Overview
The prostate is a small gland that sits just below the bladder in men, around the tube that carries urine out of the body (the urethra). It tends to grow larger with age. When it grows, it can press on the urethra and make it harder to pass urine.
This is called benign prostatic hyperplasia (BPH), or an enlarged prostate. Benign means it is not cancer. It is common in men over 50, usually not serious, and develops slowly.
Symptoms
Symptoms usually come on slowly and may get worse with age. They can include:
- Difficulty starting to pass urine, or straining
- A weak flow that stops and starts
- A feeling that the bladder has not emptied fully
- Dribbling at the end of, or just after, passing urine
- Needing to pass urine more often or more urgently, including several times at night
Some men have no symptoms at all, and the size of the prostate does not always match how bad they are.
When to see a doctor
See a doctor soon if you have difficulty passing urine, pass urine much more often than before, or have pain when passing urine. These symptoms can also be caused by other problems, including infection and prostate cancer, so they should be checked rather than put down to age.
Causes
The exact cause is not known. Ageing and changes in hormone levels are thought to play a part.
An enlarged prostate is not caused by cancer, and it does not cause cancer.
Risk factors
- Age: it becomes much more common after 40, and especially after 50
- A family history of BPH
- Heart and blood vessel disease, type 2 diabetes, obesity or chronic kidney disease
- Erectile dysfunction
- Being physically inactive
Complications
When the bladder cannot empty well over a long time, problems can follow:
- Sudden inability to pass urine (urinary retention), which is an emergency
- Urinary tract infections
- Bladder stones
- Blood in the urine
- Damage to the bladder or kidneys
Prevention
No proven way to prevent an enlarged prostate has been found, though being physically active may lower the risk. Some habits can ease symptoms:
- Cutting down on alcohol and caffeine
- Drinking enough through the day, but less in the evening and before going out
- Passing urine when you need to, taking time to empty the bladder fully, and not straining
- Eating enough fibre to avoid constipation, and keeping to a healthy weight
- Asking a doctor or pharmacist whether any of your medicines, such as some cold or allergy tablets, may be making symptoms worse
Diagnosis
A doctor will ask about your symptoms and medicines, examine your tummy and usually do a rectal examination to feel the prostate. Tests may include:
- A urine test, to look for infection or blood
- A PSA blood test, to help check the prostate
- Blood tests to check how well the kidneys are working
- A urine flow test and a scan, to see how well the bladder empties
- Cystoscopy, a thin camera passed into the bladder, if needed
Treatment
Mild symptoms that do not bother you may only need lifestyle changes and yearly check-ups. Other options depend on how severe the symptoms are:
- Medicines (alpha blockers) that relax the muscles around the prostate and bladder neck, so urine flows more easily
- Medicines that shrink the prostate slowly, which take several months to work, sometimes used together with the first type
- Procedures that use heat, steam, laser or small implants that hold the prostate open
- Surgery, most often TURP, in which part of the prostate is removed through a thin tube, when medicines do not work or for complications such as retention, repeated infections or bladder stones
A catheter may be needed if the bladder cannot empty.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“An enlarged prostate is a kind of cancer, or it will turn into cancer.”What is true?
Fact
An enlarged prostate is not cancer and does not raise your risk of prostate cancer. However, prostate cancer can cause similar urine symptoms, so a doctor should check any change in how you pass urine.
Myth“Getting up at night to pass urine is just old age, so nothing can be done.”What is true?
Fact
Frequent trips to the toilet, especially at night, are a common symptom of an enlarged prostate, and they can be treated. Lifestyle changes, medicines and procedures can all help, and other conditions can cause the same symptoms, so it is worth being checked.
Myth“Drinking much less water will stop the trips to the toilet.”What is true?
Fact
Drinking less in the hours before bed or before going out can help. But cutting fluids too much can lead to urinary infections, so drink enough through the day.
Myth“Everyone with an enlarged prostate ends up needing an operation.”What is true?
Fact
Mild symptoms that do not bother you may only need lifestyle changes and yearly check-ups, and medicines help many men. Surgery is considered when medicines do not work, symptoms are severe, or complications develop.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
Does an enlarged prostate cause prostate cancer?
No. An enlarged prostate is not cancer and does not raise your risk of prostate cancer. The two can cause similar urine symptoms, so a doctor will check for both when you report a change in how you pass urine.
Will I definitely need an operation?
No. Mild symptoms may only need lifestyle changes and regular check-ups, and medicines help many men. Surgery is considered if medicines do not work, symptoms are severe, or complications develop.
Can an enlarged prostate affect the kidneys?
Over a long time, if the bladder cannot empty properly, the pressure and infections can damage the bladder and kidneys. This is one reason to get urine symptoms checked rather than put up with them.
Should I stop drinking water to avoid going to the toilet?
No. Drinking less in the evening can reduce night-time trips, but drinking too little can lead to urinary infections. Keep drinking enough through the day, and cut down on alcohol and caffeine, which can make symptoms worse.
