Fast facts

  • Benign prostatic hyperplasia (BPH) is when the prostate gland grows larger. It is a common condition in older men. Its cause is not known.
  • BPH can cause problems with urination (peeing).
  • BPH is not a serious condition in itself, although the symptoms can be bothersome. It is, however, important to have a doctor check you and rule out other, more serious, conditions that give rise to  similar symptoms.

Prostate gland

A male reproductive organ that surrounds parts of the bladder and urethra. It secretes a sperm-nourishing component of semen.

What is benign prostatic hyperplasia?

Benign prostatic hyperplasia (BPH), also known as prostatic hypertrophy, is an enlargement of the prostate gland. BPH can cause problems with urination (peeing). BPH happens to all men, to some degree, as they get older.

Prostate gland

A male reproductive organ that surrounds parts of the bladder and urethra. It secretes a sperm-nourishing component of semen.

Causes

The cause of BPH is not completely understood, although hormones, such as testosterone, may play a role.

The prostate is a small ring-shaped gland that sits just under the bladder and in front of the rectum. It surrounds the urethra, the tube that carries urine from the bladder and through the penis. When it grows larger, the prostate gland can press on the bladder and the urethra, interfering with urination.

Two cross-section diagrams of the male reproductive system, one showing a prostate gland of regular size, the other an enlarged prostate gland pressing against the underside of the bladder.An enlarged prostate gland can interfere with normal urination. 

Prostate gland

A male reproductive organ that surrounds parts of the bladder and urethra. It secretes a sperm-nourishing component of semen.

Rectum

The final part of the large intestine, leading to the anus.

Testosterone

A hormone that plays a key role in the development of male sexual characteristics and reproduction. It is produced by both sexes, but in much larger amounts in men.

Urethra

The duct through which urine flows from the bladder to outside the body.

Risk factors

The factors that increase the risk of BPH are not very clear at this stage. Family history, increasing age, being overweight or obese, diabetes, high blood pressure (hypertension) and a diet high in saturated fat and red meat have been suggested.

Diabetes

A metabolic disorder that is caused by problems with insulin secretion and regulation and which is characterised by high blood sugar levels. Also known as diabetes mellitus.

Signs and symptoms

Symptoms of BPH can include:

  • Difficulty beginning urination;
  • Having to urinate often, especially at night;
  • A weak or interrupted stream of urine;
  • Straining while urinating;
  • A sudden and urgent need to urinate,
  • Not being able to completely empty your bladder, and;
  • Dribbling at the end of urination.

These symptoms are sometimes known as lower urinary tract symptoms (LUTS). 

Symptoms due to BPH often develop gradually and do not usually occur before 50 years of age. The increased size of the prostate does not always correspond to the level of symptoms you may experience.

Ruling out other conditions

Some serious conditions can cause similar symptoms to those of BPH. Checking in with your doctor if you have problems with urinating, or if your pattern of urination changes, can help to identify and treat these early on.

Blood in the urine is a symptom that can indicate serious health conditions that need prompt investigation.

Urinary tract

The organs and tubes involved in transporting urine within the body and out of it.

Methods for diagnosis

Your doctor will ask you for details about your symptoms in order to understand how severe they are and how much they affect your lifestyle.

Your doctor may perform a digital rectal exam in order to examine the shape and size of the prostate gland. This test involves a doctor putting a gloved finger into the anus in order to examine the shape and size of your prostate gland.

Your doctor may recommend further tests or refer you to a specialist (urologist).

A male patient in a gown for a physical examination and a doctor. 

Protein-specific antigen testing

A blood test is used to to measure the level of prostate-specific antigen (PSA) in the blood. High PSA levels can be caused by a number of different prostate conditions including BPH, prostatitis (inflammation of the prostate) and prostate cancer.

There have been questions raised about PSA testing because PSA levels do not always reflect the risk of prostate cancer. Some men with high PSA levels do not have prostate cancer, while other men with relatively low PSA levels may have prostate cancer.

It is important to note that prostate cancer rarely causes lower urinary tract symptoms in its early stages, because it can grow within the prostate without pressing on the urethra.

Your doctor can explain more about PSA testing and discuss the potential benefits and harms of the test.

Additional tests

Othe tests that may be recommended include:

  • Urine test - to rule out prostate infections;
  • Ultrasound scan to assess the size of the prostate, as well as look at the bladder and kidneys, and;
  • Urodynamic testing will test how your urinary system (including the bladder, the urethra and the muscles that control urine flow) stores and releases urine.

Antigen

A substance or particle that is recognised as foreign by the immune system, stimulating an immune response.

Prostate gland

A male reproductive organ that surrounds parts of the bladder and urethra. It secretes a sperm-nourishing component of semen.

Ultrasound

A scan that uses high-frequency soundwaves to produce images of the body’s internal structures.

Urethra

The duct through which urine flows from the bladder to outside the body.

Urinary tract

The organs and tubes involved in transporting urine within the body and out of it.

Urologist

A physician who specialises in diagnosing and treating conditions of the urinary tract.

Prostate cancer

A cancer of the prostate, which is a gland in males that produces a fluid that is part of the semen.

Types of treatment

Men with mild BPH may not require treatment if the symptoms do not bother them. Symptoms can sometimes improve without treatment.

A variety of treatments and self-care measures are available:

Lifestyle changes

There are things you can do that can help to reduce and/or manage symptoms caused by BPH:

  • Caffeine and alcohol increase how frequently you urinate. Limiting of amount of these drinks can help;
  • Limit the amount of fluids you drink before bed. This will make you less likely to need to urinate during the night;
  • Be physically active for 30-60 minutes a day. Regular exercise, such as walking or cycling, can help to improve symptoms;
  • Avoid constipation by eating a healthy diet that is rich in fibre. Constipation can strain your pelvic floor muscles which are important for bladder control, and;
  • Lose weight if you are overweight or obese.

Bladder training

Bladder training involves exercises that can help to increase the amount of urine your bladder can hold before needing to urinate. Bladder training is not suitable for everyone; your doctor or urologist can advise whether it can help you.

Medications

Seeral types of medications can help you with the urinary flow problems that BPH causes. Once you start taking medications, you will need to continue to take them on an ongoing basis for them to be effective. 

Medications include:

Alpha blockers

Alpha blockers such as prazosin and tamsulosin can help to relax muscles in the bladder and prostate, and improve urinary flow. Side effects of these drugs can include dizziness, headaches and, particularly with tamsulosin, little or no sperm when you ejaculate. They can also cause problems if you have eye surgery while taking these medications.

5-alpha-reductase inhibitors

5-alpha-reductase inhibitors, such as dutasteride and finasteride, work by blocking the production of dihydrotestosterone (DHR). DHR is a hormone that stimulates growth of the prostate. Blocking DHR can reduce the size of the prostate gland and improve urinary symptoms.

These medications are usually only prescribed for men who have a particularly large prostate. It can take a few months for these medications to have a noticeable effect.

Common side effects of these medications can include a decreased sex drive, erectile dysfunction, and problems with ejaculation. These medications can also cause birth defects in babies if the father is taking them when the baby is conceived, or if broken or crushed tablets are handled by a pregnant woman.

Complementary medicine

Saw palmetto (also known as Serenoa repens) has been used to treat urinary symptoms associated with BPH. However, trials have not shown evidence that it is effective.

Surgery

For men with severe BPH symptoms, surgery to remove some or all of the prostate may be recommended.

Transurethral resection of the prostate (TURP)

A small instrument called a resectoscope is inserted into the urethra. The end of the instrument (a wire loop) is used to cut away excess tissue in the region where the prostate is pressing on the urethra.

This operation is done under anaesthesia. You may spend one or more nights in hospital recovering.

A diagram of the male reproductive system showing three close up views of the prostate gland and with a resectoscope inserted to remove tissue during a transurethral resection of the prostate.Transurethral resection of the prostate. 

Transurethral incision of the prostate (TUIP)

The resectoscope is used to make one or two cuts in the bladder neck, the area where the bladder and prostate connect. This can help to open up the area and increase urinary flow.

Laser-based surgeries

Techniques such as photoselective vaporisation of the prostate (PVP) and Holmium laser enucleation of the prostate (HoLEP) are similar to TURP, but use lasers to remove the prostate tissue. These techniques are less invasive than TURP and may offer some benefits, such as reduced recovery time.

Prostatectomy

Rarely, the whole prostate may be removed. It is not commonly performed for BPH, but may be recommended if the prostate is severely enlarged.

Ejaculate

The semen that has been ejected from the penis.

Ejaculation

The release of semen from the penis in a single emission.

Prostate gland

A male reproductive organ that surrounds parts of the bladder and urethra. It secretes a sperm-nourishing component of semen.

Sperm

The mature male sex cell that fertilises the female ovum.

Urethra

The duct through which urine flows from the bladder to outside the body.

Urologist

A physician who specialises in diagnosing and treating conditions of the urinary tract.

Pelvic floor muscles

A group of deep muscles and ligaments at the bottom of the pelvis that support the organs that lie on it and control the anal, vaginal and urinary openings.

Potential complications

While BPH is unlikely to cause serious health conditions, it can sometimes lead to:

  • Urinary tract infection. If your bladder does not empty of urine completely, bacteria can infect the urinary tract, and;
  • Acute urinary retention (AUR). This is a condition in which a person is suddenly unable to pee. While it is not common for BPH to cause acute urinary retention, it requires immediate treatment, because it can lead to kidney damage.

Complications of surgery

All surgeries to treat BPH can have complications. Before surgery, your urologist can discuss the potential benefits and drawbacks of the surgical techniques available, and which of them may be most suitable for you.

Complications can include:

  • Bleeding following the surgery. This normally stops within weeks;
  • Retrograde ejaculation. In this condition, the semen passes back into the bladder and then is passed when you next urinate. It does not cause health problems and does not prevent an orgasm; however, it can cause infertility;
  • Erectile dysfunction. Some men are not able to get or sustain an erection following surgery. This is more common in men who have erectile problems prior to surgery;
  • Urinary incontinence. Due to bladder problems or damage to the muscles that control urine flow (called sphincters), some men are unable to control urinary flow after surgery, and;
  • Urethral strictures. Scarring in the urinary tract can lead to blockages of flow.

Ejaculation

The release of semen from the penis in a single emission.

Infertility

Inability to produce offspring.

Urinary tract

The organs and tubes involved in transporting urine within the body and out of it.

Urologist

A physician who specialises in diagnosing and treating conditions of the urinary tract.

Prognosis

BPH does not usually cause serious health problems for men, although the symptoms can be bothersome and affect your quality of life. Generally, symptoms slowly get worse without treatment. Treatments can help to deal with symptoms, but can have significant side effects.

Prevention

The lifestyle mesures listed in the 'Types of treatment' section above can help to prevent or delay BPH.