What Are the Symptoms of BPH or Enlarged Prostate?

What Are the Symptoms of BPH or Enlarged Prostate?

What Are the Symptoms of BPH or Enlarged Prostate?

The symptoms of an enlarged prostate, otherwise known as benign prostatic hyperplasia (BPH), include:

  • Frequent urination.
  • Difficulty starting a urine stream.
  • A weak urine flow.
  • Needing to rush to the bathroom to urinate.

Over time, it can lead to urinary tract infections, bladder stones, and chronic kidney disease in some people.1

BPH is a common condition, affecting up to 50% of men over 50 and 80% of men over 80. BPH cannot be cured, but it can effectively be managed with the appropriate treatment to ease symptoms and prevent disease complications.2

This article explains what a prostate is and describes the signs, symptoms, and complications of prostate enlargement. It also offers insights into the causes and risk factors of benign prostatic hyperplasia and ways to manage an enlarged prostate at home.

Gender Terms

For the purpose of this article, "male" and "men" refer to people born with a penis regardless of the gender or gender they identify with. The sex and gender terms used in this article reflect those used by the cited sources.

Enlarged Prostate

What Is a Prostate? 

A prostate, otherwise known as a prostate gland, is a walnut-sized organ below the bladder that is part of the male reproductive tract. The gland produces and stores a fluid called prostatic fluid that forms part of semen. Semen, in turn, is the fluid containing sperm ejected from the penis during ejaculation.3

Passing through the prostate gland is a tube called the urethra, through which semen and urine exit the body. During ejaculation, prostatic fluid is ejected into the urethra through 12 to 20 small ducts (called prostatic ducts) to mix with other fluids that make up semen.3

The four main zones making up the prostate gland are:3

  • Peripheral zone: The back portion, which makes up 70% of the organ
  • Central zone: The area surrounding the ducts that makes up 20% of the organ
  • Transitional zone: The section covering the urethra that makes up 5% of the organ
  • Stroma: The non-glandular portion made up of muscle and fibrous tissues

The prostate gland goes through two significant growth periods, the first during puberty and the second starting around age 25.1

With the onset of the second phase, the prostate will continue to grow throughout most of a person's life. The vast majority of growth occurs in the transitional zone. The other zones are less commonly affected.2

When these changes affect the size of the prostate gland, it is referred to as BPH. The condition may be symptomatic (with symptoms) or asymptomatic (without symptoms).4

 4 Most Common Prostate Problems

Common BPH Symptoms to Watch For 

Symptoms of BPH begin when the growing prostate starts to pinch the urethra and block the neck of the bladder (leading to a bladder outlet obstruction). Over time, the pressure placed on the bladder can cause the walls to thicken, making it less able to empty.1

The symptoms of BPH can be divided into "voiding" symptoms (related to the urethra and bladder neck) and "storage" symptoms (related to the bladder).5

Voiding symptoms of BPH include:5

  • Difficulty starting a urine stream (urinary hesitancy)
  • A weak, intermittent, or split urine stream
  • Having to push or strain to pee
  • A feeling that your bladder isn't empty (urinary retention)

Storage symptoms of BPH include:5

These symptoms can explain which part of the urinary tract is affected. This, in turn, can help direct the diagnosis and treatment of BPH.

Symptoms of Advanced or Complicated BPH 

The course of BPH can vary from one person to the next. For some people, the growth of the prostate gland can be slow and never cause significant problems. In others, the growth may be exceptional, increasing from 11 grams (under half an ounce) in weight to over 500 grams (over 1 pound) in rare instances.6

But a prostate gland doesn't need to grow to this proportion for complications to occur. The progressive pressure exerted by the prostate can damage the bladder wall, leading to fibrosis (scarring) and hypertrophy (muscle enlargement). Persistent bladder outlet obstruction (BOO) can also affect organs upstream, including the kidneys and ureters.7

Some of the possible complications of advanced BPH include:7

   Complication Symptoms

Acute urinary retention

  Inability to pee despite having a full bladder

  A strong urge to pee

  Intense lower abdominal pain

  Lower abdominal swelling

 

Urinary tract infection (UTI)

 A strong urge to pee

 Needing to urinate frequently at night

 Passing frequent, small amounts of urine

 Bladder leakage (urinary incontinence)

 Foul-smelling urine

 Cloudy urine (pyuria)

 Blood in the urine (hematuria)

 Lower abdominal or pelvic pain

 Fever

 Fatigue

 

 Bladder stones

 Severe pain in the side and back below the ribs

 Radiating pain to the lower abdomen and groin

 Pain or burning with urination

 A strong urge to pee

 Sweating

 Restlessness

 Nausea or vomiting

 Blood in the urine

 

Chronic kidney disease (CKD)

 Itchy skin

 Fatigue

 Muscle cramps

 Shortness of breath (dyspnea)

 Loss of appetite

 Swollen hands, feet, or ankles (edema)

 Frequent peeing, especially at night

 Blood in the urine

 Trouble sleeping (insomnia)

 A general feeling of unwellness

 Ejaculation problems

Erectile dysfunction

 Painful ejaculation (dysorgasmia)

 

When to Call a Healthcare Provider 

Not everyone with BPH has symptoms. Some may only learn that they have BPH after a routine blood test, called a prostate-specific antigen (PSA) test, reveals signs of prostate inflammation.

To this end, it is in your best interest to see a healthcare provider if you have any signs of a prostate problem. While the condition may turn out to be BPH, it could also be due to more severe issues such as bacterial prostatitis (an infection of the prostate), chronic pelvic pain syndrome (CPPS), or prostate cancer.8

On the other hand, annual PSA screening is generally not advised. This is because it has not been shown to increase detection in asymptomatic people. In addition, a false-positive result (when the results incorrectly state you have the condition) can create anxiety and lead to unnecessary and potentially harmful procedures, such as a prostate biopsy.9

U.S. Preventive Services Task Force. Prostate cancer: screening.

When to Seek Emergency Care

Seek immediate medical care if you develop the following urinary tract symptoms:1

  • Complete inability to urinate
  • Painful, frequent, and urgent need to urinate with fever and chills
  • Bloody urine
  • Severe pain in the lower belly and urinary tract

Complications like acute urinary retention are considered a medical emergency. Even with treatment, there's as much as a 17% risk of mortality (death).10

 

What Causes BPH? 

The actual cause of BPH—why some people get it and others don't—is largely unknown. Given that BPH mainly affects older people, many scientists believe that changes in hormones play a central role.

Testosterone (an androgen sex hormone). After the age of 30, testosterone levels gradually decline in males. By 60, 20% of males have testosterone levels below the normal range, increasing to 50% by age 80.11

Some scientists contend that the drop in testosterone paired with increasing levels of estrogen (another sex hormone) may promote prostate cell growth. Estrogen is known to play a role in the development of the prostate during puberty, and the sudden imbalance in testosterone/estrogen levels may trigger growth in later years.12

Others believe that an androgen called dihydrotestosterone (DHT) may be responsible. Like estrogen, DHT is a hormone that supports prostate growth during adolescence and early adulthood. Unlike testosterone, DHT levels can sometimes rise in older males.13

Other risk factors strongly associated with the development of BPH are:1

Can BPH Be Cured? 

BPH cannot be cured, but it can be managed. Many people with an enlarged prostate do not need treatment if it is not causing symptoms and may instead be monitored for any changes in the disease.4

If treatment is needed, it may involve medications that alleviate prostate inflammation and improve BPH symptoms, including

Minimally invasive procedures like transurethral needle ablation (used to destroy enlarged prostate tissue) or prostatic stent insertion (used to improve urine flow) may also be recommended.1

Surgeries like transurethral resection of the prostate (TURP)  remove large portions of prostate tissue. In severe cases, an open prostatectomy may be needed to remove part or all of the prostate gland.1

 UroLift Procedure for an Enlarged Prostate

Tips for Dealing With BPH  

Lifestyle changes are a significant part of managing BPH, whether your symptoms are severe or not. In some cases, lifestyle changes may be all that is needed.

Examples include:1

 Can Prostate Massage Help BPH?

Does Having BPH Increase the Risk of Prostate Cancer? 

Despite having many of the same symptoms, BPH does not increase your risk of getting prostate cancer.4 Some studies suggest that having BPH may be associated with a lower risk of prostate cancer.

According to a 2021 study published in the journal The Prostate, among 405 people who underwent a prostate biopsy or removal, those with a larger prostate volume had a lower risk of precancerous or cancerous changes. In fact, for every one cubic centimeter increase in prostate volume, there was a 3% decrease in the odds of a precancerous or cancerous change.14

But this shouldn't suggest that BPH is necessarily "protective" against prostate cancer. It may simply be that the mechanisms for the diseases are vastly different.

For one thing, BPH arises from the transitional zone of the prostate gland, while prostate cancer is mainly limited to the peripheral zone.15 As such, each disease can—and sometimes does—occur independently of the other, making it all the more important to see a healthcare provider if you have symptoms of a prostate problem.

 

Summary 

The symptoms of an enlarged prostate (benign prostatic hyperplasia) include frequent urination, difficulty starting a urine stream, a weak urine flow, nighttime urination, and urinary incontinence.

Advanced BPH can lead to complications like urinary tract infections, bladder stones, chronic kidney disease, and even erectile dysfunction. Arguably, the most severe complication is acute urinary retention, which can become life-threatening if not treated as a medical emergency.

BPH is not associated with an increased risk of prostate cancer.

 

By James Myhre & Dennis Sifris, MD 

Published on June 27, 2023

 Medically reviewed by Matthew Wosnitzer, MD

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