Enlarged Prostate

Overview

An enlarged prostate means the prostate gland has grown bigger. The prostate is a small, walnut-sized gland that sits just under a man's bladder and wraps around the tube that carries urine out of the body (called the urethra). As it grows, it can squeeze that tube, so it becomes harder to pass urine, and you may need to go more often. The medical name is benign prostatic hyperplasia, or BPH. 'Benign' means it is not cancer, and having it does not mean you have or will get prostate cancer. It is a normal part of ageing for many men, and there are many ways to manage it.

Yes, it is one of the most common health issues in men. The prostate naturally gets bigger as men get older, and urinary symptoms become more likely with each decade of life. It is so common that many men over 60 have some degree of prostate enlargement, even if it does not bother them much.

It mainly affects men over 50. It becomes more likely and more noticeable with age, and by age 80 most men have some prostate enlargement. It is rare in men under 40. Men with a father or brother who had prostate problems, and men who are obese or have diabetes, may be more likely to notice symptoms.

Symptoms

Common symptoms

• A weak or slow urine stream
• Straining or pushing to start peeing
• Needing to wait a while before urine comes
• Dribbling at the end of urination
• Going to the toilet more often during the day
• Waking up several times at night to pee (called nocturia)
• A sudden, urgent need to pee that is hard to hold
• Feeling that your bladder is not fully empty after peeing
• Needing to pee again soon after you have just been

Symptoms in children

• An enlarged prostate does not happen in children. The prostate only starts to grow at puberty and enlargement is a condition of adult men.
• Children can have other reasons for trouble peeing, such as urine infections, constipation or a condition they are born with. If a child has pain when peeing, a weak stream, or wets the bed after being dry, they should see a doctor.

Symptoms in older adults

• Symptoms tend to be more noticeable and to build up slowly over years.
• Waking at night to pee is more common and can disturb sleep and make you feel tired in the day.
• Older men may also take medicines (such as some cold and flu remedies or water tablets) that affect peeing, so it is worth asking your pharmacist or doctor about this.
• Other conditions, like diabetes or a urine infection, can cause similar symptoms, so it is worth getting checked rather than assuming it is just the prostate.
• Falls and dizziness can happen if you are rushing to the toilet at night, so keep a clear, well-lit path to the bathroom.

Causes

Main causes

• Age-related hormone changes. Over time, the balance of male hormones changes in a way that makes the prostate grow.
• The growing prostate presses on the urethra (the urine tube), which is what causes the symptoms.
• Genes play a part — some families seem more likely to have prostate enlargement.
• In most cases there is no single cause; it is a natural change that happens with age.

Risk factors

• Being over 50 — risk rises steadily with age
• Having a father or brother with an enlarged prostate
• Carrying extra weight, especially around the belly
• Type 2 diabetes and metabolic syndrome
• A mainly inactive lifestyle
• Some medicines, such as certain cold and flu remedies, can make symptoms worse

When to see a doctor

See a doctor urgently if:

• You cannot pass urine at all, even though you feel you need to
• You have a fever with pain when peeing, or blood in your urine
• You have severe pain in your lower belly or back
• You feel confused or very unwell along with trouble peeing

Book a routine appointment if:

• Urinary symptoms are bothering you or affecting your sleep, work or daily life
• You are getting up two or more times a night to pee
• You have had a weak stream or dribbling for more than a few weeks
• You have a family history of prostate problems and want to talk about it
• You notice blood in your urine, even once — always get this checked

Diagnosis

Your doctor will start by asking about your symptoms — how often you pee, how strong the flow is, and how much it affects your life. They will usually use a short symptom score questionnaire. They may then examine you, ask for a urine sample, and arrange a simple blood test. The examination usually includes a quick check of your prostate through the back passage (a rectal exam), which feels a bit odd but takes only seconds and is not usually painful. Your doctor may also check how fast you pee and how well your bladder empties.

Tests that may be done

• A symptom questionnaire (often called the IPSS) to see how much your symptoms affect you
• A urine test to rule out infection or blood
• A blood test, which may include a PSA test — your doctor will explain what this means
• A physical exam of your abdomen and a gloved finger check of the prostate through the back passage
• A urine flow test — you pee into a special machine that measures speed and amount
• A bladder scan (an ultrasound over your belly) to see if urine is left behind after you pee
• Sometimes a scan of your kidneys and bladder, or a camera test (cystoscopy), depending on your results

What to expect at your appointment

Most of these checks are quick and can be done at your GP surgery or a clinic. You can usually go home the same day. If a camera test is needed, it may feel uncomfortable but it is brief. Results often take a week or two. Ask your doctor to explain anything you do not understand, and feel free to bring someone with you or write down your questions beforehand.

Treatment

Treatment depends on how much your symptoms bother you, not just on how big the prostate is. Many men choose to wait and watch with regular check-ups, because symptoms often stay stable for years. Others find lifestyle changes are enough. If symptoms are troublesome, there are medicines and, for some men, procedures or surgery. Your doctor will talk you through the pros and cons of each option so you can choose what suits you.

Self-care at home

• Cut down on drinks in the 2–3 hours before bed to reduce night-time trips
• Reduce caffeine and alcohol, which can irritate the bladder and make you pee more
• Drink enough water during the day — cutting down too much can make urine more concentrated and cause irritation
• Pee 'twice' — after you finish, wait a few seconds and try again to help empty your bladder
• Sit down to pee, which can help you empty more fully
• Stay active and keep to a healthy weight
• Treat constipation — a full bowel presses on the bladder
• Check with your pharmacist whether any of your medicines could be making symptoms worse
• Keep a simple diary of when and how much you drink and pee, to see patterns

Medical treatments

There are two main types of daily tablets for an enlarged prostate. One type relaxes the muscle in the prostate and bladder neck so urine flows more easily; this usually works within days but does not shrink the gland. The other type slowly shrinks the prostate over months and can reduce the risk of complications, but it takes longer to work and can affect sexual function. Some men take both. Your doctor or pharmacist will explain the benefits and side effects of any medicine, and check it does not clash with anything else you take. Never start, stop or change a medicine without talking to them first.

When is surgery considered?

Surgery or a procedure is usually considered when symptoms are severe, when medicines have not helped or caused troublesome side effects, or when there are complications such as repeated urine infections, bladder stones, kidney problems or being unable to pee. Modern options range from smaller, less invasive procedures done as a day case to surgery to remove the inner part of the prostate. Most people recover well, and your specialist team will explain the risks, benefits and recovery time for each option.

Living with this condition

Most men carry on with normal life. A few small changes make a big difference: know where toilets are when you go out, plan longer journeys around breaks, and keep the route to the bathroom clear and lit at night. If symptoms are affecting your work, travel or sleep, tell your doctor — there is often something that can help.

Lifestyle tips

• Stay physically active — walking, swimming or cycling most days helps bladder and bowel health
• Keep to a healthy weight
• Limit alcohol and caffeine, especially in the evening
• Do not hold on too long when you need to pee
• Manage stress — anxiety can make urinary urgency feel worse
• Talk to your partner or a friend; hiding symptoms adds to the strain

Diet and exercise

Eat a balanced diet rich in vegetables, fruit, wholegrains and lean protein, and limit very spicy or acidic foods if you notice they make symptoms worse. Drink normally through the day and cut back in the evening rather than drinking less overall. Regular moderate exercise, such as a brisk 30-minute walk most days, helps with weight, bladder health and mood. Pelvic floor exercises can help some men with leaking or urgency — ask your doctor or a physiotherapist about them.

Mental health and emotional wellbeing

It is very common to feel embarrassed, frustrated or anxious about urinary symptoms, and broken sleep can wear you down and affect your mood. These feelings are normal and worth mentioning to your doctor — they are part of the picture, not something to hide. If low mood or worry is lasting more than a couple of weeks or affecting daily life, please reach out for help. If you ever feel you cannot cope or have thoughts of harming yourself, contact your local emergency number or a crisis support line in your country straight away.

Prevention

You cannot fully prevent an enlarged prostate, because growing older is the main cause. But staying at a healthy weight, being active, eating a balanced diet and managing conditions like diabetes may help reduce how much it bothers you. Looking after your general health also makes symptoms easier to manage.

Screening programmes

There is no routine screening programme for an enlarged prostate. If you have urinary symptoms, or a strong family history of prostate problems, talk to your doctor about whether checks are right for you. A blood test called PSA can be part of the discussion, but it is not a perfect test; your doctor will explain the pros and cons so you can decide together.

Complications

If left untreated

• Sudden inability to pee (urinary retention), which is painful and needs emergency treatment with a catheter
• Urine infections that keep coming back
• Bladder stones
• Blood in the urine
• Damage to the bladder or kidneys if urine has been blocked for a long time
• Leaking urine (incontinence) in some men

Long-term outlook

The outlook is generally very good. Most men with an enlarged prostate live full, normal lives, and many never need anything more than check-ups and small lifestyle changes. Symptoms can come and go, and only a small number of men go on to have complications or need surgery. If symptoms do get worse, there are plenty of effective options — so keep your appointments and speak up early rather than putting up with it.

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