Enlarged prostate (BPH) explained: symptoms and treatment

What the prostate does and why it grows

The prostate is a small gland, about the size of a walnut, that sits just below the bladder and surrounds the tube that carries urine out of the body, called the urethra. It helps make the fluid that carries sperm. From around middle age onwards the prostate naturally tends to enlarge, driven partly by hormones and ageing. Because it wraps around the urethra, an enlarged prostate can squeeze this tube like a hand around a straw, making it harder for the bladder to empty and irritating the bladder over time. This is a normal age-related change rather than a disease in the usual sense, and how much it enlarges — and how much bother it causes — varies a lot from person to person.

The symptoms it causes

The symptoms are grouped into two kinds. Voiding symptoms come from the blocked flow: a weak or slow stream, difficulty starting, straining, dribbling at the end, a stop-start flow, and a feeling that the bladder has not fully emptied. Storage symptoms come from the irritated bladder: needing to pass urine more often, sudden urgency, and getting up at night to go, which disturbs sleep. These symptoms often develop gradually over years. Importantly, they are not unique to an enlarged prostate — urine infections, an overactive bladder, diabetes and, occasionally, prostate cancer can cause similar problems — which is why it is worth having them assessed rather than assuming the cause and worth mentioning any that come on quickly.

How it is assessed

Assessment starts with the story of the symptoms and how much they bother you, often using a simple symptom questionnaire. A urine test checks for infection or blood, and a blood test can check kidney function. Your clinician may examine the prostate through the back passage to gauge its size and feel for anything unusual. A PSA blood test may be discussed; it can be raised by an enlarged prostate as well as by other prostate conditions, so its meaning is talked through carefully. Sometimes the flow of urine is measured, or a scan checks how well the bladder empties. The aim is to confirm that symptoms fit BPH, to rule out other causes, and to match treatment to how much the symptoms affect daily life.

Treatment options

Treatment is guided by how troublesome the symptoms are. Mild symptoms often need only reassurance, monitoring and simple measures: cutting evening fluids and caffeine and alcohol, not rushing, and double voiding. When symptoms are more bothersome, medicines help — some relax the muscle around the prostate and bladder neck to ease flow, while others gradually shrink the prostate over months; sometimes both are used together. If medicines are not enough, or there are complications such as repeated retention, infections or kidney effects, surgery to remove or reduce the obstructing tissue can give lasting relief, and several techniques are available. Your clinician will weigh the benefits and side effects of each option with you, as the right choice depends on prostate size, symptoms and your preferences.

When to seek urgent help

Most enlarged-prostate symptoms build slowly and can be dealt with at a routine appointment. But some situations need prompt or urgent care. Being suddenly unable to pass urine at all, with a painful, full bladder, is called acute urinary retention and is a medical emergency — go to A&E or call 999. See a clinician promptly if you have blood in your urine, pain or burning passing urine with fever, or if you are having to strain hard and never feel empty. It is also worth seeing your GP if symptoms are new, changing quickly, or come with unexplained weight loss or bone pain, so that other causes, including prostate cancer, can be checked and treated early.