Benign enlarged prostate (benign prostatic hyperplasia)

Published by Bupa's Health Information Team, March 2011.

This factsheet is for men who have an enlarged prostate caused by benign prostatic hyperplasia (BPH), or for anyone who would like information about it.

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 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 factsheet is just about enlarged prostate caused by BPH.

The 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. Any change in the size or shape of your prostate can narrow this tube, making it difficult for you to pass urine.

If you have BPH, a rapid growth in the cells in your prostate can lead to growth of your prostate gland. Not all men with BPH will develop an enlarged prostate. 

Symptoms of benign enlarged prostate

 If you have an enlarged prostate you may get symptoms such as:

• difficulty in passing urine
• a weak flow of urine that sometimes starts and stops
• dribbling of urine before and after urinating
• feeling that you haven’t emptied your bladder after urinating
• a frequent or urgent need to pass urine
• frequently needing to go to the toilet 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, such as the following.

• Urinary retention. This means you are unable to urinate at all. If this develops suddenly (acute urinary retention) and you have pain in your lower abdomen (tummy), seek urgent medical attention. If it develops gradually (chronic urinary retention), you may start to develop symptoms such as a swollen abdomen and passing urine involuntarily, for example in your sleep. Urinary retention can be treated in hospital by inserting a thin tube (catheter) into your bladder to drain the urine.
• Recurrent urinary tract infections. You may develop frequent urinary tract infections because you are unable to empty your bladder properly. See your GP if you have symptoms such as pain when passing urine, needing to urinate more often than usual, pain in your lower abdomen or cloudy urine.
• Bladder stones. Bladder stones may form if you are unable to empty your bladder. You may have pain in your lower abdomen or find it painful to urinate. Bladder stones sometimes pass on their own, or you may need surgery to remove them.

Causes of benign enlarged prostate

The exact reasons why some men develop BPH and an enlarged prostate are not fully understood at present. However, the main risk factor is age. Nearly a third of men over the age of 50 are thought to have symptoms caused by an enlarged prostate.

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 to assess how severe your symptoms are and how much they are bothering you.

Your GP will feel your abdomen to check whether your bladder is swollen. Your GP may suggest the following tests to rule out prostate cancer as a cause of your symptoms.

• 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.
• 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. Your GP will discuss the pros and cons of this test with you to help you decide whether to have it.

Your GP may also ask you for a urine sample and blood tests to check for urinary tract infections and check how well your kidneys are working.

Your GP may refer you to a urologist (a doctor who specialises in identifying and treating conditions that affect the urinary system) if there are any doubts about your diagnosis, or if you need surgery. 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.
• A urine flow test. This measures the speed of your urine output (how fast it flows).
• A urodynamic study. In this test, a fine tube (catheter) is inserted up through your urethra and into your bladder to measure the pressure inside your bladder.

Treatment of benign enlarged prostate

There are various treatments available for enlarged prostate. Your treatment will depend on a number of factors, including your age, your general health and the type of symptoms you have.

Conservative management

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. 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 in the evening.

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. Only do this if you are advised by your GP.

Medicines

If your symptoms are bothering you, your GP may suggest treatment with one or a combination of the following 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

If medicines don’t help to improve your symptoms, or if you have complications or your symptoms are particularly severe, your GP may refer you to a urologist for further treatment. He or she may suggest one of the following types of surgery.

• Transurethral resection of the prostate (TURP). This is the most common operation for enlarged prostate. 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.
• Transurethral vaporisation of the prostate. This uses a high-voltage electrical current to vaporise some of the prostate.
• Laser surgery. Types of laser surgery include laser resection (holmium laser prostatectomy) that uses a laser to cut out large sections of the prostate, which are then broken down and removed by suction. Photoselective vaporisation is another type of laser surgery, which uses a green light to vaporise the prostate tissue without affecting the surrounding tissue. These procedures are relatively new techniques, only available at certain hospitals. More studies need to be done to confirm how effective they are compared to older treatments over the long term.
• Transurethral incision of the prostate. This is similar to TURP but involves making one or two small cuts in the neck of your bladder and prostate, rather than removing part of the prostate. It's usually only suitable for men who only have a moderately enlarged prostate.
• Open prostatectomy. This involves making a large cut into your lower abdomen, so that the surgeon can access your prostate gland and remove the middle piece of your prostate. It's usually only appropriate for men who have a very large benign (non-cancerous) prostate and is rarely carried out.

New treatments

New treatments, such as botulinum toxin injections, laser vaporisation techniques and laparoscopic prostatectomy are under development. You may be offered a new technique as part of a clinical trial. Ask your surgeon for more details.

Complementary therapies

There have been claims that a number of plant extracts, such as saw palmetto, are effective at treating symptoms of enlarged prostate. However, there is no good quality evidence to support these claims. In addition, these therapies are not regulated, so effective dosages and risk of side-effects are uncertain.

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

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.