Enlarged prostate

The prostate is a small, walnut-sized gland that sits at the base of the bladder in men. As you age, it often gets bigger, pressing on your bladder and urethra — the tube that carries urine to your penis and out of your body. This is common in men over the age of 50 and can cause symptoms that affect your urine flow. Symptoms are usually mild and can remain the same or improve over time even without treatment. 

Although an enlarged prostate is not serious in itself, it can raise your risk of a urinary tract infection (UTI) or a condition called acute urinary retention, when you can’t empty your bladder even though it’s full — this is a medical emergency.

An enlarged prostate doesn’t increase your risk of prostate cancer, but you can have both at the same time.

If you have an enlarged prostate, you may not experience any symptoms — only between a quarter to half of men with an enlarged prostate have symptoms. Prostate size doesn't always affect how severe the symptoms are. Symptoms are usually mild to start and worsen over months or years. In some cases, complications occur. 

Typical symptoms of an enlarged prostate include:

• Blood in your urine
• Difficulty starting to pass urine, needing to strain to pass urine and/or a weak flow of urine that stops and starts
• Feeling that you haven’t emptied your bladder properly
• Frequent urination, especially at night, and/or getting sudden urges to pass urine
• Pain when urinating
• Urinary incontinence, which includes: 
• Stress incontinence — leaking urine when you strain your body eg when you cough, laugh, lift heavy objects or sneeze
• Terminal dribbling — leaking a little urine into your underwear after you have finished urinating
• Urge incontinence — having a sudden urge to urinate but being unable to hold your pee until you reach the toilet, resulting in leakage 

Being incontinent, passing blood, pain and urinary problems are not always caused by an enlarged prostate. These symptoms can be caused by bladder, kidney or other prostate problems. If you’re experiencing any of these symptoms, see your GP. 

Some of the symptoms of an enlarged prostate are similar to those caused by prostate cancer, so it’s important to get them checked by your GP. 

Your GP will ask about your symptoms and how they are affecting your quality of life. They may also ask you to complete a chart every day to record: 

• How much liquid you drink
• How much urine you pass
• How often you have to urinate
• Whether you leak any urine

They may also carry out tests including:

• A physical examination of your back passage, stomach and genitals
• Blood tests to check your kidney function or your level of a protein called prostate-specific antigen (PSA) — raised levels may be a sign of cancer
• Urine tests to check for blood or sugar in your urine, which are signs of an infection or diabetes, respectively  

Your GP may refer you to a urologist, a doctor who specialises in urinary problems, or another appropriate specialist, if:

• You cannot completely empty your bladder
• You have a urinary infection that does not go away or keeps coming back
• You have kidney problems
• You have stress incontinence — leaking urine when you strain your body eg when you cough, laugh, lift heavy objects or sneeze
• Your urinary problems have not got better with previous treatments

Your GP may also refer you to a specialist if they are concerned that your symptoms are caused by cancer — this is not the underlying cause for most men. 

A urologist may carry out further tests to investigate your symptoms and decide how to treat them, including:

• A cystoscopy — a thin, tube-like telescope is used to look inside your bladder
• A test to measure how fast your urine flows
• An ultrasound scan — this will check how much urine remains in your bladder after you urinate

The exact causes are unknown but it’s thought to be due to hormonal changes that happen as men get older. Certain things that may increase your risk include:

• Being middle-aged or older
• Being overweight
• Having close relatives with an enlarged prostate
• Having diabetes

An enlarged prostate can also be caused by other conditions, including acute prostatitis, chronic (long-term) prostatitis and prostate cancer.

Treatment is unlikely to completely resolve all of your symptoms but can considerably improve them. The type of treatment you receive will depend on how severe your symptoms are and how much they affect your quality of life. 

If you have mild symptoms, having no treatment may be a suitable option. You can see your doctor every year to review your symptoms or when your symptoms change. Symptoms do not always worsen and can improve on their own. 

The main treatments are:

• Catheters
• Lifestyle changes
• Medicine
• Surgery and other medical procedures

You may be able to manage your symptoms through lifestyle changes alone, such as:

• Drinking less in the evenings and not drinking fluids at all two hours before you go to bed
• Eating more fibre — a low-fibre diet can cause constipation, which can worsen your symptoms by putting pressure on your bladder
• Losing weight
• Reducing alcohol, artificial sweeteners, caffeine and fizzy drinks — these can irritate your bladder and worsen your symptoms
• Strengthening your pelvic floor muscles
• Wearing pads or a sheath inside your underwear to deal with leaks — sheaths look like condoms but with a tube at the end that connects to a bag strapped to your leg under your clothing

You can also try changing your urinary habits:

• Emptying your bladder before long trips or when you know you won't have easy access to a toilet
• Emptying your bladder twice in quick succession — this is called double voiding and you should be careful not to strain yourself when doing this
• Practising urethral massage — a technique to help you empty your urethra
• Trying a bladder-training programme to increase the time between trips to the toilet and the amount of urine you can hold in your bladder — you will be given an initial target number of hours to wait before going to the toilet (eg two hours) and will be taught exercises to help you achieve your target, such as breathing, muscle and relaxation exercises, with the goal of increasing your hours between urinating

If lifestyle changes aren’t enough, your GP may recommend medications, including: 

• 5-alpha-reductase inhibitors — shrink your prostate gland
• Alpha-blockers — relax muscles in your prostate gland
• Anticholinergics — relax your bladder muscle
• Desmopressins — taken before bedtime to slow down urine production so you pass less urine at night
• Diuretics — taken during the day to speed up urine production so you pass more urine in the day and less at night 

You can also check with your GP that medications you’re taking for other conditions are not worsening your symptoms. 

If symptoms persist, there are many surgical and non-surgical methods available. Your doctor will recommend what’s best for you.

Surgical procedures

Surgical procedures carried out on your prostate include: 

• Laser prostate surgery — removal of prostate tissue using heat generated from a laser
• Open prostatectomy — removal of the prostate gland via a cut made in your body
• Transurethral resection of the prostate (TURP) — removal of part of the prostate gland using a heated metal loop
• Water ablation — water or steam under pressure is used to destroy prostate tissue

Other surgical procedures include:

• Cystoplasty to increase the size of your bladder by sewing piece of intestine into your bladder wall
• Prostatic urethral lift implants to push the prostate away from your urethra 
• Urinary diversion — rerouting the tubes that carry urine from your kidneys away from your bladder to outside your body 

Non-surgical procedures

• Injections of botulinum toxin — relaxes your bladder wall muscles so they don’t contract too early
• Implanted sacral nerve stimulation — a small electrical device implanted under the skin of your buttocks sends signals to the nerves that control your bladder
• Prostate artery embolisation — a catheter is inserted into an artery in your groin or wrist

Catheters

A catheter is a soft tube that can help drain your bladder. It may be an option if lifestyle changes and medication haven’t worked, you aren’t suitable for surgery and you have problems completely emptying your bladder.

A catheter can be passed through your penis or via a small hole made above your pubic bone. Your doctor may recommend a removable catheter or one that remains in your body for longer. 

Benign prostate enlargement can lead to:

• A urinary tract infection (UTI)
• Acute urinary retention (AUR) — a sudden inability to pass urine, which needs the insertion of a catheter to drain your bladder; symptoms include severe lower tummy pain and swelling of the bladder to the point that you can feel it with your hands
• Chronic urinary retention — only some of the urine in your bladder is passed when you urinate

Benign prostate enlargement does not increase your risk of prostate cancer.