum is another minimally invasive option that uses steam to destroy excess prostate tissue. Each treatment spot takes only 9 seconds. The procedure is done through your urethra with local anesthesia.
The way Rezum works is fascinating. Your doctor infuses saline through a needle into the prostate tissue and then delivers radio frequency energy. The saline acts as a conductor, allowing the energy to treat a larger area of tissue than would be possible otherwise. As the treated tissue heals over time, the prostate opens up and relieves the obstruction.
Like UroLift, Rezum is indicated for smaller to medium prostates (up to about 80 grams). Most men only need a catheter for two or three days after the procedure. By 10 days after surgery, most men are urinating better than before. By two to three months, improvement continues as the prostate continues to heal and open up.
Rezum works well for men with a posterior lobe (the back of the prostate) or a moderate-sized middle lobe. Like UroLift, it preserves sexual function in most cases.
iTind: The Temporary Stent Option - iTind is a newer device that represents a different approach. It's a temporary stent that expands the prostate tissue mechanically, creating a spring-like action that opens up the compressed areas. You leave it in place for one week. A string hangs out that you use (with a special device) to pull the stent back out after seven days.
The beauty of iTind is its simplicity and its data. Studies show that five to ten percent of men need to go back on medications within four to seven years—meaning the majority stay symptom-free for years after just one week of having the device in place.
This option is particularly appealing for men who are hesitant about any procedure. It's one of the least invasive options available, yet the results are comparable to more invasive surgeries. It's especially good for tight bladder necks and works well in office-based settings.
Choosing the Right Enlarged Prostate Treatment for You
Here's the most important thing to understand: there's no one "best" BPH treatment that works for everyone. The right choice depends on several factors:
Your Prostate Size - Very large prostates (over 100 grams) are best treated with bipolar TURP because it can handle any size. Smaller to medium prostates have more options available, including UroLift and Rezum.
Your Priorities - If preserving sexual function (particularly ejaculation) is important to you, UroLift and Rezum have better profiles than bipolar TURP. If you want a permanent solution and don't mind potential sexual side effects, bipolar TURP is highly effective. If you want the absolute minimal approach, iTind might appeal to you.
Your Age and Overall Health - Younger men often prefer to avoid long-term medications, making a minimally invasive procedure attractive. Older men might be fine taking a medication for a few more years.
How Bothered You Are - If your symptoms are mild and lifestyle changes help, medications might be all you need. If your symptoms are severe or you're in urinary retention, you might need a procedure.
Your Doctor's Experience - Having several treatment options available is great, but your specific doctor's expertise with each procedure matters. A surgeon who does bipolar TURP hundreds of times might get better results than someone just learning the technique. Ask your doctor which procedures they perform most frequently and what their outcomes are.
When Medical Treatment Becomes Necessary
Some men reach a point where they absolutely need medical intervention. If you're unable to urinate at all (acute urinary retention), you need immediate care—usually a temporary catheter while you figure out your treatment plan. If you're experiencing repeated urinary tract infections, kidney problems, or blood in your urine because of your enlarged prostate, medical treatment becomes more urgent.
The good news? Most men who get appropriate BPH treatment report dramatic improvements. They go from waking up multiple times each night to sleeping through. They go from constant daytime urgency to normal bathroom habits. Many say they feel like they got their quality of life back.
Taking Action on Prostate Health
If you're experiencing BPH symptoms, the first step is talking to a urologist who takes a comprehensive approach—someone interested in your lifestyle, your full health picture, and all your available options. Don't just accept that surgery is your only choice, and don't assume you have to live with these symptoms forever.
Start with these steps:
First, keep track of your symptoms for a week or two. Write down how many times you get up at night, how often you go during the day, and what's bothering you most. This information will help your doctor understand what's really going on.
Second, think about your lifestyle. Are you drinking too much caffeine? Do you have back pain that could be contributing? Are you experiencing signs of sleep apnea? Making changes in these areas might solve your problem without any medication at all.
Third, schedule an appointment with a urologist who will take time to understand your situation. Don't just accept the first recommendation—ask questions. Ask about your prostate size. Ask what's actually causing your symptoms. Ask about all your options, not just the one your doctor mentions first.
Remember that your urologist's time is valuable, so come prepared with your symptom information and stay focused on your specific concerns. But also know that good urologists understand that taking time to understand the whole picture often leads to better outcomes.
Final Thoughts on BPH and Enlarged Prostate Relief
Having an enlarged prostate doesn't mean you're broken or that you have to accept a lower quality of life. Modern medicine offers excellent options, from simple lifestyle modifications to sophisticated minimally invasive procedures. The key is finding an approach that matches your specific situation, your priorities, and your goals.
Whether you choose to start with lifestyle changes and medications or jump to a minimally invasive procedure, know that you have options. You don't have to wake up multiple times each night. You don't have to deal with constant urinary urgency. And you definitely don't have to assume that surgery means weeks of recovery and permanent sexual side effects.
Take action. Talk to your doctor. Explore your options. Get your quality of life back.
About Dr. Robert Caruso: Board-Certified Urologist Specializing in BPH Treatment
Dr. Robert Caruso is a board-certified urologist and surgeon with over 25 years of clinical experience. Based in Bloomfield, New Jersey, and affiliated with Clara Maass Medical Center and Newark Beth Israel Medical Center, Dr. Caruso trained at NYU and completed a fellowship in robotic and laparoscopic urologic surgery.
Dr. Caruso specializes in prostate health, minimally invasive BPH treatment techniques, laser surgery, and bladder and kidney conditions. He's published extensively on prostate cancer, urologic conditions, and advanced surgical techniques. Beyond his clinical work, Dr. Caruso is co-founder of MedPro Wellness and has volunteered worldwide providing surgical care.
Dr. Caruso's approach to urology combines advanced surgical expertise with a deep interest in whole-person health, functional medicine, and preventive care. He's known for taking time with patients to understand their complete health picture before recommending treatment.
Contact Information:
Main Office Locations:
- Bloomfield, NJ
- Helenhurst, NJ
- Ironbound, Newark, NJ
Phone: 973-743-4450
Website: ehurology.com
Insurance: Essex Hudson Urology is now part of RWJ Barnabas Health and accepts most major insurance plans.
Note: New patient wait times can be up to two months, but the office works to fit patients in sooner when cancellations occur. Mentioning you heard about Dr. Caruso on the prostate health podcast may help with scheduling.
Medical Disclaimer
This article is for informational and educational purposes only and should not be considered medical advice. The information presented is based on a discussion between healthcare professionals and is meant to help you understand BPH and available treatment options. It is not a substitute for professional medical advice, diagnosis, or treatment.
Every person's situation is unique. What works for one man may not work for another. Before starting any new treatment—whether lifestyle-based, supplement-based, or medical—talk to your healthcare provider. Your doctor knows your complete medical history and can make personalized recommendations based on your specific health situation.
If you're experiencing severe urinary symptoms, blood in your urine, or inability to urinate, seek immediate medical attention.
Always discuss any concerns about your prostate health with a qualified urologist or healthcare professional.
Ready to Take Control of Your Prostate Health?
If you're experiencing symptoms of an enlarged prostate, don't wait. Talk to your urologist about which BPH treatment option makes sense for your situation. Whether you start with lifestyle changes, medications, or a minimally invasive procedure, taking action now can significantly improve your quality of life. Your doctor can help you explore all your options and find the approach that's right for you. Schedule your appointment today and get back to the life you want—including sleeping through the night.
Last edited by a moderator:
