Benign prostatic hyperplasia (BPH)
Benign prostatic hyperplasia (BPH) is noncancerous enlargement of the prostate. It becomes more common with age and can obstruct urine flow, causing weak stream, hesitancy, frequency, urgency, nocturia and incomplete bladder emptying.
At a glance
Quick facts
- Category
- Benign prostate enlargement
- Cancer
- BPH is not prostate cancer
- Typical age
- More common after 50
- Common symptoms
- Weak stream, nocturia, urgency
- Complication
- Urinary retention
- Treatment
- Observation, medicines or procedures
Dr. Francis Chibueze Nwokpoku
Medical Officer · 9th Division Hospital, Nigerian Army
Reviewed for clinical accuracy, important omissions and patient-facing safety wording.
Names & terminology
How this entity may be named or searched
- Benign prostatic hyperplasia (BPH)
- Noncancerous enlargement of the prostate associated with aging.
- Enlarged prostate
- Common patient-facing term for BPH, though prostate size and symptom severity do not always match.
- LUTS
- Lower urinary tract symptoms such as hesitancy, weak flow, urgency, frequency and nocturia.
- Benign prostatic obstruction
- Functional obstruction caused by the prostate; not every enlarged prostate produces obstruction.
Structured entity profile
Clinical profile
Overview
BPH is a benign increase in prostate tissue that can compress the urethra and alter bladder emptying. It is not prostate cancer, and having BPH does not mean a person has cancer, although the two conditions can coexist and may cause overlapping urinary symptoms. [1]
Prostate size does not reliably predict symptom severity. A large prostate may cause few symptoms, while a smaller enlargement can significantly affect urine flow depending on anatomy, bladder function and other factors. [1]
Symptoms and warning signs
Common symptoms include difficulty starting urination, weak or interrupted stream, dribbling, feeling that the bladder has not emptied, urinary frequency, urgency and waking at night to urinate. Some medicines such as decongestants or antihistamines can worsen urinary symptoms in susceptible people. [1]
When taking a history, I separate urinary urgency from urgency urinary incontinence. I ask whether the patient can defer urination until reaching the toilet; involuntary leakage associated with urgency points to urgency urinary incontinence rather than urgency alone.
Many of my patients with BPH describe waking several times at night to urinate. Asking exactly how often this happens, rather than simply asking whether they wake at night, helps me understand how much nocturia is disrupting sleep and daily life.
SYMPTOM MATRIX
BPH can produce both voiding and storage urinary symptoms
Urinary symptoms are not specific to BPH and can reflect infection, bladder disease, prostatitis or cancer.
- Difficulty starting the stream
- Weak or interrupted urine flow
- Straining to urinate
- Dribbling after urination
- Feeling of incomplete emptying
- Frequent urination
- Urgency
- Nocturia
- Urge leakage
- Symptoms worsened by some medicines
- Complete inability to urinate
- Fever with painful urgent urination
- Visible blood in urine
- Severe lower-abdominal pain with a full bladder
Acute urinary retention or urinary symptoms with systemic infection require prompt medical assessment.
Diagnosis
Evaluation starts with symptom history, medication review and physical examination, often including a digital rectal examination. Urinalysis helps look for infection or blood, while PSA testing may be discussed when the result would influence evaluation for prostate cancer or management. [1]
A digital rectal examination uses a gloved, lubricated finger to assess the prostate through the rectum. Most patients tolerate it, although it can be uncomfortable and tenderness may be more marked when prostatitis or another painful condition is present. PSA can support prostate-cancer assessment, but a result within the expected range does not completely rule cancer out, so I interpret it together with age, symptoms, examination findings and the overall level of clinical suspicion.
Additional tests can include postvoid residual measurement, urinary flow testing, ultrasound, cystoscopy or other urologic studies when symptoms are severe, the diagnosis is uncertain or complications are suspected. [1]
For uncomplicated lower urinary tract symptoms, transrectal ultrasound is not usually part of my initial evaluation. If prostate size needs to be estimated, a transabdominal study can provide a practical estimate without making TRUS a routine first step.
Diagnostic pathway
Confirm that urinary symptoms fit BPH and exclude important alternatives
BPH is one cause of lower urinary tract symptoms, not a diagnosis made from symptoms alone.
PSA is not a diagnostic test for BPH itself; it is interpreted in the wider context of prostate-cancer risk and shared decision-making. Source [1]
Symptoms do not always match prostate size
Treatment decisions are based mainly on symptom burden, quality-of-life impact and complications rather than gland size alone. Clinicians also consider postvoid residual, urinary retention history, recurrent infection, bladder stones, kidney effects and whether another diagnosis may be present. [1]
Treatment and management
When symptoms are mild and not bothersome, watchful waiting with periodic reassessment may be appropriate. Measures such as reducing evening fluids, limiting excess caffeine or alcohol and reviewing medicines that worsen retention can help some people. [1]
Medicines include alpha-1 blockers, which relax smooth muscle around the prostate and bladder neck, and 5-alpha reductase inhibitors, which can reduce prostate growth over time. Other medicines may be used in selected patients. Minimally invasive procedures or surgery are considered when symptoms remain troublesome, complications develop or medicines are unsuitable. [1]
When the prostate is clearly enlarged and the risk of progression is higher, a 5-alpha-reductase inhibitor can become more relevant. In practice, prostate size is one of the factors I use when deciding whether this class, alone or with an alpha blocker, is appropriate.
Treatment & care hub
Match treatment intensity to symptoms, obstruction and complications
BPH treatment ranges from observation to medicine and surgery.
Monitor when impact is low
Periodic review is reasonable when symptoms are not troublesome and there are no high-risk complications.
Relax the prostate and bladder neck
These medicines can improve urine flow relatively quickly in many patients.
Reduce prostate growth
These medicines act more slowly and are useful in selected people at risk of progression.
Relieve obstruction mechanically
Minimally invasive procedures or surgery are options when medication is insufficient or complications are present.
Possible complications
Progressive obstruction can contribute to acute or chronic urinary retention, recurrent urinary tract infection, bladder stones, hematuria or kidney damage. These complications can change the urgency and type of treatment. [1]
United States estimate
BPH becomes much more common with age
NIDDK estimates BPH affects about 5–6% of men ages 40–64 and 29–33% of men ages 65 and older.
Common questions
Frequently asked questions
No. BPH is benign prostate enlargement and is not cancer, although BPH and prostate cancer can coexist.
No. Prostate size and urinary symptom severity do not always match.
Weak stream, hesitancy, dribbling, incomplete emptying, frequency, urgency and nocturia are common.
Yes. Severe obstruction can cause acute urinary retention, which requires urgent bladder drainage and assessment.
No. Mild symptoms may be observed, and many people are treated with medicines. Procedures are used when clinically appropriate.
Sources
- NIDDK, NIH — Enlarged Prostate (Benign Prostatic Hyperplasia)
This article is based on trusted medical sources and has been reviewed by a clinician. It is not a substitute for personalized medical advice.
Age is an important part of the clinical picture. BPH becomes more common as men get older, but many men with an enlarged prostate have few or no lower urinary tract symptoms, so enlargement and symptom burden are not the same thing.