What is the role of physical therapy in treating Benign Prostatic Hyperplasia (BPH)?

From the Guidelines

Physical therapy, specifically pelvic floor exercises, can be a beneficial complementary approach to medical management in treating benign prostatic hyperplasia (BPH), as it improves urinary control and quality of life. According to the most recent guideline on the management of lower urinary tract symptoms attributed to BPH 1, patients should be counseled on options for intervention, including behavioral/lifestyle modifications, medical therapy, and/or referral for discussion of procedural options. Pelvic floor exercises, particularly Kegel exercises, are the primary physical therapy intervention for BPH symptoms. Patients should perform Kegel exercises by contracting the pelvic floor muscles (as if stopping urination midstream) for 5 seconds, then relaxing for 5 seconds, repeating this 10-15 times per session, with 3 sessions daily.

Some key points to consider in the management of BPH include:

• The initial evaluation of patients presenting with bothersome LUTS possibly attributed to BPH should include a medical history, physical examination, International Prostate Symptom Score (IPSS), and urinalysis 1.
• Patients should be evaluated by their providers 4-12 weeks after initiating treatment to assess response to therapy, which may include the IPSS, post-void residual (PVR), and uroflowmetry 1.
• The use of 5 alpha-reductase inhibitors, such as finasteride and dutasteride, is an appropriate treatment option for patients with LUTS associated with demonstrable prostatic enlargement 1.
• Physical therapy techniques, such as bladder training and biofeedback, can also be useful in improving urinary control and reducing symptoms like urgency, frequency, and nocturia.

It is essential to note that while physical therapy can improve quality of life, it will not reduce prostate size. Therefore, patients should consult with a urologist before starting physical therapy to ensure it's appropriate for their specific condition. The combination of physical therapy with standard medical treatments like alpha-blockers or 5-alpha-reductase inhibitors can be an effective approach in managing BPH symptoms, and patients should be consistent with their physical therapy regimen for at least 6-8 weeks to see benefits.

From the Research

Treatment Options for BPH

• The primary goal of BPH management is to reduce lower urinary tract symptoms and prevent associated morbidities, such as urinary retention, persistent gross hematuria, recurrent infections, bladder stones, or renal insufficiency 2.
• Medical therapy is becoming increasingly important in the treatment of patients with moderate symptoms of BPH, with options including androgen-suppressing therapy and alpha-adrenoceptor blockade 3.
• Pharmacologic interventions, such as alpha-blockers and 5-alpha-reductase inhibitors, are often preferred as a first approach due to their less invasive nature compared to surgery 4, 5.

Alternative Therapies for BPH

• Alternative therapies, including phytotherapy (e.g., saw palmetto, pumpkin seed) and physical therapy (e.g., acupuncture, radial extracorporeal shock wave therapy), are being explored for the management of BPH 6.
• Physical therapy, such as prostate urethral lift and transurethral needle ablation, may be used in the treatment of BPH, although more research is needed to fully understand their efficacy 6.

Combination Therapies for BPH

• Combination therapy using 5-alpha-reductase inhibitors and alpha-blockers may be effective in treating lower urinary tract symptoms secondary to BPH 5.
• The use of combination therapy should be tailored to individual patient needs and preferences, taking into account the patient's medical history, symptoms, and treatment goals 4, 5.