Enlarged prostate (BPH): symptoms, tests and treatment options

An enlarged prostate can cause urinary problems in men. This article explains the symptoms, tests and treatment choices, using information from the NHS and MedlinePlus.

1. Introduction

The prostate is a small gland below the bladder that makes some of the fluid in semen and surrounds the urethra, the tube that carries urine out of the body ^{[1, 2]}. The NHS says that when the prostate enlarges it can press on the urethra and cause urinary problems, and that this is common and not usually serious ^[1]. Many men feel embarrassed to talk about urine problems, yet doctors are used to discussing them. This article is general information, and your doctor decides which tests and treatment suit you. MedlinePlus explains that the condition, called benign prostatic hyperplasia (BPH), is not cancer and does not raise the risk of prostate cancer, and that it becomes more common with age ^[2]. The NHS likewise says it is not caused by prostate cancer and does not increase the risk of getting it ^[1].

2. Causes and risk factors

The NHS says the cause is thought to be linked to hormone changes with age. Risk is higher over the age of 50 or with a family history ^[1]. MedlinePlus says the exact cause is unknown and that ageing and changes in testosterone levels may play a role. It adds that a small amount of enlargement is present in many men over 40 and that more than 90 percent of men over 80 have the condition ^[2].

3. Signs and symptoms

Symptoms usually develop slowly and may worsen with age ^[1]. The NHS lists ^[1]:

• Difficulty starting to pass urine, or straining
• A weak flow, stop-start flow, or taking longer to finish
• A feeling that the bladder is not fully empty
• Dribbling after passing urine
• Needing to pass urine more often or more urgently, including at night

MedlinePlus notes that fewer than half of men with BPH have symptoms, and that pain when passing urine or blood in the urine may signal infection ^[2].

4. Diagnosis and tests

The NHS says a GP will discuss your symptoms and may ask you to keep a record of fluids and urination for at least three days. They may carry out a physical examination including a rectal examination, test a urine sample and arrange a PSA blood test. You may be referred for a urine flow test, a bladder ultrasound or a cystoscopy, which uses a small camera to look inside the bladder ^[1]. MedlinePlus adds that the PSA test is used to screen for prostate cancer, and that kidney function blood tests may be done ^[2].

5. Treatment and management

Treatment depends on how severe and how bothersome the symptoms are. The NHS says treatment is not always necessary, and for mild symptoms lifestyle changes are usually advised first ^[1]. Your doctor decides what suits you.

Lifestyle and self-care

• Cut down on alcohol and caffeine.
• Reduce fluids before bed or before going out, but drink enough during the day.
• Eat enough fibre to prevent constipation.
• Keep to a healthy weight.
• Wait a moment after passing urine and try again to empty the bladder.
• Avoid straining, and do not cut back fluids too much ^[1].

MedlinePlus also advises passing urine on a schedule, keeping warm and exercising regularly, and trying to reduce stress. It says over-the-counter cold and sinus medicines with decongestants or antihistamines can increase BPH symptoms ^[2], and the NHS suggests checking with a doctor or pharmacist whether any medicines you take for other conditions could be making symptoms worse ^[1].

Medicines

For moderate or severe symptoms, the NHS describes three types of medicine: medicines that help you pass urine, medicines for frequent or urgent urination, and medicines that lower hormone levels to slow prostate growth, which are for people at high risk of the condition worsening. These can have side effects, and regular check-ups are needed ^[1]. MedlinePlus says some of the medicines that help you pass urine relax the muscles of the bladder neck and prostate, and that medicines that shrink the gland can take 3 to 6 months to work ^[2].

Surgery

The NHS says surgery is usually considered if medicines have not helped or symptoms are severe. The most common operation is transurethral resection of the prostate (TURP), which removes part of the prostate through a thin tube. Other procedures use lasers, an electrical current, steam or a jet of water to remove or destroy part of the prostate, or an implant to hold it open, and they are not suitable for everyone ^[1]. Support such as pads, bladder training and pelvic floor exercises is also available ^[1].

6. Prevention and complications

The sources do not describe a proven way to prevent BPH, but the self-care steps above may help with symptoms. MedlinePlus says men who have had BPH for a long time with slowly worsening symptoms may develop sudden inability to pass urine, urinary tract infections, urinary stones, kidney damage and blood in the urine, and advises a yearly assessment to check symptoms ^[2].

7. When to see a doctor

See a GP if you have trouble passing urine or need to pass urine more often, since these symptoms should be checked because they can sometimes point to more serious conditions such as prostate cancer ^[1]. Ask for an urgent appointment or call NHS 111 or your local advice line if you notice blood in the urine, pain when passing urine or you cannot pass urine at all ^[1]. MedlinePlus says to contact a provider right away for reduced urine output, fever or chills, back, side or belly pain, or blood or pus in the urine ^[2]. Do not stop prescribed medicines without advice ^[2].

In an emergency, call your local emergency number (112 in India, 911 in the United States).

8. Conclusion

An enlarged prostate is common with age and is not cancer. Symptoms can be eased with lifestyle changes, medicines or surgery, depending on the person. Talk to a doctor early, and seek urgent help for blood in the urine, pain or being unable to pass urine.