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Benign enlarged prostate
(benign prostatic hyperplasia)

Key points

  • Benign enlarged prostate is a condition where the prostate gland gets gradually bigger.
  • A condition known as benign prostatic hyperplasia (BPH) can cause your prostate gland to become enlarged.
  • The main symptom of BPH are having problems passing urine.
  • There are a number of different treatments, including medicines and surgery.

Benign enlarged prostate is a condition that affects many men as they get older. In some men, increased growth of the tissue in the prostate gland (known as benign prostatic hyperplasia or BPH) can cause the prostate gland to become enlarged, which can make it difficult to pass urine.

About benign enlarged prostate

Benign means non-cancerous. Many things, including prostate cancer and prostatitis, can cause an enlarged prostate. This information is just about an enlarged prostate caused by BPH.

Your prostate is a gland that produces the liquid part of semen (the fluid produced when you ejaculate). It’s about the size of a walnut and lies at the base of your bladder. The front of your prostate surrounds your urethra – the tube that carries urine from your bladder and out through your penis.

If you have BPH, a rapid growth in the cells in your prostate can cause the middle part of your prostate to gradually grow bigger. When this happens the prostate gland presses on your urethra, narrowing it and making it more difficult to pass urine.

BPH is a common problem in men as they get older. Around half of all men have an enlarged prostate by the age of 50 and about 9 out of 10 men have an enlarged prostate by the age of 90.

Image showing the position of the prostate gland and surrounding structures.

Symptoms of benign enlarged prostate

If you have an enlarged prostate you may not have any symptoms at all. If you do have symptoms, how severe they are isn’t linked to the size of your prostate. For example, if your prostate is very large it doesn’t mean your symptoms will be severe. The symptoms of BPH may include:

  • difficulty starting to pass urine
  • a weak flow of urine
  • dribbling of urine before and after urinating
  • feeling that you haven’t totally emptied your bladder after urinating
  • a frequent or urgent need to pass urine
  • needing to go to the toilet more often, especially at night

If you have any of these symptoms, see your GP.

Complications of benign enlarged prostate

In some men, enlarged prostate can lead to more serious problems. The main complications of benign enlarged prostate are listed below.

  • Urinary retention. This means you’re unable to urinate at all. If this develops suddenly (acute urinary retention) and you have pain in your lower abdomen (tummy), see your GP straightaway. If it develops gradually (chronic urinary retention), you may start to develop symptoms such as a swollen abdomen and pass urine involuntarily, for example in your sleep. Urinary retention can be treated by inserting a thin tube (catheter) into your bladder to drain the urine.
  • Repeated urinary tract infections. You may keep getting urinary tract infections, because you can’t empty your bladder properly. See your GP if you have symptoms such as pain when passing urine, needing to urinate urgently or more often than usual, pain in your lower abdomen, cloudy or smelly urine or blood in your urine.
  • Bladder stones. Bladder stones may form if you’re unable to empty your bladder. You may have pain in your lower abdomen or find it painful to urinate.
     

Causes of benign enlarged prostate

The exact reasons why some men develop BPH and an enlarged prostate aren’t fully understood at present. However, there are two factors that affect your likelihood of developing BPH; your age and the level of hormones in your body. As you get older the level of hormones in your body change and this may affect your prostate gland.

Diagnosis of benign enlarged prostate

Your GP will ask you about your symptoms and examine you. He or she may ask you to complete a questionnaire, or a keep a diary, to assess how severe your symptoms are and how much they are bothering you.

Your GP will feel your abdomen to check if your bladder is swollen. Your GP will also do a digital rectal examination. This is an examination to check the size of your prostate gland and what it feels like. Your doctor will insert his or her finger into your rectum (back passage), where he or she will be able to feel your prostate gland.

Your GP may also ask you for a urine sample and do blood tests to check for urinary tract infections and check how well your kidneys are working. You may also have a blood test for prostate-specific antigen (PSA). This is a protein produced by the prostate. High levels of PSA can sometimes be a sign of cancer, but may also be a result of BPH, infections and other reasons. In fact, around half of men with BPH will have a raised PSA level. Your GP will discuss the pros and cons of this test with you to help you decide whether to have it.

Your GP may refer you to a urologist if there are any doubts about your diagnosis, or if you need surgery. A urologist is a doctor who specialises in identifying and treating conditions that affect the urinary system. The urologist may advise the following tests.

  • An ultrasound. This uses sound waves to produce an image of the inside of your abdomen. This can be used to check the size of your prostate and your bladder. An ultrasound can also help to show whether your bladder is emptying properly.
  • A urine flow test. This measures the speed of your urine output (how fast it flows).
     

Treatment of benign enlarged prostate

There are various treatments available for enlarged prostate. Your treatment will depend on a number of factors, including how severe your symptoms are and how much they bother you. Treatment may not be able to get rid of your symptoms completely but it can ease them effectively.

Watchful waiting

If you have mild to moderate symptoms that aren't bothering you much, your GP may suggest you don’t have any immediate medical treatment, but just monitor your condition with routine check-ups. This is called watchful waiting. Your GP may give you some advice on simple lifestyle changes you can make to improve your symptoms, such as cutting down on caffeine and alcohol and reducing the amount of fluid you drink when you know you’re going out.

He or she may also suggest a programme of exercises known as bladder training. This involves increasing how much urine your bladder can hold by trying to increase the amount of time before you need to urinate.

Medicines

If your symptoms are bothering you, your GP may suggest treatment with medicines.

Alpha-blockers

These include alfuzosin, doxazosin and tamsulosin. Alpha-blockers work by relaxing the muscles at the neck of your bladder, reducing the pressure on your urethra and increasing the flow of urine. They don’t cure BPH but may help to alleviate some of your symptoms. Alpha-blockers can be associated with side-effects such as dizziness and light-headedness, as a result of low blood pressure. Your GP can prescribe alpha-blockers. You can also buy tamsulosin from a pharmacist.

5-alpha reductase inhibitors

If you have a particularly large prostate or a high PSA level (but don’t have any signs of prostate cancer), your GP may prescribe you a 5-alpha reductase inhibitor, such as finasteride or dutasteride. These medicines work by blocking the production of a hormone called dihydrotestosterone, which can reduce the size of your prostate. They can take six months or more to work.

The most common side-effects of 5-alpha reductase inhibitors are sexual problems, including a reduced sex drive, difficulty in maintaining an erection and problems with ejaculation. However, these problems seem to affect more men during the first year of treatment and become less common as treatment continues.

Surgery

Your urologist may suggest an operation if other treatments haven’t worked, or if your symptoms are severe. If you develop any complications as a result of your enlarged prostate your urologist may also suggest surgery.

There are a number of different types of surgery that can treat an enlarged prostate. The most common type of surgery is transurethral resection of the prostate (TURP). The procedure involves passing a narrow, flexible tube-like telescopic camera called an endoscope up through your urethra, and cutting out the middle of your enlarged prostate using specially adapted surgical instruments.

There are other types of procedure, such as holmium laser enucleation of the prostate (HoLEP) and transurethral vaporisation of the prostate (TUVP), where some or all of your prostate gland is removed or destroyed. Your urologist will discuss the options with you.

Complementary therapies

There have been claims that the plant extract saw palmetto is an effective treatment for symptoms of enlarged prostate. However, there is no good quality evidence to support these claims.

If you do choose to try herbal medicines, talk to your GP or pharmacist first.

 

Produced by Dylan Merkett, Bupa Health Information Team, June 2013.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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