Enlarged Prostate (BPH): Symptoms, Tests and Treatment in Men

Getting up three or four times a night to pass urine. A weak stream that stops and starts. Standing at the toilet waiting for the flow to begin. Many men over 50 put up with this for years, believing it is just part of ageing and too embarrassing to mention. In most cases the cause is benign prostatic hyperplasia, or BPH, a very common and treatable condition, and not cancer.

What is BPH?

The prostate is a walnut-sized gland below the bladder, which surrounds the tube (urethra) that carries urine out of the body. As men age, the prostate slowly grows. When it grows large enough it squeezes the urethra, making it harder to empty the bladder. About half of men over 50, and most men in their 70s and 80s, have some degree of enlargement.

Symptoms

• Needing to pass urine often, especially at night (nocturia)
• Sudden strong urge to go
• Weak, slow or interrupted urine stream
• Hesitancy: difficulty starting
• Dribbling at the end of urination
• A feeling that the bladder is not completely empty
• Straining to pass urine

Is it cancer?

BPH is not cancer and does not turn into cancer. However, prostate cancer can cause similar symptoms and both can occur together, so any man with urinary symptoms should be examined. Blood in the urine, bone pain, or unexplained weight loss need prompt checking.

Other causes of similar symptoms

• Urinary infection (UTI) or prostatitis
• Diabetes, which causes frequent urination and bladder nerve damage (see early signs of diabetes)
• Bladder or kidney stones
• Medicines such as some cold remedies (decongestants), water tablets and antidepressants
• Urethral narrowing (stricture)
• Heart failure causing fluid retention that is passed at night

Tests

• Symptom score questionnaire and a physical exam, including a gentle examination of the prostate
• Urine test to check for infection or blood
• Ultrasound of the kidneys, bladder and prostate, including how much urine remains after passing
• Blood tests: kidney function, and a PSA test if indicated, after discussion with your doctor
• Urine flow test and, in some cases, further specialist tests

Treatment

Treatment depends on how much the symptoms bother you and whether there are complications.

• Watchful waiting and lifestyle changes for mild symptoms: cut down on fluids, tea and coffee in the evening, avoid alcohol late in the day, empty the bladder fully (double voiding), and keep active. Review decongestants and water tablets with your doctor.
• Alpha-blockers (such as tamsulosin, silodosin and alfuzosin) relax the muscle around the prostate and improve flow within days. Side effects include dizziness on standing, tiredness and a drier ejaculation.
• 5-alpha-reductase inhibitors (finasteride, dutasteride) slowly shrink the prostate over months, and help men with larger prostates. They may affect sex drive and PSA levels.
• Combination tablets may be used when both are needed.
• Surgery (such as TURP or laser procedures) for those with retention, repeated infections, bladder stones, kidney damage or symptoms that do not respond to medicines.

Please do not take prostate medicines from a friend or based on herbal advertisements. Dosing and choice depend on your tests and other medicines, especially blood pressure tablets.

Complications if ignored

• Sudden inability to pass urine (acute retention), which is painful and an emergency
• Repeated urinary infections
• Bladder stones
• Bladder damage, and in severe cases kidney damage (see chronic kidney disease)

When to see a doctor

• Urinary symptoms that bother your sleep or daily life
• Blood in the urine
• Burning with urination or fever
• You cannot pass urine at all. Go to hospital at once.
• Lower abdominal pain or a swollen bladder

Key takeaways

• BPH is a common, non-cancerous enlargement of the prostate in older men.
• Night-time urination and a weak stream are the typical signs. Do not ignore them.
• Lifestyle changes and tablets work well. Surgery is for complications or severe symptoms.
• Get examined to rule out infection, diabetes and prostate cancer.

Related medicines on Medimart

• Tamsulosin, silodosin and alfuzosin: alpha-blockers that ease urine flow
• Finasteride: shrinks an enlarged prostate over time
• Dutasteride-tamsulosin: a combination used for larger prostates

Browse enlarged prostate products on Medimart, delivered across Pakistan. Prescription medicines are supplied only against a valid prescription and should be taken only as advised by your doctor.

This guide is for general information and does not replace advice from a doctor.