An enlarged prostate is a condition that commonly affects older people with a prostate. Symptoms include increased urinary frequency and urgency. People may also experience difficulty starting a urine stream.
The prostate gland makes some of the fluid that goes into semen. The most common prostate issue in people over 50 years old is Benign Prostatic Hyperplasia (BPH), a prostate that is swollen but not cancerous.
According to the National Institutes of Health, BPH affects approximately 50% of males aged 51–60. It may also affect up to 90% of males older than 80. Research suggests that the prevalence of BPH in older males is increasing.
This article discusses the symptoms of an enlarged prostate, potential causes, treatment, prevention, and when to speak with a doctor.
A note about sex and gender
Sex and gender exist on spectrums. This article will use the terms "male," "female," or both to refer to the sex assigned at birth.
A person with BPH may experience the following symptoms:
· increased urinary frequency or needing to urinate eight or more times a day
· increased urinary urgency or an inability to delay urination
· difficulty starting a urine stream
· a weak or interrupted urine stream
· Dribbling at the end of urination
· An increased need to urinate when sleeping
· The inability to empty all of the urine from the bladder, also known as urinary retention
· urinary incontinence
· Pain when urinating
· Pain after ejaculation
· unusually colored urine
· unusual-smelling urine
Potential complications of an enlarged prostate
Most people with BPH do not develop complications. However, possible complications include:
· acute (sudden) urinary retention
· chronic (long-term) urinary retention
· urinary tract infections
· Blood in the urine
· bladder stones
· bladder damage
· kidney damage
Medical professionals do not fully understand the exact causes of BPH. Some researchers believe it may have something to do with the hormone estrogen.
Throughout their lives, people assigned as male at birth produce the hormone testosterone and small amounts of estrogen. As they age, the amount of testosterone in their Blood decreases, leaving a higher proportion of estrogen.
Studies suggest BPH may occur because the increased estrogen levels in the prostate increase the activity of substances that promote prostate cell growth.
Research also suggests that metabolic syndrome, obesity, and genetic factors may increase a person's risk of developing BPH.
Other conditions that may cause an enlarged prostate
Other causes of an enlarged prostate that medical professionals do not associate with BPH include prostate cancer and chronic prostatitis.
Prostate cancer occurs when cells in the prostate gland begin to grow out of control. An enlarged prostate is one symptom of prostate cancer.
Chronic prostatitis, or inflammation of the prostate, can also cause the prostate to become enlarged.
Treatment for BPH varies. Healthcare professionals treat BPH based on:
· the severity of the symptoms
· how much the symptoms affect a person's life
· an individual's preferences
Below are some of the possible treatments for BPH.
A doctor may recommend that people with BPH make the following lifestyle changes:
· Reducing their intake of liquids, particularly before going out in public or sleeping
· Avoiding caffeine and alcohol
· Avoiding or monitoring the use of medications such as:
· Training the bladder to hold more urine for more prolonged periods.
· Doing pelvic floor muscle exercises
· Preventing or treating constipation
A doctor may prescribe certain medications to treat BPH. These medications can:
· stop the growth of the prostate.
· shrink the prostate.
· reduce BPH symptoms.
Possible medications for treating BPH include:
· alpha blockers
· phosphodiesterase-5 inhibitors
· 5-alpha reductase inhibitors
· combination medications
Minimally invasive procedures
Medical professionals may suggest one of several minimally invasive procedures that relieve BPH symptoms when medications do not work. Some of these are transurethral methods, which involve feeding a thin tube through the urethra.
Possible procedures include:
· transurethral needle ablation
· transurethral microwave thermotherapy
· high-intensity focused ultrasound
· transurethral electro vaporization
· water-induced thermotherapy
· prostatic stent insertion
These procedures may destroy enlarged prostate tissue. Some widen the urethra, which can help relieve blockages and urinary retention.
A healthcare professional may suggest that a person with BPH undergo surgery if medications and other treatments do not work.
During surgery, a surgeon may remove some enlarged prostate tissue. They may also make cuts in the prostate to widen the urethra to relieve blockages.
Surgery may be endoscopic or conventional open surgery, depending on the size of the enlarged prostate. Very large prostate glands may require open surgery. Surgical procedures a doctor may recommend include:
· transurethral resection of the prostate
· transurethral incision of the prostate
· laser surgery
· open prostatectomy
Removing prostate tissue does not cure BPH but does help relieve symptoms.
Enlarged prostate prevention.
Medical professionals do not fully understand how to prevent BPH.
If a person has a high risk of BPH, it is best to speak with a doctor. Early diagnosis can be important as early treatment can minimize the effects of BPH.
When to speak with a doctor
Experts recommend that people who experience any symptoms of BPH speak with a healthcare professional because early treatment of BPH can be vital in reducing the condition's effect on a person's well-being.
Symptoms of BPH may also be a sign of a more severe condition, such as prostate cancer. Individuals who experience any of the following symptoms need to seek immediate medical care:
· a complete inability to urinate.
· fever and chills alongside a need to urinate, that is:
· Blood in the urine
· Great Pain or discomfort in the lower abdomen and urinary tract
Benign prostatic hyperplasia (BPH) is a common condition in older people with a prostate. It causes the prostate to become enlarged. BPH is not cancerous.
Common symptoms of BPH include:
- Increased urinary frequency.
- Increased urinary urgency.
- Trouble starting a urine stream.
- A weak or interrupted urine stream.
BPH can also cause a person to experience accidental loss of urine and Pain when urinating or after ejaculation.
Prostate cancer and chronic prostatitis are other possible causes of an enlarged prostate. It is best for a person experiencing BPH symptoms to speak with a healthcare professional who can diagnose accurately and suggest early treatment options.
Last medically reviewed on June 21, 2023
Medically reviewed by Roger Bielinski, MD, Urology — By Adam Rowden on June 21, 2023