Essential Facts About Enlarged Prostate

Plus how to deal with the condition’s hallmark symptom: frequent urination.

Medically reviewed in January 2023

Over 80 percent of men older than 80 have an enlarged prostate. The prostate is the walnut-sized gland that sits just below a man’s bladder. Its job is to produce a fluid that protects sperm as it’s released from the man’s body.

“An enlarged prostate, also called benign prostatic hyperplasia (BPH), is due to an overgrowth of benign, or non-cancerous prostate tissue,” says Samuel Nickles, MD, a surgeon at Summerville Medical Center and Palmetto Adult and Children’s Urology in Charleston, South Carolina.

When the prostate becomes enlarged, it compresses the urethra, or the tube that allows urine to travel out of your body. That can cause lower urinary tract symptoms like a weak stream or having to urinate often, says Dr. Nickles.

What causes an enlarged prostate?
Starting around age 25, all men’s prostates start growing to some degree. Experts aren’t sure exactly what causes the growth, but hormones like testosterone may play a role. It’s also unclear why about 50 to 60 percent of men don’t have any symptoms, while others experience:

  • Frequent urination
  • Incomplete bladder emptying
  • Bladder leaks and dribbles
  • A weak or stop-and-start flow of urine

“Men with advanced BPH are prone to urinary tract infections (UTIs), blood in the urine and loss of bladder control as well,” adds Nickles. Since the symptoms of BPH can mimic other conditions like prostate or bladder cancer, tell your urologist if you start experiencing them. He or she can confirm your diagnosis and help you find relief.

“If you're uncomfortable because your bladder isn’t emptying or it’s keeping you up at night, call your urologist,” says Nickles. “If it's a problem to you, it's a problem to us—your urologist can recommend treatments to ease your symptoms.”

How BPH is diagnosed
“BPH is diagnosed largely based on your symptoms,” says Nickles. “Your urologist will start by asking whether symptoms have been bothersome or if they’ve been interrupting your life.”

Your urologist may also perform:

  • A rectal exam: This test can reveal changes to the size and shape of your prostate.
  • A urine test: A urine sample can show if you have a bladder infection or UTI, rather than BPH. Urine testing also looks for blood, which can be a sign of BPH or other conditions like bladder cancer or bladder stones.
  • A blood test: Your urologist may want to check your level of prostate-specific antigen, or PSA. If your PSA level is elevated, it could help confirm that you have BPH or indicate that you should get tested for prostate cancer.

Some men also undergo a series of tests to show how well urine flows past the prostate, called urodynamic testing. Urodynamic testing could include taking images to reveal how well your bladder is emptying or using sensors to determine if the muscles along your urinary tract are working properly.

How BPH is treated
Lifestyle changes can help get your BPH symptoms under control:

  • Avoid alcohol and caffeine, which make you urinate more frequently.
  • Add more fiber to your diet to help prevent constipation, which puts extra pressure on your urethra.

“Some men require medications called alpha blockers, which relax the muscles of the lower urinary tract,” says Nickles. “This widens the urethra, relieving the pressure on it and allowing urine to flow more easily.”

Another option is to try a type of medication called a 5-alpha reductase inhibitor. This type of drug can slow prostate growth or shrink the prostate in certain cases. For severe prostate enlargement, additional procedures or surgery may be needed.

Will BPH interfere with your sex life?
“BPH doesn’t cause erectile dysfunction,” says Nickles. “Erectile dysfunction (ED) is actually a blood flow issue, rather than a prostate problem,” he explains. However, certain BPH treatments like alpha-blockers or surgery may cause sexual symptoms.

BPH and certain BPH treatments can sometimes cause retrograde ejaculation as well. Retrograde ejaculation happens when your semen travels back towards your bladder, instead of being released when you orgasm. This isn’t medically dangerous, but it can make it harder for your partner to get pregnant.

Does BPH cause prostate cancer?
An enlarged prostate doesn’t cause or increase your risk of prostate cancer, says Nickles. However, both men with enlarged prostates and those with prostate cancer can have an elevated PSA level. If your PSA count is high, your doctor may send you for additional tests to make sure you don’t have cancer.

Essential tips for living with an enlarged prostate
Here are four tips that may help ease uncomfortable BPH symptoms:

  1. Avoid over the counter medications like decongestants, which can make the muscles around your urinary tract tense up.
  2. If prescriptions like your antidepressant or diuretic are making your symptoms worse, ask your healthcare provider about switching to a different drug or lowering your dose.
  3. Avoid fluids before bed, especially nightcaps: Alcohol makes you urinate frequently and it interferes with your natural sleep cycle.
  4. Try “double voiding”: After urinating, wait a few seconds, and then prompt yourself to go again to fully empty your bladder.

Daily life with BPH can be frustrating and uncomfortable, but healthy habits and strong communication with your urologist can help you get your symptoms under control.

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