By Dr. Becker
Today, I want to discuss a condition known as benign prostatic hyperplasia, or BPH.
The prostate is an accessory sex gland that surrounds the urethra and neck of a male dog's bladder. The prostate gland produces a fluid that helps nourish and transport sperm.
Benign prostatic hyperplasia is a condition in which the prostate gland is enlarged. The word "hyperplasia" means increased in size.
BPH is the most common disorder of the prostate gland seen in dogs. It is estimated that about 50 percent of intact male dogs will develop BPH by the age of five, 60 percent by the age of six, and 95 percent by the age of nine. Diseases of the prostate are rare in cats.The prostate gland depends on hormones from the testicles to regulate its size and function. As the balance of hormones in a dog's body changes with age, the prostate tends to enlarge as a result of excess production of androgens, especially testosterone and estrogen. BPH is a condition seen only in intact (unneutered) male dogs.
Symptoms of BPH
BPH often causes no symptoms, and the enlargement of the gland isn't painful for the dog. As the prostate increases in size, it expands backwards – in four-legged animals, that means toward the spine. If there's significant enlargement, it can obstruct the rectum, causing straining during defecation, constipation, and even fecal impaction. Feces may have a flat or ribbon-like appearance.
Once in a while, an enlarging prostate pushes forward rather than backward, pressing on the urethra. This can cause a dog to strain while urinating. Blood in the urine is one of the signs of BPH.Another symptom of BPH can be a thick, bloody discharge from the penis (originating in the urethra).
Diagnosing Benign Prostatic Hyperplasia
A rectal exam will confirm the presence of an enlarged prostate gland. There may also be abdominal distension due to an enlarged bladder.
Blood work, urinalysis, x-rays, an ultrasound, a urine culture and microscopic evaluation of fluid drawn from the prostate gland can help confirm the diagnosis.In diagnosing BPH, it's important to rule out other causes of an enlarged prostate, including cysts, infection with inflammation (prostatitis), and cancer.
For dogs that show no clinical symptoms of discomfort or distress and have no elimination problems caused by an enlarged prostate, typically no treatment is recommended. However, when I diagnose BPH on a physical exam and the dog is clinically normal (the owner and dog have no idea the condition is occurring), I recommend the owner start a supportive protocol of saw palmetto, which is an herb.
If a dog has mild BPH symptoms and the owner is interested in exploring non-surgical options first, I suggest starting a protocol of saw palmetto plus DIM (diindolymethane) and high lignan flax hulls – not flax seeds or flax oil, but hulls. DIM and high lignan flax hulls help regulate estrogen metabolism.
Pumpkin seeds, nettle extracts, quercetin, lycopene, and natural vitamin E, as well as food sources of selenium, along with saw palmetto, can all be beneficial in regulating BPH in dogs.
The most effective and recommended treatment for moderate to severe (symptomatic) BPH is to neuter the dog. Castration completely resolves the problem. If the dog has discomfort from clinical symptoms, this is often the kindest and speediest treatment.
In any case, rechecking an enlarged prostate regularly is very important, as the condition can cause the dog to be unable to void urine normally, which can become a life-threatening condition.
My childhood dog, a Schnoodle (Schnauzer/Poodle cross) named Sooty, acquired BPH when he was 13. Thankfully my mom, who walked him every day, noticed that his urinary habits had changed. Most notably, he would raise his leg to pee and produce only a weak stream of urine. Then he would almost immediately stop somewhere else, raise his leg again and produce very little urine.
So Sooty was neutered at 13, and he went on to live a happy, healthy life to the age of 18 with no further prostate (or secondary endocrine) issues. In a situation like this, neutering older dogs who've had a lifetime of healthy hormone levels rarely results in the endocrine dysfunction we see in dogs that are neutered as puppies.
As some of you know, I am not an advocate of early desexing (neutering) surgeries for puppies. However, mature intact male dogs with BPH have had the benefit of a lifetime of sex hormones, so thankfully the endocrine imbalances we see with neutered puppies don't occur when dogs are neutered as seniors. In the case of a mature dog with moderate to severe symptomatic BPH, the benefits of neutering far outweigh the risks.
Rarely, breeding dogs can develop this condition, and some vets prescribe drugs to control prostatitis. I don't advocate the use of these drugs, as they have significant side effects and only provide temporary relief from discomfort.
Untreated or chronic BPH can make the prostate more susceptible to infection from the urinary tract. This can result in bacterial prostatitis, which is infection and inflammation of the prostate. The condition can be acute or chronic, and can progress to the formation of abscesses in the prostate.
Occasionally, prostatic cysts develop secondary to BPH or prostatitis. Dogs that have benign prostatic hyperplasia but are asymptomatic should have twice yearly physical examinations. Owners should monitor their dogs for any potential changes related to the condition, and alert their veterinarian immediately if there is any problem or change in urination or defecation.
A dog that is neutered to resolve BPH should be rechecked within a few weeks of surgery to insure the prostate is shrinking in size.If a dog's mild BPH is being managed with nutraceuticals, it's also important that the prostate is rechecked regularly to insure he is responding to the natural treatment protocol.