Benign Prostatic Hyperplasia (BPH)
Sources consulted
This article is original patient-education content.
- WHO—Health topics A–Z(2024)
- NHS—Health A to Z(2024)
- CDC—Health topics(2024)
Based on international clinical guidelines
Overview
Benign Prostatic Hyperplasia, or BPH, is a condition where the prostate gland—a small gland found only in men—grows larger than normal. This growth is not cancer, but it can press against the urethra (the tube that carries urine out of the body) and make it harder to urinate.
Key facts
- BPH is not cancer and does not increase your risk of prostate cancer.
- It is one of the most common conditions in older men.
- Many men with BPH have mild symptoms that do not need treatment.
Yes, BPH is very common. About half of all men over age 50 have some symptoms of BPH, and by age 80, that number increases to about 90%.
BPH affects men, especially as they get older. It is rare in men under 40 but becomes more common after age 50.
Symptoms
- If you are unable to urinate at all (this is called acute urinary retention and can be very painful).
- If you see blood in your urine (this can also be a sign of other problems).
- If you have sudden and severe pain in your lower belly or back that does not go away.
- ⚠If you have a fever, chills, or burning when you urinate – these could be signs of a urinary tract infection.
- ⚠If your symptoms become much worse very quickly, or if you have pain that worries you.
- ⚠If you notice blood in your urine that is not there one time only.
Common symptoms
- Needing to urinate more often, especially at night (this is called nocturia).
- A sudden, strong urge to urinate that is hard to control.
- A weak or slow urine stream, or a stream that starts and stops.
- Trouble starting to urinate, or straining to urinate.
- Feeling like your bladder is not completely empty after urinating.
Symptoms in children
- BPH does not occur in children. It only affects adult men, usually after age 40.
Symptoms in older adults
- Older men may notice the same symptoms but they can become more bothersome over time.
- Frequent nighttime urination can disturb sleep and increase the risk of falls if you need to get up in the dark.
- Some older adults may be less aware of mild symptoms, so it is important to talk to your doctor.
Causes
Main causes
- Age is the main cause – as men get older, the prostate naturally grows larger.
- Changes in hormone levels, especially an increase in a hormone called dihydrotestosterone (DHT), which can make the prostate grow.
Risk factors
- Age: Being over 40 increases risk.
- Family history: If your father or brother had BPH, you are more likely to have it.
- Obesity or being overweight.
- Not being physically active.
- Having certain medical conditions like type 2 diabetes or heart disease.
When to see a doctor
See a doctor urgently if:
- If you cannot urinate at all.
- If you have pain in your lower belly, back, or genitals that is severe or getting worse.
- If you see blood in your urine more than once.
Book a routine appointment if:
- If your symptoms bother you or affect your daily life.
- If you have trouble sleeping because you need to urinate often at night.
- If you have noticed a change in your urine stream or feel like your bladder is not emptying fully.
Diagnosis
Your doctor will start by asking about your symptoms and your health history. They will also do a physical exam, which includes a digital rectal exam (DRE) to feel the size and shape of your prostate. This helps rule out other conditions.
Tests that may be done
- Digital rectal exam (DRE) – the doctor inserts a gloved, lubricated finger into your rectum to check your prostate.
- Urine test (urinalysis) to check for infection or blood.
- Blood test (PSA test) to measure prostate-specific antigen, which can be high with BPH or other prostate conditions.
- Urine flow test (uroflowmetry) to measure how fast your urine flows.
- Post-void residual volume test – an ultrasound after you urinate to see how much urine is left in your bladder.
What to expect at your appointment
The diagnosis is usually straightforward and can often be done in your doctor's office. The tests are not painful, though the digital rectal exam might feel a little uncomfortable. Your doctor will explain each step and answer any questions you have.
Treatment
Treatment for BPH depends on how bothersome your symptoms are. For mild symptoms, lifestyle changes and watchful waiting are often enough. If symptoms are more troublesome, there are medications and procedures that can help. Your doctor will work with you to find the best approach.
Self-care at home
- Limit drinks that can irritate your bladder, like coffee, tea, alcohol, and fizzy drinks.
- Avoid drinking large amounts of fluids in the evening to reduce nighttime trips to the bathroom.
- Try to urinate when you first feel the urge – don't hold it in.
- Double voiding: after you urinate, wait a moment and try to urinate again to empty your bladder more completely.
- Stay active and maintain a healthy weight.
Medical treatments
If lifestyle changes are not enough, your doctor may suggest medicines that help relax the muscles around the prostate and bladder neck, or medicines that shrink the prostate over time. These are taken as tablets or capsules. Some men may need a combination of medicines. Your doctor will explain the options, benefits, and possible side effects.
When is surgery considered?
Surgery may be considered if symptoms are severe and do not improve with medicines, or if you develop complications such as repeated urinary retention, bladder stones, or kidney problems. There are different types of surgery, often done with a camera through the urethra (no cuts on the outside). Your doctor will discuss what might be right for you.
Living with this condition
Many men with BPH live normal, active lives. The key is to manage your symptoms so they do not interfere with sleep, work, or social activities. Simple routines like using the bathroom before leaving the house and planning bathroom breaks can help.
Lifestyle tips
- Stay physically active – even a daily walk can help.
- Maintain a healthy weight.
- Try pelvic floor exercises (Kegel exercises) to strengthen the muscles that help control urination.
- Avoid constipation by eating fibre-rich foods, as constipation can make BPH symptoms worse.
Diet and exercise
A balanced diet rich in fruits, vegetables, whole grains, and lean proteins supports overall health. Some studies suggest that a diet low in red meat and high in vegetables may help reduce symptoms. Regular exercise, like walking or swimming, can improve urinary symptoms and help with weight management.
Mental health and emotional wellbeing
Living with BPH can be frustrating and may affect your confidence or mood, especially if you worry about not getting to a toilet in time. This is understandable. It is important to talk to your doctor or a mental health professional if you feel anxious or depressed. You are not alone, and help is available. If you are having thoughts of self-harm, please contact a crisis helpline immediately.
Prevention
It is not possible to prevent BPH completely, but a healthy lifestyle may reduce your risk or delay the onset of symptoms. Staying at a healthy weight, eating a balanced diet, and staying physically active are good steps. Managing conditions like diabetes and heart disease may also help.
Complications
If left untreated
- Acute urinary retention – suddenly not being able to urinate at all, which is a medical emergency.
- Urinary tract infections (UTIs) from urine staying in the bladder too long.
- Bladder stones, which can cause pain and blood in the urine.
- Damage to the bladder or kidneys over time if the bladder is constantly overstretched.
Long-term outlook
Most men with BPH have a good outlook. With proper care and the right treatment, symptoms can be managed well, and serious complications are rare. Many men live comfortably with BPH for years. Even when surgery is needed, it is usually very effective and allows men to return to normal activities.
Find support
International organisations
Local organisations
- Prostate Cancer UK ↗ · UK
Helplines
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Always verify with your doctor
Health guidelines vary by country and region. The information in this article is based on international clinical guidelines but may not reflect the specific guidelines, medications, or practices in your country. Always discuss your health concerns with your own doctor or healthcare provider, and refer to your local national health guidelines where available.
Important notice This information is for educational purposes only. It does not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider about your specific situation. If you are experiencing a medical emergency, call your local emergency services immediately.