BPH

Overview

BPH, or benign prostatic hyperplasia, is a non-cancerous enlargement of the prostate gland. The prostate is a small gland in men that surrounds the urethra (the tube that carries urine out of the body). When it grows, it can squeeze the urethra and cause problems with urination.

Yes, BPH is very common. About half of all men over 50 have some symptoms, and the rate increases with age. By age 80, nearly 90% of men have an enlarged prostate.

BPH affects men, especially those over 40. It becomes more common as men age. It is not a condition that affects women or children.

Symptoms

Common symptoms

• Frequent need to urinate, especially at night (nocturia)
• A weak or interrupted urine stream
• Difficulty starting to urinate (hesitancy)
• A sense that your bladder is not completely empty after urinating
• Urgency – a sudden, strong need to urinate

Symptoms in older adults

• Older adults may experience more severe symptoms, such as dribbling after urination or complete inability to urinate (retention)
• They may also be at higher risk of complications like urinary tract infections or bladder stones

Causes

Main causes

• Aging – the prostate naturally grows as men get older
• Changes in hormone levels, particularly a rise in dihydrotestosterone (DHT), which stimulates prostate growth

Risk factors

• Age over 40
• Family history of BPH (if your father or brother had it, your risk is higher)
• Obesity
• Lack of physical activity
• Other health conditions like diabetes or heart disease

When to see a doctor

See a doctor urgently if:

• If you cannot urinate at all
• If you have blood in your urine
• If you have severe pain or fever along with urinary symptoms

Book a routine appointment if:

• If you have bothersome urinary symptoms that affect your daily life, such as frequent urination or weak stream
• If you notice a change in your urinary habits

Diagnosis

Your doctor will ask about your symptoms and medical history, perform a physical exam, and may order some tests to confirm the diagnosis and rule out other conditions.

Tests that may be done

• Digital rectal exam (DRE) – your doctor inserts a gloved, lubricated finger into your rectum to feel the size and shape of your prostate.
• Urine tests to check for infection or blood
• Blood test for prostate-specific antigen (PSA) – a high level may suggest prostate enlargement or other prostate issues.
• Questionnaire about your symptoms (International Prostate Symptom Score or IPSS)
• Flow test – measures the strength of your urine stream.
• Post-void residual test – checks how much urine remains in your bladder after you urinate.

What to expect at your appointment

These tests are usually painless and done in your doctor's office. You may be asked to fill out a symptom questionnaire and provide a urine sample. The digital rectal exam may feel slightly uncomfortable but is over quickly. Results help your doctor understand how enlarged your prostate is and how much it affects your urination.

Treatment

Treatment for BPH depends on how bothersome your symptoms are. For mild symptoms, watchful waiting and lifestyle changes may be enough. For moderate to severe symptoms, medications or procedures can help relieve the blockage. Surgery is an option when other treatments are not effective or if complications develop.

Self-care at home

• Urinate as soon as you feel the urge – don't hold it in.
• Try double voiding: wait a few seconds after urinating, then try to go again to empty your bladder fully.
• Avoid drinks that can irritate your bladder, such as caffeine, alcohol, and citrus juices, especially in the evening.
• Stay active – regular exercise can help reduce symptoms.
• Manage constipation, as straining can worsen urinary problems.

Medical treatments

Your doctor may prescribe medications that help relax the muscles of the prostate and bladder neck, allowing easier urination, or medications that gradually shrink the prostate. These are taken by mouth. It is important to discuss the benefits and side effects with your healthcare provider. Never start or stop any medication without your doctor's advice.

When is surgery considered?

Surgery may be considered if medications do not control symptoms, if you develop complications like bladder stones, kidney damage, or repeated urinary retention, or if you prefer a more permanent solution. Common surgical procedures involve removing part of the prostate tissue through the urethra (minimally invasive) or open surgery for very large prostates.

Living with this condition

Living with BPH often means managing your bathroom schedule and making small adjustments. Plan ahead when going out – know where restrooms are. Reduce fluid intake a few hours before bedtime to decrease nighttime trips. Keep a symptom diary to share with your doctor.

Lifestyle tips

• Maintain a healthy weight – losing excess weight can improve symptoms.
• Stay physically active – walking, swimming, or cycling can help.
• Limit caffeine and alcohol, especially in the evening.
• Avoid medications that can make symptoms worse, such as some cold and allergy medicines (decongestants). Check with your pharmacist.

Diet and exercise

Eat a balanced diet rich in fruits, vegetables, and whole grains. Some studies suggest that foods high in zinc (like pumpkin seeds) and omega-3 fatty acids (like fish) may support prostate health. Exercise for at least 30 minutes most days can help reduce symptom severity and improve overall well-being.

Mental health and emotional wellbeing

Dealing with frequent urination and other symptoms can be frustrating and embarrassing. It may affect your sleep, work, and social life. It is normal to feel anxious or down. Talk to your doctor – treatment can greatly improve your quality of life. If you feel depressed, seek support from a mental health professional.

Prevention

You cannot fully prevent BPH, but you may lower your risk by maintaining a healthy weight, staying active, and eating a balanced diet. Regular check-ups can help detect any changes early.

Screening programmes

There is no national screening program for BPH, but if you have symptoms or are concerned, talk to your doctor. They can recommend appropriate tests based on your age and health.

Complications

If left untreated

• Urinary tract infections (UTIs) due to incomplete bladder emptying
• Bladder stones
• Damage to the bladder or kidneys from long-term obstruction
• Sudden inability to urinate (acute urinary retention), which is an emergency

Long-term outlook

BPH is a treatable condition. Most men find that lifestyle changes, medications, or simple procedures effectively manage their symptoms. With proper care, complications are rare, and you can maintain a good quality of life. Even if surgery is needed, outcomes are usually very good.

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