Enlarged Prostate (BPH): Symptoms and Treatment

Introduction

Benign prostatic hyperplasia, or BPH, is a noncancerous growth of the prostate gland ^[1,2]. It becomes more common with age and may block urine flow ^[2,8].

This guide explains enlarged prostate BPH symptoms, diagnosis, treatment, and warning signs. It covers common symptoms, medical tests, and available BPH treatment options.

BPH is not prostate cancer ^[1,3]. It also does not itself raise the risk of prostate cancer ^[1,3]. However, BPH and prostate cancer can occur at the same time ^[6,7].

Overview: What Is an Enlarged Prostate?

The prostate and its role

The prostate is part of the male reproductive system ^[1]. It sits below the bladder and in front of the rectum ^[1,9].

The prostate surrounds part of the urethra ^[9]. The urethra is the tube that carries urine out of the bladder.

The prostate makes fluid that becomes part of semen ^[1,9]. A healthy prostate is often close to the size and shape of a walnut ^[9].

Benign prostatic hyperplasia means that cell growth has made the prostate larger ^[1]. The word “benign” means the growth is not cancer ^[1,2].

How BPH affects urine flow

The prostate sits around the urethra ^[9]. As it grows, it may squeeze and narrow this tube ^[2,7].

The bladder then works harder to push urine through the narrow area ^[2]. Over time, its muscles may become weak ^[2,5].

A weak bladder may not empty fully ^[2,5]. The urine left behind after urination is called postvoid residual urine.

Prostate growth can compress the urethra and weaken bladder emptying ^[2,5]. It may also cause urinary retention ^[2,5]. Retention means the bladder cannot empty fully or at all.

The size of the prostate does not always match the severity of symptoms ^[8]. A small increase may cause major problems in one person ^[8]. Another person may have a large prostate but few symptoms ^[8].

BPH risk factors and prevalence

Age has a strong link to prostate growth ^[2,3]. BPH rarely causes symptoms in men younger than age 40 ^[2,5].

BPH is the most common prostate problem in men older than age 50 ^[2,5]. An estimated 5% to 6% of men ages 40 to 64 have BPH ^[2,5]. About 29% to 33% of men ages 65 and older have it ^[2,5].

Some prostate growth occurs in almost all men as they age ^[3,7]. However, fewer than half of men with BPH develop symptoms ^[3].

The exact cause of this growth remains unknown ^[3]. Aging and changes in male hormones may play a role ^[3].

Causes of BPH and Urinary Problems

Age-related changes appear to affect prostate cells ^[3]. Hormone activity may also influence prostate growth ^[3].

BPH symptoms begin when prostate growth affects the urethra or bladder ^[2,7]. A narrow urethra makes it harder for the bladder to release urine ^[2].

Not every urinary problem comes from BPH. A urinary tract infection can cause similar symptoms ^[4,6]. Overactive bladder and nerve problems may also affect urination ^[4].

Prostate cancer can also cause symptoms that resemble BPH ^[6,7]. For this reason, urinary symptoms need a proper medical review ^[6].

A clinician will ask about medicines and other health problems during the review ^[6]. This step helps find other possible reasons for the symptoms ^[6].

Symptoms and Warning Signs

Enlarged prostate symptoms are often called lower urinary tract symptoms ^[4]. Doctors divide them into storage and voiding symptoms ^[4].

Storage symptoms happen while the bladder fills ^[4]. Voiding symptoms happen while a person passes urine ^[4].

Symptoms may affect sleep and daily activities ^[6,8]. Their effect on daily life can help guide BPH treatment options ^[8].

Storage symptoms

Common storage symptoms include:

• Urinating more often than usual, which is called frequency ^[4,8].
• Feeling a sudden need to urinate, which is called urgency ^[4,8].
• Waking at night to urinate, which is called nocturia ^[4,8].
• Leaking urine or failing to reach the toilet in time ^[3].

Nighttime urination may disturb sleep. Urgency can also make work, trips, and social events harder.

However, these symptoms do not prove that BPH is present ^[4,6]. Bladder disease, infection, or nerve problems may cause similar changes ^[4].

Voiding symptoms

Common voiding symptoms include:

• Trouble starting the urine stream, which is called hesitancy ^[4,8].
• A weak urine stream ^[4,8].
• A flow that stops and starts ^[4,8].
• Straining or pushing to urinate ^[4].
• Taking a long time to empty the bladder ^[4].
• Dribbling near the end of urination ^[3,8].
• Feeling that the bladder remains partly full ^[3,8].
• Being unable to urinate, which is called urinary retention ^[2,3].

These problems may worsen as the urethra becomes more narrow ^[2]. Long-term blockage can leave more urine inside the bladder ^[2,5].

Symptoms do not confirm BPH

Urinary symptoms alone cannot confirm BPH. Infection and bladder disease may cause the same problems ^[4,6].

Nerve conditions and prostate cancer may also cause urinary symptoms ^[4,6,7]. A medical review helps identify the cause ^[6].

The severity of symptoms does not always match prostate size ^[8]. Doctors consider symptoms, test results, general health, and personal needs ^[6,8].

Warning signs

Sudden inability to urinate is a medical emergency ^[2,3]. It may mean acute urinary retention and requires immediate care ^[2,3].

Blood in the urine also needs medical review ^[2,5]. The medical term for blood in urine is hematuria.

Seek prompt care for fever or chills with urinary symptoms ^[2]. Severe lower abdominal pain also needs urgent assessment ^[2]. Painful urination should be checked because infection may cause it ^[2,4].

Diagnosis of an Enlarged Prostate

A BPH diagnosis starts with a health history and physical examination ^[6]. The clinician may then order urine, blood, or bladder tests ^[6].

These tests can assess urine flow and bladder emptying ^[6]. They may also help find another cause of the symptoms ^[6].

Medical history and symptom score

The clinician will ask when the symptoms began ^[6]. Questions may cover frequency, urgency, nighttime urination, and weak flow.

The discussion may also include straining and incomplete emptying. The clinician will ask how symptoms affect daily life ^[6,8].

A standard symptom form may help measure the problem. Repeating the form can help track changes during follow-up.

Patients should bring a list of all medicines and supplements. The review helps the clinician identify products that may affect urination ^[6].

The clinician may also ask about past urinary infections and other health problems ^[6]. Clear answers help guide the choice of tests.

Physical examination

The examination may include the abdomen and external genitals ^[4]. The clinician may also check nervous system function ^[4].

These checks may find a full bladder or signs of nerve problems ^[4]. They may also reveal genital changes that affect urine flow ^[4].

A digital rectal examination may be part of the visit ^[4,6]. During this test, the clinician feels the prostate through the rectum ^[6].

The examination gives information about prostate size and shape ^[4]. It can also show changes in firmness or symmetry ^[4].

However, this examination cannot confirm the cause on its own. Doctors consider it with the history and other test results ^[6].

Urine and blood tests

A urinalysis is a laboratory test of a urine sample. It may find an infection or another cause of urinary symptoms ^[6].

A blood test may check for kidney problems ^[6]. Kidney testing can be useful when blockage or retention is possible ^[2,6].

A prostate-specific antigen test measures PSA in the blood ^[6]. PSA is a protein made by the prostate ^[6].

PSA may rise because of BPH ^[6]. Prostate inflammation and recent medical procedures can also raise it ^[6]. Prostate cancer is another possible cause of a high PSA level ^[6].

Therefore, a raised PSA result does not diagnose cancer ^[6]. A clinician must review it with other health information ^[6].

Urinary flow and bladder tests

A urinary flow test measures the strength of the urine stream ^[6]. It also records how much urine a person passes ^[6].

Results may show whether urine flow is getting better or worse ^[6]. Doctors may repeat this test during follow-up ^[6].

A postvoid residual test measures urine left after urination ^[6]. A large amount may show that the bladder is not emptying well.

Imaging may help measure the urine left in the bladder ^[6]. Test choices depend on symptoms and possible complications ^[6].

Treatment Options for an Enlarged Prostate

BPH treatment options include monitoring, medicine, procedures, and surgery ^[7,8]. The right choice depends on the symptoms and prostate size ^[8].

Other health problems also affect the decision ^[8]. Personal goals and the effect on daily life matter as well ^[8].

Watchful waiting

Mild enlarged prostate symptoms may not need treatment right away. A clinician may suggest regular monitoring instead ^[6,8].

This plan is often called watchful waiting. It includes follow-up rather than ignoring the condition.

A person may choose to limit drinks before bedtime. Reducing alcohol and caffeine may also help with bothersome urinary habits.

Avoiding constipation may make urination more comfortable. A clinician can also review medicines that might worsen urinary problems ^[6].

Do not make major changes to fluid intake without medical advice. Ask how to manage nighttime urination while drinking enough during the day.

Medicines for BPH symptoms

Alpha blockers are one type of medicine used for BPH. They relax smooth muscle near the prostate and bladder neck. This action can improve urine flow.

These medicines aim to ease symptoms. They do not mainly work by reducing prostate size.

Five-alpha-reductase inhibitors are another type of BPH medicine. They may shrink the prostate over several months.

These medicines work slowly. A clinician may choose them when prostate size suggests they could help.

Some patients may receive more than one BPH medicine. Treatment depends on symptoms, prostate findings, and other health concerns.

Every medicine can cause unwanted effects. Patients should report dizziness or other new problems to the prescriber.

Take BPH medicine only as directed. Do not stop or combine treatments without speaking with the prescriber.

Minimally invasive procedures and surgery

Some treatments use a procedure to reduce the blockage ^[7,8]. Others remove or open prostate tissue that blocks urine flow ^[7,8].

A minimally invasive procedure usually involves less treatment than traditional surgery. Surgery may remove or open more of the tissue causing the blockage.

Surgery or a procedure may be right for severe symptoms ^[7,8]. It may also help when medicine does not provide enough relief ^[7,8].

Doctors may recommend a procedure for urinary retention ^[2,5]. Repeated infections or bladder stones may also support this choice ^[2,5].

Kidney problems or major blockage may require a procedure ^[2,5]. The final choice depends on prostate size and overall health ^[8].

Each option has possible benefits and risks. Patients should ask about recovery and the need for anesthesia. They should also ask about possible urinary or sexual effects.

Complications, Follow-Up, and Prevention

Possible complications

Severe or untreated blockage may stop the bladder from emptying well ^[2]. This problem can cause short-term or long-term urinary retention ^[2,5].

BPH complications can include:

• Urinary tract infections ^[2,5].
• Bladder stones ^[5].
• Blood in the urine, called hematuria ^[2,5].
• Bladder muscle damage from long-term blockage ^[2].
• Kidney disease or other kidney problems ^[2,5].
• Acute or long-term urinary retention ^[2,3].

These complications do not affect every person with BPH. Early medical review may find blockage or infection before more harm occurs.

Monitoring symptoms and treatment effects

Follow-up may include a review of symptoms and medicines ^[4,6]. The clinician may also repeat a physical examination or urine test ^[4,6].

Urinary flow testing can show changes over time ^[6]. A postvoid residual test can check how well the bladder empties ^[6].

Tell the clinician if symptoms become worse. Report new warning signs, repeated infections, or medicine side effects.

Also report a major change in urine flow or bladder control. New symptoms may require more tests or a change in treatment.

No method prevents all prostate growth linked to age. Early assessment can still find other causes of urinary symptoms.

Questions to ask a healthcare professional

Consider asking:

• Are my symptoms likely to come from BPH?
• Could another condition be causing them?
• Do I need urine, blood, PSA, or bladder tests?
• Could any of my medicines affect urination?
• Is watchful waiting safe for me?
• Which BPH medicine may help?
• Which side effects should I report?
• How will we know whether treatment works?
• When should I consider surgery or another procedure?
• Which warning signs require emergency care?

A written symptom list can help during the visit. Include nighttime trips, urgency, weak flow, and trouble emptying the bladder.

When to See a Doctor

Arrange a medical visit for urinary symptoms that continue or get worse. These include frequency, urgency, nocturia, and hesitancy ^[4,6].

Weak flow, straining, and incomplete emptying also need assessment ^[4,6]. BPH or another urinary condition may cause these symptoms ^[4,6].

Sudden inability to urinate is a medical emergency ^[2,3]. Seek immediate care if no urine will pass ^[2,3].

Prompt care is also important for:

• Blood in the urine ^[2,5].
• Fever or chills with urinary symptoms ^[2].
• Severe pain in the lower abdomen ^[2].
• Painful urination ^[2].
• Repeated urinary tract infections ^[2,5].
• Signs of urinary retention ^[2,3].
• Possible signs of kidney trouble ^[2,5].

Do not assume that urinary changes are a normal part of aging. Prostate, bladder, urinary tract, and kidney problems may cause similar symptoms ^[4,6].

Conclusion

Understanding enlarged prostate BPH symptoms, diagnosis, treatment, and warning signs supports informed choices. BPH is noncancerous and becomes more common with age ^[1,2].

Common symptoms include frequency, urgency, nocturia, and hesitancy ^[4,8]. Weak flow, straining, dribbling, and incomplete emptying are also common ^[3,4,8].

Doctors use the health history, examination, and selected tests to assess these symptoms ^[6]. Treatment may include monitoring, medicine, a procedure, or surgery ^[7,8].

Sudden urinary retention requires immediate medical care ^[2,3]. Blood in the urine and severe pain also need prompt evaluation ^[2,5]. Seek care for fever, repeated infections, or possible kidney problems ^[2,5].