Should I be concerned about an enlarged prostate?

Almost all men will develop an enlarged prostate as they get older — it’s medically known as benign prostatic hyperplasia (BPH).

What is your prostate?

The prostate gland is only found in men. It is a gland that sits at the base of your bladder and surrounds your urethra (the tube that urine passes through when you urinate). It’s quite small and is often compared to the size of a walnut. One of its jobs is to help you produce semen.

As you get older, it’s common for it to get bigger, which can cause problems with urinating because it sits right below your bladder.

What are the symptoms of an enlarged prostate?

An enlarged prostate can affect how you urinate in different ways, including:

• A weak urine flow
• Feeling like you haven’t completely emptied your bladder
• Needing to get up in the night to urinate
• Needing to urinate more frequently and/or urgently
• Not managing to get to the toilet in time when you need to go
• The flow of urine not starting straight away

You may not get all of these symptoms and some men who have an enlarged prostate won’t get any of them. This is because the prostate can enlarge in different ways and put pressure on different parts of the urethra or bladder. 

It’s also important to remember that these symptoms can be caused by other conditions too.

What are the stages of an enlarged prostate?

There are three stages of prostate enlargement. The first stage is called microscopic growth — it affects small areas that can only be seen under a microscope.

The second stage is called macroscopic growth. At this stage, the enlargement can be felt if you have a physical examination.

The final stage is called symptomatic growth. This is when the enlargement starts to cause problems when you urinate.

Many men will have microscopic and macroscopic enlargement of their prostate but won’t progress to the symptomatic stage, so won’t ever know that they have the condition.

Is the condition serious?

An enlarged prostate is a benign condition, though its symptoms are similar to prostate cancer symptoms, so it’s important to get them checked out.

A small number of men with an enlarged prostate will develop urine retention.

Chronic (long-term) urine retention

If it’s left untreated, an enlarged prostate can lead to chronic urine retention. This is where you can’t completely empty your bladder. Leaving urine in your bladder can lead to a urine infection and can also stretch your bladder muscle, making it weaker. Eventually, this condition can cause damage to your bladder and kidneys.

Acute urine retention

Acute urine retention is where you suddenly can’t urinate at all. It’s painful and it’s a medical emergency. You should go to a hospital straight away, where your bladder might be drained using a catheter.

Urine retention is rare and normally only happens if you don’t get treatment for your enlarged prostate.

Is an enlarged prostate linked to prostate cancer?

While the two conditions can share similar symptoms, an enlarged prostate has no link to developing prostate cancer. The two conditions normally affect different parts of the prostate gland.

You can, however, have both conditions at the same time, so having an enlarged prostate doesn’t rule out having prostate cancer too.

What are the treatments for an enlarged prostate?

If you’ve got an enlarged prostate and it’s causing you problems, your doctor will assess your symptoms and medical history and recommend different treatments.

Lifestyle changes

Many cases of an enlarged prostate can be managed by making lifestyle changes, including:

• Avoiding alcohol, caffeine, fizzy drinks and artificial sweeteners — all of these can irritate the bladder and make your symptoms worse
• Double-voiding — this is where you urinate, wait a few minutes and then go again to make sure you have completely emptied your bladder
• Eating healthily and maintaining a healthy weight — being overweight can make your symptoms worse
• Not drinking in the two hours before bedtime
• Making sure you urinate before you go out
• Wearing absorbent pads

Medicines

If you can’t manage your symptoms with lifestyle changes, there are medicines that can help.

• 5-alpha-reductase inhibitors slowly shrink your prostate gland
• Alpha-blockers relax the muscles around your bladder and prostate, making it easier to urinate
• Anticholinergics relax your bladder muscle, making it easier to urinate 
• Desmopressin reduces urine production, so can help when taken during the night
• Diuretics increase urine production, so can help when taken during the day

Surgery

If symptoms persist or are severe, you may need to consider surgery. There are a number of different types of surgery that can help, including:

• Laser prostate surgery — uses heat from a laser to remove tissue from your prostate
• Open prostatectomy — a small cut is made in your body and the prostate gland is removed
• Transurethral resection of the prostate (TURP) — a heated metal loop is used to remove part of the prostate
• Water ablation — prostate tissue is removed using pressurised water or steam 

If you have enlarged prostate symptoms and you’re over 50, it’s most likely harmless. You should, however, get checked out by a doctor to make sure you get the most suitable treatment and rule out prostate cancer.