Benign prostatic hyperplasia (BPH) is an enlarged prostate gland. The prostate gland surrounds the urethra, the tube that carries urine from the bladder out of the body. As the prostate gets bigger, it may squeeze or partly block the urethra. This often causes problems with urinating.
BPH occurs in almost all men as they age. BPH is not cancer. An enlarged prostate can be a nuisance. But it is usually not a serious problem. About half of all men older than 75 have some symptoms.
Benign prostatic hyperplasia is also known as benign prostatic hypertrophy.
Benign prostatic hyperplasia is probably a normal part of the aging process in men, caused by changes in hormone balance and in cell growth.
BPH causes urinary problems such as:
In a small number of cases, BPH may cause the bladder to be blocked, making it impossible or extremely hard to urinate. This problem may cause backed-up urine (urinary retention), leading to bladder infections or stones or kidney damage.
BPH does not cause prostate cancer and does not affect a man's ability to father children. It does not cause erection problems.
Your doctor can diagnose BPH by asking questions about your symptoms and past health and by doing a physical examination. Tests may include a urine test (urinalysis) and a digital rectal examination, which lets your doctor feel the size of your prostate. In some cases, a prostate-specific antigen (PSA) test is done to help rule out prostate cancer. (Prostate cancer and BPH are not related, but they can cause some of the same symptoms.)
Your doctor may ask you how often you have symptoms of BPH, how severe they are, and how much they affect your life. If your symptoms are mild to moderate and do not bother you much, home treatment may be all that you need to help keep them under control. Your doctor may want to see you regularly to check on your symptoms and make sure other problems haven't come up.
You can use this tool to help you think about how bothersome your symptoms are:
As a rule, you don't need treatment for BPH unless the symptoms bother you or you have other problems such as backed-up urine, bladder infections, or bladder stones.
Although home treatment cannot stop your prostate from getting larger, it can help reduce or control your symptoms. Here are some things you can do that may help reduce your symptoms:
If home treatment does not help, BPH can be treated with medicine. Medicine can reduce the symptoms, but it rarely gets rid of them. If you stop taking medicine, symptoms return.
If your symptoms are severe, your doctor may suggest surgery to remove part of your prostate. But few men have symptoms or other problems severe enough to need surgery.
You cannot prevent BPH or the urination problems it may cause. Some people believe that regular ejaculations will help prevent prostate enlargement. But there is no scientific proof that ejaculation helps.
Learning about benign prostatic hyperplasia (BPH):
Living with BPH:
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Benign prostatic hyperplasia (BPH) is probably a normal part of the aging process in men. It is caused by changes in hormone balance and cell-growth factors. Genetics may also play a role. This is especially true for severe BPH requiring surgery in men younger than 60.
Men who are older than 50 have a higher chance of developing BPH. But why some men have more severe symptoms than others is not known.
Many men with benign prostatic hyperplasia (BPH) have no symptoms. When symptoms (known as lower urinary tract symptoms, or LUTS) occur, they may range from mild and barely noticeable to serious and disruptive. The amount of prostate enlargement is not always related to the severity of the symptoms. Some men with only slight enlargement have serious symptoms. And some men with a great deal of enlargement have few symptoms.
Your symptoms may become worse during cold weather or as a result of physical or emotional stress.
Some medicines can make your symptoms worse. These include over-the-counter cold medicines such as diphenhydramine (Benadryl, for example), pseudoephedrine (such as Sudafed), oxymetazoline spray (such as Dristan), and prescription medicines such as antidepressants, water pills (diuretics), testosterone (gels, implants, or injections), and pain medicines (opioids).
The symptoms of BPH may involve problems emptying the bladder or problems with bladder storage.
Symptoms related to bladder emptying include:
Symptoms related to bladder storage include:
These symptoms are not always related to prostate enlargement and can be caused by other conditions. BPH symptoms are often balanced between the two types of symptoms. If symptoms come on rapidly, or if you have more of one type of symptom than the other type, you may have another condition. Other conditions that may cause similar symptoms include urinary tract infections, prostatitis, prostate cancer, diabetes, heart failure, and neurologic diseases.
You can use the Interactive Tool: How Bad Are Your Urinary Symptoms From BPH? to evaluate how bad your symptoms are and, later, to judge how well your treatment is working.
The prostate gland grows as men age, with the fastest growth occurring at middle age. By age 50, 5 out of 10 men have an enlarged prostate. By age 80, up to 9 out of 10 men have an enlarged prostate. Having an enlarged prostate does not always cause symptoms.
As the prostate enlarges, the urethra (the tube that carries urine from the bladder out of the body) may become narrowed or partially blocked. The narrowed or blocked urethra is what causes the symptoms of benign prostatic hyperplasia (BPH). By age 55, over 2 out of 10 men have some symptoms. By age 75, 5 out of 10 men complain of a decrease in the force of their urine streams.footnote 1
In rare cases, severe obstruction of the urine flow occurs and may lead to complications, including complete or partial blockage of the urethra, urinary tract infection (UTI), bladder stones, or visible blood in the urine.
Every man's experience with BPH is different. Symptoms may be stable, may come and go, or may become more bothersome over time. Some men find the symptoms to be mild and do not require treatment with medicines. Other men find the symptoms bothersome and choose treatment with medicine or, less commonly, surgery.
BPH does not cause prostate cancer. But prostate cancer may cause symptoms similar to those of BPH. It is important to have your symptoms checked by a doctor to be certain they are not caused by prostate cancer.
Men who are older than 50 have a higher risk for benign prostatic hyperplasia (BPH).
The hormone testosterone, which is produced mainly by the testicles, is needed in order for BPH to develop. Men who have their testicles removed before puberty never develop BPH. Men who have their testicles removed after puberty (but before they have symptoms of BPH) rarely develop BPH.
A family history of BPH may increase your risk for needing treatment for this condition, especially if a relative needed treatment before age 60.
A vasectomy does not increase your risk of BPH.
Call your doctor immediately if:
Call your doctor if you have painful urination and any of the following signs of a possible urinary tract infection or prostate infection that last longer than 24 hours:
Call your doctor if you have urination problems that have developed over a few weeks or a few months and are frequent.
If urinary symptoms are minor or they don't bother you too much, and you do not have prostate cancer or a prostate infection, it may be appropriate to try watchful waiting or home treatment. Call a doctor if your symptoms change or get worse or if you change your mind about treatment.
Mild and moderate urinary symptoms that are caused by BPH can be evaluated and treated by your family doctor, general practitioner, or a nurse practitioner. You may be referred to a urologist.
If the symptoms are severe or if surgical treatment is being considered, you probably need to see a urologist.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Your doctor will first want to make sure that your urination problem is caused by benign prostatic hyperplasia (BPH) and not by something else. This can usually be determined from your medical history, a physical examination that focuses on the urinary tract, a urinalysis, and a blood test. A neurological examination should also be done to determine whether your symptoms are related to a problem with the nerves to the bladder. A questionnaire such as the International Prostate Symptom Score (IPSS) may be used to evaluate how bothersome your symptoms are. It is not used to diagnose BPH.
If your symptoms are moderate to severe, additional tests, called urodynamic studies, may be done.
The following tests may be done if you have complications of BPH or if there is a need to look for other causes of the symptoms.
Benign prostatic hyperplasia (BPH) cannot be cured, so treatment focuses on reducing your symptoms. Treatment is based on how severe your symptoms are, how much they bother you, and whether you have complications.
Deciding how to treat BPH is greatly influenced by how bothersome your symptoms are. The International Prostate Symptom Score (IPSS) is an interactive questionnaire that can help you tell how bad your symptoms are and measure how well your treatment is working. This questionnaire ranks the severity of your symptoms on a numerical scale. The higher the number, the more you are bothered by your symptoms. The more your symptoms bother you, the more aggressive you may want to be in your treatment.
The Canadian Urological Association (CUA) makes the following treatment recommendations for benign prostatic hyperplasia (BPH) based on how bad your symptoms are.
There are some things you can do that may help reduce how much BPH affects your quality of life.
If your symptoms of benign prostatic hyperplasia (BPH) remain mild and not bothersome, watchful waiting may be your best treatment. With this treatment, you may make small changes to your lifestyle to control your symptoms. You do not take medicines or have surgery. You have regular checkups to be sure your symptoms are not getting worse.
If symptoms get worse or become bothersome, or if you develop complications, you can consider medicine or surgery.
If any of the following occur, you will probably need surgery for benign prostatic hyperplasia (BPH):
Unless surgery is required because of a complication, choosing a treatment is largely up to you and your doctor. If complications arise, surgery may be needed.
The extent to which treatment improves your symptoms depends partly on how bad your symptoms are and how much you are bothered by them. If you are not bothered by your symptoms before treatment, you are less likely to notice much improvement after treatment.
Surgery offers the best chance for improving the symptoms but also has the risk of causing other problems.
The urination problems caused by benign prostatic hyperplasia (BPH) cannot be prevented. Some people believe that regular ejaculations will help prevent prostate enlargement. But there is no scientific proof that ejaculation helps.
If your urination problem caused by benign prostatic hyperplasia (BPH) is mild to moderate and does not bother you, home treatment may be all you need to help keep your symptoms from interfering with your daily activities. Your doctor may want to see you regularly to check on your symptoms.
The following tips may help minimize your symptoms:
Medicines are sometimes used to help relieve bothersome, moderate to severe urination problems caused by benign prostatic hyperplasia (BPH). If you stop using medicine, the symptoms will usually return.
The International Prostate Symptom Score (IPSS) is an interactive questionnaire that can help you determine how bad your urinary symptoms are and check how well your treatment is working. But the most important thing in deciding whether to use medicines is not your IPSS score but how much the symptoms bother you and affect your quality of life. A high score on the IPSS does not necessarily mean you need medicines.
In general, the side effects of the most commonly used medicines are minor. And the side effects stop when you stop taking the medicine.
and 5-alpha reductase inhibitors affect different prostate tissues. How much your symptoms improve may depend on which tissue is contributing most to your symptoms. None of these medicines work for everyone.
Medicines used to treat urinary incontinence and overactive bladder may help BPH symptoms, too. And men with BPH can have multiple urinary problems.
If you have difficulty urinating because of benign prostatic hyperplasia (BPH), you may need surgery if you:
If you have no complications but have symptoms that bother you or if other treatment has not worked, you may choose to have surgery. In this case, think about:
For more information on this decision, see:
Surgery that does not require an incision through the skin is usually used. The surgical instruments are passed up the urinary opening in the penis to the location of the prostate. This is described as a transurethral surgery of the prostate.
Types of surgeries include:
A newer surgery option is the prostatic urethral lift (such as Urolift). During this surgery, a device is placed to compress the prostate tissue and improve urine flow. This is a minimally invasive procedure that is still being studied, but it appears to reduce symptoms of BPH without the serious side effects, such as erectile dysfunction, that are common with other surgeries. This procedure may not be available in all provinces.
The oldest surgical method to treat BPH is an open prostatectomy, in which an incision is made through the skin to reach the prostate. Doctors use this method less often now, but it is still preferred if the prostate is very large.
Surgery is the most reliable way to relieve symptoms. But surgery may not relieve all your symptoms. And it puts you at risk for certain surgical complications, including erection problems (erectile dysfunction). Other complications include the inability to control the release of urine (urinary incontinence) and ejaculation of semen into the bladder instead of out through the penis (retrograde ejaculation). The complication depends on which type of surgery is used.
Men who have severe symptoms often notice great improvement in the quality of life following surgery. Men whose symptoms are mild may find that surgery does not greatly improve quality of life, and they may want to think carefully before deciding to have surgery to treat BPH.
If you have decided to have surgery, or if there are clear medical reasons to have surgery, the best surgical option depends on the size and shape of your prostate and the experience of the surgeon.
Some men take natural health products for BPH, such as saw palmetto. If you're thinking about trying something like this, talk with your doctor about whether it might be helpful for you.
Presti JC, et al. (2008). Benign prostatic hyperplasia (BPH) section of Neoplasms of the prostate gland. In EA Tanagho, JW McAninch, eds., Smith's General Urology, 17th ed., pp. 348-370. New York: McGraw-Hill.
Roehrborn CG, et al. (2008). The effects of dutasteride, tamsulosin and combination therapy on lower urinary tract symptoms in men with benign prostatic hyperplasia and prostatic enlargement: 2-year results from the CombAT study. Journal of Urology, 179(2): 616-621.
Liu L, et al. (2011). Phosphodiesterase-5 inhibitors for lower urinary tract symptoms secondary to benign prostatic hyperplasia: A systematic review and meta-analysis. Urology, 77(1): 123-130.
Other Works Consulted
Aho TF, Gilling PJ (2003). Laser therapy for benign prostatic hyperplasia: A review of recent developments. Current Opinion in Urology, 13(1): 39-44.
Helfand M, et al. (2007). Benign prostatic hyperplasia (BPH). Management in primary care-Screening and therapy. Department of Veterans Affairs Health Services Research and Development Service. Available online: http://www.hsrd.research.va.gov/publications/esp/BPH-2007.pdf.
Murray MT, Pizzorno JE (2006). Serenoa repens (saw palmetto). In JE Pizzorno Jr, MT Murray, eds., Textbook of Natural Medicine, 3rd ed., vol. 1, pp. 1245-1250. St. Louis: Churchill Livingstone Elsevier.
Saw palmetto (2009). In A DerMarderosian et al., eds., Review of Natural Products. St. Louis: Wolters Kluwer Health.
Soliman SA, et al. (2007). Rotoresection versus transurethral resection of the prostate: Short-term evaluation of a prospective randomized study. Journal of Urology, 177(3): 1036-1039.
Wilt TJ, N'Dow J (2008). Benign prostatic hyperplasia. Part 1-Diagnosis. BMJ, 336(7636): 146-149.
ByHealthwise StaffPrimary Medical ReviewerE. Gregory Thompson, MD - Internal MedicineE. Gregory Thompson, MD - Internal MedicineAnne C. Poinier, MD - Internal MedicineAdam Husney, MD - Family MedicineKathleen Romito, MD - Family MedicineSpecialist Medical ReviewerJ. Curtis Nickel, MD, FRCSC - UrologyJ. Curtis Nickel, MD, FRCSC - Urology
Current as ofMarch 14, 2017
Current as of: March 14, 2017
E. Gregory Thompson, MD - Internal Medicine
& E. Gregory Thompson, MD - Internal Medicine & Anne C. Poinier, MD - Internal Medicine & Adam Husney, MD - Family Medicine & Kathleen Romito, MD - Family Medicine & J. Curtis Nickel, MD, FRCSC - Urology & J. Curtis Nickel, MD, FRCSC - Urology
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