Enlarged prostate (benign prostatic hyperplasia): what is BPH?

As we age, a lot of things happen to our bodies. We may begin to lose things like muscle mass and hair, and, for men, the size of the prostate often changes (Bhasin, 2022). This change in prostate size is typically a result of a process called benign prostatic hyperplasia (BPH) (Ng, 2022).

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Benign prostatic hyperplasia (BPH) describes growth of the prostate tissue, which ultimately results in an enlarged prostate gland (Ng, 2022). 

The prostate is a small gland in the male reproductive system, about the size of a walnut. It is located around the urethra (the thin tube through which urine and semen travel to exit the penis) and helps produce the seminal fluid that is ejaculated during an orgasm (NCI, n.d.). 

BPH is not prostate cancer. It also does not increase the chances of getting prostate cancer (Chang, 2012). However, the symptoms can be bothersome and affect one’s quality of life (Foster, 2019).

BPH is considered a normal part of aging. It is very common in men over 50, affecting up to 60% of men by the time they’re in their 60s and up to 90% once they’re in their 70s. Researchers believe that the hormonal changes that naturally occur with aging may contribute to BPH, but they don’t know for sure (Ng, 2022).

People with a family history of prostate issues may be more likely to experience BPH, as are people who have obesity, metabolic syndrome, or hypertension (Ng, 2022). 

Given the prostate’s location, an enlarged prostate can place pressure on your urethra. As a result, BPH symptoms are typically urinary in nature. For example, they may include (Ng, 2022):

• Urinating more than once per night (nocturia)

• Urinary incontinence

• Sudden urges to urinate, even if you just went

• Needing to urinate more frequently than typical

• Pain or straining during urination

• Incomplete emptying of the bladder

• A slow, delayed, or weak urine stream

• Dribbling at the end of urinating

If you notice any of these signs of BPH, make an appointment with your healthcare provider. Symptoms of enlarged prostate typically start out mild but may worsen if left untreated. Complications can include (Ng, 2022):

• Bladder obstruction

• Bladder stones

• Blood in urine (haematuria)

• An inability to urinate

• Kidney damage

• Prostatitis (an inflammation of the prostate)

• Urinary tract infections (UTIs)

A BPH diagnosis includes a review of your medical history, a physical exam, and additional testing. 

During the appointment, your healthcare provider will ask about your medical history and any medications you’re taking. They will also perform a physical exam, including an abdominal exam, genital exam, and rectal examination to feel for the size of your prostate (Ng, 2022). 

They may order additional testing to make a more informed diagnosis, such as urinalysis (an analysis of your urine) or tests that analyze your bladder function or help rule out other issues, like kidney problems or an infection. They may also order a prostate-specific antigen (PSA) test to screen for prostate cancer (Ng, 2022).

Fortunately, the symptoms of BPH are often treatable. BPH treatment options can include a mix of natural lifestyle changes, medication, and surgery (Ng, 2022).

Enlarged prostate natural remedies

Making certain lifestyle adjustments may relieve the symptoms of BPH. For example (McVary, 2020; Ng, 2022; NCI, n.d.):

• Use the restroom as soon as you feel the need to. Don’t delay.

• Avoid medicines that can cause urinary retention, such as decongestants or antihistamines.

• Limit diuretic substances that make you need to pee more often, like caffeine or alcohol.

• Watch your fluid intake while still taking care to keep hydrated. Drink less if you know you won’t have access to a bathroom. Stop drinking a few hours before bedtime. 

• Make efforts to lose weight if you have overweight or obesity.

• Practice Kegel exercises. These can strengthen your pelvic floor, improving your chances of holding urine and preventing accidents.

Enlarged prostate medications

If you don’t experience symptom improvement after adopting lifestyle changes, your healthcare provider may recommend medications. Different BPH medications target different symptoms of an enlarged prostate. For example (Ng, 2022):

• Alpha-1 blockers relax the bladder and prostate muscles, making it easier for you to pee freely. Alpha-1 blockers include alfuzosin and tamsulosin.

• Alpha-reductase inhibitors like dutasteride and finasteride (Propecia) work by reducing levels of the hormone dihydrotestosterone (DHT). This may help reduce the size of the prostate. 

• Antimuscarinic drugs like solifenacin, tolterodine, and oxybutynin target the bladder overactivity symptoms of BPH.

Enlarged prostate surgery

Surgical procedures may be recommended in more severe cases of enlarged prostate. Different procedures use different techniques to either destroy or shrink prostate tissue and prevent it from blocking the urethra. For example (Foster, 2019; Das, 2019):

• Transurethral microwave therapy (TUMT) uses microwaves.

• Aquablation uses heated pressurized water.

• Water vapor thermal therapy (Rezum) uses water vapor.

Instead of destroying or shrinking the prostate tissue, a prostatic urethral lift (Urolift) uses implants to lift the prostate and relieve pressure on the urethra (Foster, 2019; Das, 2019). These are all examples of outpatient procedures, which are typically less invasive and can be completed at a health provider’s office or same-day surgical center. 

Inpatient procedures are more invasive and typically need to be performed in a hospital. They may be recommended for people who have an enlarged prostate along with other symptoms such as (Ng, 2022):

• Bladder stones

• Frequent urinary tract infections (UTIs)

• Blood in their urine (haematuria) 

• Incontinence

• Kidney failure

• Total inability to empty their bladder

Transurethral resection of the prostate (TURP) is the primary surgical treatment for BPH. In a TURP, the surgeon removes the prostate entirely via an instrument inserted through the urethra (Foster, 2019; Ng, 2022). 

TURP has traditionally been shown to be the most effective treatment for BPH. However, some research shows that less invasive procedures, like Rezum or Urolift, may be equally effective and less likely to cause or worsen erectile dysfunction, which can be a side effect of BPH surgery (Foster, 2019; Das, 2019). 

Transurethral incision of the prostate (TUIP) uses a similar technique to TURP, but instead of removing the prostate, it makes a tiny incision in order to enlarge the bladder outlet—enabling easier urine flow through the urethra (Ng, 2022).

Finally, in a simple prostatectomy, only part of the prostate is removed. The surgeon may insert an instrument via an incision in the abdomen or perineum (the area between the scrotum and the anus), or they may use lasers or robot assistance to remove some prostatic tissue (Foster, 2019; Ng, 2022).

If you notice any of the signs of prostate enlargement, such as urinary problems, talk to your healthcare provider. The symptoms of enlarged prostate are treatable but may lead to complications over time if left untreated (Ng, 2022). 

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Current version

June 13, 2022

Written by

Amelia Willson

Fact checked by

Steve Silvestro, MD

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About the medical reviewer

Steve Silvestro, MD, Ro

Dr. Steve Silvestro is a board-certified pediatrician and Associate Director, Clinical Content & Education at Ro.