Enlarged Prostate – spot symptoms and what can help

Benign prostate enlargement (BPE) or an enlarged prostate is a common condition and affects how you pee – find out what can help.

Symptoms of an enlarged prostate

What’s the cause?

When to see a doctor 

How is enlarged prostate diagnosed?

What’s the treatment?

Benign prostate enlargement (BPE) is common in men over the age of 50, and affects the bladder. It’s not cancerous and is rarely a serious threat. Here’s how to recognize symptoms, get a diagnosis, and manage the condition.


An enlarged prostate, also known as benign prostate enlargement or benign prostate hyperplasia, is when an increase of cells in the prostate makes it grow bigger.

The prostate is a small gland in the pelvis, between the penis and bladder. When it is enlarged, it can press on the bladder and urethra (the tube that pee flows through), causing problems.

You may  worry that an enlarged prostate increases the risk of [prostate cancer](https://www.livehealthily.com/health-library/conditions/cancer-of-the-prostate), but this isn’t the case.

Find out if you need treatment for an enlarged prostate and what can help. 


## Symptoms of an enlarged prostate

Pressure on the bladder can cause:
- trouble starting or stopping peeing
- weak flow or "stop-start" urine
- urgent or frequent need to pee, including at night
- accidental leaks or incontinence
- A feeling that your bladder is not empty.

In some cases symptoms are mild, while other people may need treatment.


Get help with this

## What’s the cause?

Although it’s not known exactly what causes the prostate to increase in size, there are risk factors linked to developing the problem, they include:

- __age__ – men aged 50 or over tend to get an enlarged prostate but they may not get symptoms at all, or they are mild
- __hormones__ – it’s thought that changes in the levels of testosterone and progesterone as you get older can affect your prostate
- __other factors__  – conditions such as [diabetes](https://www.livehealthily.com/health-library/conditions/diabetes), or genetics (if your father or brother has the condition) mean your risk may increase, but more research is needed. 


## When to see a doctor 
Seek emergency medical help if:
- you can't pee at all
- you have a bad pain in your lower belly
- your bladder is noticeably swollen (you can find this out by touch).

Make an appointment with your doctor if you have [symptoms of an enlarged prostate](https://www.livehealthily.com/health-library/conditions/benign-prostate-enlargement#symptoms). They will discuss your symptoms and their impact on your life.


## How is enlarged prostate diagnosed?

You may be asked to complete:
- __a urinary frequency-volume chart__: tracks your fluid intake, how much and how often you pee, including if you have any leakage
- __IPSS questionnaire__: assesses the severity of your symptoms.

__Physical exams may be given including:__
- checking your stomach, genital area
- a [digital rectal examination (DRE)](https://www.livehealthily.com/health-library/medical-exams/rectal-examination) to feel the prostate through the rectum.

__Tests might include:__
- blood tests to check kidney function, [diabetes](https://www.livehealthily.com/health-library/conditions/diabetes), and [prostate-specific antigen (PSA)](https://www.livehealthily.com/health-library/medical-exams/psa-tests) levels (to check for prostate conditions such as enlarged prostate or prostate cancer)
- urine tests to check for other infections that can cause similar symptoms
- additional tests may include measuring urine flow and checking how much urine remains in your bladder after peeing.

__You may need to see a urologist if:__
- your symptoms continue despite having treatment
- you can’t fully empty your bladder, have recurring infections, or kidney issues
- your doctor suspects cancer, though this is uncommon.


## What’s the treatment?
The type of treatment you have for an enlarged prostate depends on how bad your symptoms are, plus your age and your health. Treatments can include managing symptoms with lifestyle changes, training techniques, medication, and surgery.

### Lifestyle changes
Take these steps to help limit your symptoms, including:
- __limit irritants__ – reduce alcohol, caffeine, fizzy drinks, and artificial sweeteners to ease bladder irritation
- __avoid evening fluids__ –  try not to drink anything 2 hours before bed to reduce nighttime toilet trips, but stay hydrated during the day.
- __empty your bladder__ – when you need to plus use the toilet before long journeys or situations where access is limited
- __double voiding__ – after peeing, wait briefly and try again to fully empty your bladder (try not to strain)
- __review medications__ – consult your doctor about drugs like antidepressants or decongestants that may worsen symptoms.
- __prevent constipation__ – eat more fruit and fiber to reduce bladder pressure
- __manage leaks__ – use absorbent pads or urinary sheaths for protection and comfort.

### Bladder training exercises
This is a program to help you delay peeing and hold more in your bladder, starting with a goal like waiting for a set period of time between trips. 
You can:

- __track progress:__ use a chart to log when and how much you pee, with a plastic jug to measure volume
- __exercise:__ including breathing, relaxation, and muscle techniques to distract from the urge to pee
- __expect gradual improvement:__ targets increase over time, helping you extend intervals between bathroom visits.
- __Ask your doctor or nurse for advice__ and resources on bladder training.

### Medication

If lifestyle changes don’t work, you may be offered:

- __alpha blockers__ – relax prostate and bladder muscles to make peeing easier – types include tamsulosin and alfuzosin
- __anticholinergics__ – calm overactive bladder muscles
- __5-alpha reductase inhibitors__ – medication to shrink the prostate – examples are finasteride and dutasteride 
- __diuretics__ – increase daytime urine (pee) production, reduce the amount you pee at night
- __desmopressins__ – slow the amount of urine you produce, especially at night
- __mirabegron__ – a medicine that treats an overactive bladder, including the urgent or frequent need to pee
- __a catheter__ – a tube that carries urine out of your body can be used if problems trying to pee continue. 

### Surgery

Surgery is not usually needed for urinary symptoms but may be considered if other treatments have not worked. Types include:
- __transurethral resection of the prostate (TURP)__ – involves removing part of the prostate to make it easier for pee to pass through to the urethra (the tube that pee flows through)
- __open prostatectomy__ – removes the inside part of the prostate through a cut in your lower belly – usually best suited to larger prostates
- __cystoplasty__  – enlarges the bladder using tissue from your intestine helping control bladder contractions (and the urge to pee)
- __greenlight laser treatment__  – a laser is used to destroy your enlarged prostate tissue 
- __water ablation__  –  either high pressure jets of water, or steam, is used to remove prostate tissue.


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References

Fiona Bugler

Jo Wheatley

Dr Emily Blount

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