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.
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.
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.
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
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
- Peeing eight or more times a day (urinary frequency)
- The inability to delay urination (urinary urgency)
- Frequent urination during sleep (nocturia)
- Pain while urinating (dysuria)
- A loss of urine when you suddenly need to pee (urge incontinence)
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
Inability to pee despite having a full bladder
A strong urge to pee
Intense lower abdominal pain
Lower abdominal swelling
A strong urge to pee
Needing to urinate frequently at night
Passing frequent, small amounts of urine
Bladder leakage (urinary incontinence)
Cloudy urine (pyuria)
Blood in the urine (hematuria)
Lower abdominal or pelvic pain
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
Nausea or vomiting
Blood in the urine
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
Painful ejaculation (dysorgasmia)
When to Call a Healthcare Provider
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
- A family history of BPH
- Lack of physical exercise
- Heart disease
- Type 2 diabetes
- Erectile dysfunction
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
- Alpha blockers like Flomax (tamsulosin) and Uroxatral (alfuzosin)
- 5-alpha reductase inhibitors like Proscar (finasteride) and Avodart (dutasteride)
- Combination medications like Jalyn (dutasteride + tamsulosin)
- Phosphodiesterase-5 inhibitors like Cialis (tadalafil)
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
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.
- Limiting your intake of liquids before bedtime or going out in public
- Avoiding caffeine and alcohol, both of which promote urination
- Undergoing bladder training (scheduling bathroom breaks that teach you how to hold fluids longer)
- Double-voiding (the practice of waiting and trying to pee once more after urinating)
- Doing pelvic floor exercises to strengthen the muscles used for peeing
- Preventing and treating constipation (which can aggravate BPH symptoms)
- Avoiding or managing drugs that slow urine flow (like decongestants and antihistamines), promote urination (diuretics), or contribute to urinary retention (antidepressants)
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.
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.
Published on June 27, 2023
Medically reviewed by Matthew Wosnitzer, MD