Bladder Stones and BPH: Causes, Risks, and Treatment Choices

As people grow older, many middle-aged and elderly men may experience difficulties in urination and frequent nocturia, which may actually be a sign of benign prostatic hyperplasia (BPH).

The data shows that the incidence rate of benign prostatic hyperplasia (BPH) among men over 50 years old exceeds 50%, and it reaches as high as 80% among those over 70. What's more troublesome is that this seemingly minor problem of discomfort during urination might also secretly lead to bladder stones.

Today, let's talk about the relationship between BPH and bladder stones, the high-risk groups, and the corresponding solutions.

The Relationship Between BPH and Bladder Stones

Benign prostatic hyperplasia (BPH) refers to the abnormal growth of the prostate gland, which narrows the urethra. It is a benign disease, not cancer, but it can cause a series of urination problems: frequent urination, urgent urination, increased nocturia, difficulty in urination, reduced urine flow, incomplete urination, and even dribbling after urination.

Bladder stones are often caused by the prolongation of BPH. Under normal circumstances, urine can be smoothly expelled, and there will be no impurities accumulated in the bladder. 

However, when BPH causes obstruction of the urethra, urine will remain in the bladder. The minerals in the urine gradually form crystals, and over time, these crystals accumulate to form hard stones.

The latest EAU guidelines state that bladder stones related to BPH account for 3% to 7% (on average 5%) of all urinary tract stones (including those in the kidneys and ureters) [1]-[2]. In simple terms, BPH is a significant cause of bladder stones, and the two conditions often occur together.

To break this vicious cycle, the key lies in alleviating the urethral obstruction caused by BPH and reducing the residual urine volume. This is also one of the core concepts of traditional Chinese medicine treatment.

High-risk Groups Prone to BPH and Bladder Stones

The occurrence of benign prostatic hyperplasia (BPH) is related to multiple factors, and these factors also indirectly increase the risk of bladder stones. The following groups of people need to pay special attention:

Middle-aged and elderly men over 50:

Age is a crucial risk factor for prostate hyperplasia. As men age, there is an imbalance in the metabolism of androgens in their bodies. When testosterone is converted into dihydrotestosterone (DHT), it continuously stimulates the proliferation of prostate cells, causing the gland to continuously enlarge. This can easily lead to BPH and bladder stones.

Those with a family history of genetic diseases:

Prostate hyperplasia has a certain genetic predisposition. If the father, brothers, or other direct relatives have suffered from this disease, the risk of the individual developing the condition will be 2-3 times higher than that of the general population.

People with long-term bad habits:

Men who sit for more than 8 hours a day, regularly consume strong alcohol, prefer high-fat and high-sugar diets, and lack exercise have a significantly increased risk of illness. Sitting for long periods can cause poor blood circulation in the pelvic area, and the prostate remains in a state of congestion for a long time.

Besides, alcohol and high-fat diets interfere with androgen metabolism, further stimulating glandular hyperplasia. The combination of these habits will greatly increase the probability of developing the disease.

Patients with underlying diseases:

Those with obesity (BMI ≥ 28), hypertension, and diabetes should be particularly vigilant. In obese individuals, fat cells in the body secrete more estrogen, and the imbalance of estrogen and androgen can accelerate BPH; hypertension and diabetes can damage the blood vessels and nerves of the prostate, reduce bladder contraction function, and lead to an increase in residual urine, thus making it more likely to cause bladder stones.

Those with abnormal hormone levels:

Apart from age-related hormonal changes, long-term use of androgen-containing fitness supplements, thyroid dysfunction, and other conditions may also lead to uncontrolled proliferation of prostate cells, thereby increasing the risk of disease.

Hazards of BPH and Bladder Stones

Many people consider frequent urination, urgent urination, and difficulty in urination as "normal phenomena as one gets older" and simply endure them. However, this mindset can be detrimental. The hazards caused by BPH and bladder stones are far more serious than the surface symptoms.

Decline in quality of life:

Frequent nocturia completely disrupts the sleep pattern, causing sleep disorders and making one feel drowsy and lacking energy during the day. Difficulty in urination and incomplete emptying of the bladder can make people constantly worry about finding a toilet when out and even prevent them from participating in social activities. Over time, this may also lead to tendencies towards anxiety and depression.

The "chain effect" of the urinary system:

Residual urine serves as a "breeding ground" for bacteria, easily causing urinary tract infections with symptoms such as pain during urination and fever; prolonged excessive expansion of the bladder can damage the muscle function and lead to bladder stones. 

Even more seriously, the pressure from urethral obstruction will be transmitted upward to the kidneys, causing hydronephrosis, which, if prolonged, will damage kidney function, and in severe cases, dialysis treatment may be required.

The additional torment of bladder stones:

The constant movement of the stones within the bladder continuously irritates the bladder mucosa, making the symptoms of frequent urination and urgent urination even more severe.

If the stones block the outlet of the urethra, it may also cause acute urinary retention, a painful sensation of being unable to urinate despite the urge, which can be extremely distressing.

How to Deal with BPH and Bladder Stones

When it comes to BPH and bladder stones, the key lies in "early"—early detection and early intervention are necessary to effectively control the progression of the condition. Here are some specific steps to follow.

Regular physical examination:

For men over 50 years old, it is recommended to have a prostate ultrasound and a routine urine test once a year. People with a family history or underlying diseases can be advised to start at 45 years old. 

If symptoms such as nocturia (urinating at night) ≥ 2 times and difficulty in urination occur, they should seek medical attention promptly. Through a urine flow rate test, the degree of urethral obstruction can be evaluated.

Adjusting lifestyle habits:

Avoid prolonged sitting and get up and move for 5-10 minutes every hour; Control alcohol intake, avoid drinking on an empty stomach and excessive drinking; Eat less spicy and greasy food and more vegetables and fruits rich in dietary fiber.

Reduce water intake 2 hours before bedtime and decrease the number of nighttime urinations. Regularly engage in gentle exercises such as brisk walking and swimming to improve pelvic circulation and delay glandular hyperplasia.

Drug treatment:

For those with mild symptoms, they may be able to alleviate their condition by adjusting their lifestyle. However, for moderate or severe symptoms, it is necessary to take medication under the guidance of a doctor. 

Western medicine commonly uses α receptor blockers (such as tamsulosin) to relax the urethral muscles and quickly improve the urination symptoms; it will also use 5α reductase inhibitors (such as finasteride) to inhibit the production of DHT and gradually reduce the volume of the prostate.

From a TCM point of view, an enlarged prostate falls under what's called Long Bi, which basically means trouble with urination. It usually happens because the body's Qi is too weak to push urine properly, blood flow is sluggish, and the urinary tract, and damp-heat accumulates in the bladder. 

Treatment in TCM focuses on clearing heat and getting rid of dampness, improving blood circulation, and softening any hardness or lumps in the area. The Chinese patent medicine "Diuretic and Anti-inflammatory Pill" precisely meets these treatment requirements. It comes from Dr. Li's clinic and can effectively alleviate the congestion and edema of the prostate, relieve urethral obstruction, and reduce the residual urine in the bladder.

Moreover, it can quickly alleviate symptoms such as frequent urination, urgent urination, and difficulty in urination; reduce the risk of bladder stones; and simultaneously decrease complications such as urinary tract infections, helping patients gradually restore normal urination function. For patients who do not want to rely on Western medicine for a long time and hope for comprehensive treatment, it is an ideal choice.

Conclusion

BPH and bladder stones are never minor ailments that can be "put up with" for a while. 

Middle-aged and elderly men should pay attention to their body signals, undergo regular check-ups, adjust their lifestyles in a timely manner, and take prescribed medications when necessary. Only in this way can they firmly hold their health in their own hands.

After all, being able to urinate comfortably and sleep soundly is the small happiness of old age.

References

[1] Philippou, P., Moraitis, K., Masood, J., Junaid, I. and Buchholz, N. (2012) The Management of Bladder Lithiasis in the Modern Era of Endourology. Urology, 79, 980-986. [Google Scholar] [CrossRef] [PubMed]

[2] Skolarikos, A., Geraghty, R., Somani, B., et al. (2025) European Association of Urology Guidelines on the Diagnosis and Treatment of Urolithiasis. European Urology, 88, 64-75.