BPH (Benign Prostatic Hyperplasia)
A common, non-cancerous enlargement of the prostate causing urinary symptoms
Quick Facts
- Type: Non-cancerous prostate condition
- Who it affects: Mostly men over 50
- Main symptoms: Frequent, weak, or difficult urination
- Not linked to: Prostate cancer (separate condition)
Overview
Benign prostatic hyperplasia (BPH), often called an enlarged prostate, is a very common condition in which the prostate gland grows larger as a man ages. The prostate sits just below the bladder and surrounds the urethra, the tube that carries urine out of the body. As the gland enlarges, it can squeeze the urethra and interfere with the normal flow of urine.
BPH is not cancer and does not raise the risk of prostate cancer, although the two can occur at the same time and cause similar symptoms. Many men develop some prostate enlargement with age, and not all of them have bothersome symptoms. When symptoms do occur, effective treatments are available, ranging from lifestyle measures and medications to minimally invasive procedures and surgery.
Symptoms
BPH symptoms relate to how the enlarged prostate affects urination, and they often develop gradually:
- A frequent or urgent need to urinate, including waking at night to urinate
- A weak urine stream or a stream that starts and stops
- Difficulty starting urination or straining to urinate
- A feeling that the bladder is not fully empty
- Dribbling at the end of urination
In some men, BPH can lead to complications such as urinary tract infections, bladder stones, or a sudden inability to pass urine (acute urinary retention), which is a medical emergency.
Causes
The exact cause of BPH is not fully understood, but it is closely tied to aging and to changes in hormones. As men get older, shifts in the balance of hormones such as testosterone and its byproducts are thought to encourage the prostate to keep growing.
Because the prostate surrounds the urethra, this growth narrows the channel and forces the bladder to work harder to push urine out. Over time the bladder muscle can become thickened and overactive, which contributes to symptoms such as urgency and frequency. BPH is a normal part of aging for many men rather than a result of anything they did.
Risk Factors
- Older age, with risk rising steadily after 50
- A family history of an enlarged prostate
- Obesity
- Diabetes and heart disease
- A sedentary lifestyle
BPH becomes increasingly common with each decade of life.
Diagnosis
Diagnosis combines a symptom review with a physical exam and tests:
- Symptom questionnaire: To gauge how much the symptoms affect daily life.
- Digital rectal exam: To feel the size and texture of the prostate.
- Urine tests: To check for infection or blood.
- PSA blood test: A prostate-specific antigen test, which can be raised in BPH and helps assess prostate cancer risk.
- Additional tests: Such as measuring urine flow, checking how much urine remains after voiding, or ultrasound when needed.
Treatment
Treatment is guided by how bothersome the symptoms are and whether complications are present:
- Watchful waiting and lifestyle changes: For mild symptoms, including limiting fluids before bedtime, reducing caffeine and alcohol, and double-voiding.
- Medications: Alpha blockers relax the prostate and bladder neck to improve flow, and 5-alpha reductase inhibitors can shrink the prostate over time; the two are sometimes combined.
- Minimally invasive procedures: Office or outpatient treatments that relieve obstruction with less recovery time.
- Surgery: Procedures such as transurethral resection of the prostate (TURP) remove excess prostate tissue for more severe cases.
Prevention
BPH cannot be reliably prevented, but a healthy lifestyle may help and can ease symptoms:
- Stay physically active and maintain a healthy weight
- Manage conditions such as diabetes and heart disease
- Limit caffeine and alcohol, which can worsen urinary symptoms
- Do not delay urination and empty the bladder fully
- Have regular check-ups so symptoms can be addressed early
When to See a Doctor
See a doctor if you have urinary symptoms such as frequency, urgency, a weak stream, or waking at night to urinate, so the cause can be assessed and prostate cancer ruled out. Seek emergency care right away if you:
- Are completely unable to urinate
- Have blood in your urine
- Have fever, chills, and painful urination, which may signal infection
- Have severe lower abdominal pain with a full bladder
Frequently Asked Questions
Does BPH cause prostate cancer?
No. BPH is a non-cancerous enlargement of the prostate and does not turn into or raise the risk of prostate cancer. However, both can occur at the same time and cause similar urinary symptoms, so evaluation is important.
What are the first signs of an enlarged prostate?
Early signs usually involve urination, such as needing to go more often, getting up at night to urinate, a weak or interrupted stream, trouble starting, and a feeling that the bladder is not fully empty.
Can BPH be treated without surgery?
Yes. Many men improve with lifestyle changes and medications such as alpha blockers or 5-alpha reductase inhibitors. Minimally invasive procedures are also available, with surgery reserved for more severe or complicated cases.
Is being unable to urinate an emergency?
Yes. A sudden, complete inability to pass urine, called acute urinary retention, is a medical emergency. It causes a painfully full bladder and needs prompt treatment to drain the urine and prevent kidney problems.
Does BPH go away on its own?
BPH usually does not resolve on its own and tends to progress gradually with age. Mild symptoms may be monitored, but bothersome or worsening symptoms generally respond well to treatment.
References
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Prostate Enlargement (Benign Prostatic Hyperplasia).
- American Urological Association (AUA). Benign prostatic hyperplasia.
- Mayo Clinic. Benign prostatic hyperplasia (BPH).
- MedlinePlus, U.S. National Library of Medicine. Enlarged prostate (BPH).