Enlarged Prostate (BPH): Urinary Symptoms, Causes and When to Be Seen

What it involves

MedlinePlus explains that an enlarged prostate, also called benign prostatic hyperplasia or BPH, is when the prostate gland grows larger than normal. Benign means it is not cancer, and MedlinePlus says BPH does not raise the risk of prostate cancer. It is the most common prostate condition in people over age 50.

Who this is for

• Men who wake several times at night to urinate
• Men with a weak, slow, or stop-and-start urine stream or dribbling afterward
• Men who feel they cannot fully empty the bladder
• Partners and family who notice the bathroom trips are affecting sleep and daily life

What to expect

• Questions about your urinary symptoms, medicines, and family history
• A physical exam that, per MedlinePlus, may include a digital rectal exam to check the size and feel of the prostate
• A urine test and, if needed, other tests a provider orders, such as a PSA blood test
• A plan that may include lifestyle changes, medicine, or a referral to a urologist

Why symptoms happen

MedlinePlus says that as the prostate gets bigger, it may press against the bladder and pinch the urethra, which can slow or block the flow of urine. Over time, the bladder muscle can weaken from working against the narrowed channel, so the bladder may not empty completely. That combination explains many of the urinary problems seen with BPH. Researchers are not sure why the prostate keeps growing, and some think changes in hormones with aging play a part.

What BPH can feel like

The symptoms MedlinePlus lists are a frequent or urgent need to urinate, waking many times to urinate, trouble starting, a weak, slow, or stop-and-start stream, dribbling after urination, urinary incontinence, and the feeling the bladder is not empty. It also names pain after ejaculation or with urination and urine with an unusual color or smell. The frequent urination guide and the urinary incontinence guide describe other causes of the same complaints.

Who is more likely to have it

MedlinePlus says the chance rises from age 40 and increases with age, and is higher if family members have had BPH. Obesity, heart disease and circulation problems, type 2 diabetes, erectile dysfunction, and too little physical activity are on its list of related health conditions. Symptoms can come from more serious problems too, which is why MedlinePlus stresses seeing a provider rather than assuming it is BPH. The diabetes page covers one of the related conditions.

Get help right away if

MedlinePlus says to seek medical help right away if you cannot urinate at all, have fever and chills with painful, frequent, urgent urination, have blood in your urine, or have pain in the lower belly and urinary tract. It calls sudden inability to urinate, acute urinary retention, a medical emergency, which can be triggered by some over-the-counter cold or allergy medicines, alcohol, cold temperatures, and sitting still for a long time. Urinary tract infections are discussed in the UTI guide.

How it is checked

A provider reviews your medical history, including every medicine, since some make symptoms worse, and examines you. MedlinePlus says tests can include urine tests, a PSA blood test, urodynamic testing, cystoscopy, ultrasound, and sometimes a prostate biopsy to diagnose or rule out cancer. Which of these are needed depends on your case, and some are done by a urologist. The urinalysis guide explains the first urine test most people have.

Treatment choices

Not everyone needs treatment, per MedlinePlus. Mild symptoms may improve by drinking less before bedtime, cutting back on caffeine and alcohol, bladder training, and preventing constipation. Medicines can stop prostate growth, shrink the prostate, or relax the muscles to improve flow. Procedures that use an instrument inserted into the urethra, and surgery, are options for moderate to severe symptoms that do not respond, and a urologist performs them. Your provider explains the benefits and side effects so you can decide.

Sources

• MedlinePlus — Enlarged Prostate (BPH)
• MedlinePlus — Prostate Diseases