Benign Prostate Hyperplasia (BPH)

prostate6What is Benign Prostatic Hyperplasia (BPH) + Enlarged Prostate?

Benign Prostatic Hyperplasia (BPH) is the technical term for an enlarged prostate, a small gland found only in men.

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Symptoms of Benign Prostatic Hyperplasia
An enlarged prostate mainly affects urination:

  • Starting to urinate may become difficult.
  • The flow might be intermittent.
  • You have to strain to pass urine
  • You feel you need to ‘go’ more often
  • You wake up more frequently during the night needing to urinate
  • You have a sudden urge to urinate, which can lead to incontinence
  • You are unable to fully empty your bladder
  • You find signs of blood in your urine (haematuria)

Symptoms can vary from mild to severe, but serious complications are rare. However, if these problems continue, over time they can cause urinary tract infections (UTIs) or acute urinary retention and other complications like bladder stones or damage to the kidneys.


BPH symptoms are similar to those of prostate cancer, whilst blood in the urine could have several causes, some of them serious. Immediate investigation to rule out more serious conditions is important.


Causes of Benign Prostatic Hyperplasia
The most likely cause of prostate enlargement is due to natural changes in hormone levels in a man’s body, making it a common condition that comes with age: around 30% of men over 50 have some degree of Benign Prostatic Hyperplasia (BPH), rising to 60% over 60.


An enlarged prostate is not usually a serious threat to health and does not indicate a higher risk of prostate cancer.


What is the prostate gland?

Normally about the size of a chestnut, the prostate lies just beneath the bladder and surrounds the urethra (the tube that carries urine from the bladder through the penis to outside the body). The prostate helps to make semen, and is connected to the testicles.


If the prostate becomes enlarged it squeezes the urethra, making it difficult for the bladder to empty.

Diagnosis of Benign Prostatic Hyperplasia
A urine test will tell if your symptoms are caused by an infection in your urinary system, such as a kidney or bladder infection.


A rectal examination to check if the prostate gland has become hard and bumpy could indicate prostate cancer. The rectum is close to the prostate, so the surface of the gland can be felt through it. However, prostate cancer does not always cause changes to the gland, so further tests are needed to rule out prostate cancer.


Prostate-specific antigen (PSA) test
This is a blood test to measure the level of the prostate-specific antigen (PSA) enzyme that the prostate gland produces. [Read more at prostate-specific antigen (PSA)]


A raised PSA level suggests enlargement of the prostate, and a very high level can indicate prostate cancer.


A transrectal ultrasound (TRUS) is a scan that is specifically developed to study the prostate and surrounding area. An ultrasound probe is introduced through the rectum, sending out sound waves that construct a detailed image of the prostate on a computer screen. This can be used either to confirm or rule out a diagnosis of prostate cancer.


There is also the possibility that benign prostatic hyperplasia is caused by a problem in the urinary tract – such as a kidney or bladder stone, lodged in the part of the urethra that passes through the prostate. An Intravenous Urography (IVU) X-ray can highlight urinary tract problems. During an IVU, a harmless radioactive dye is injected to make pelvic organs show up.


A voiding chart, in which a note is kept of every trip to the toilet, can give more information and help suggest the type of treatment that would be most effective in controlling the symptoms.

Treatment of Benign Prostatic Hyperplasia
If there is no infection, blockage or cancer detected, all that may be needed to control prostate enlargement are lifestyle changes, such as avoiding alcohol and caffeine, and not drinking any liquids for one to two hours before going to bed.


There’s evidence that bladder training and moderate exercise, such as walking for around 45 minutes a day, can improve symptoms.


Medications are available, such as those that block the effects of the hormone DHT, and alpha blockers which help relax the prostate gland muscles or reduce its size to make urinating easier. They work best in conjunction with lifestyle changes.

Surgery for Benign Prostatic Hyperplasia
In more severe cases that fail to respond to medication and where the symptoms are very painful, the inner part of the prostate gland that is blocking the urethra can be surgically removed. This can be done in a procedure called Trans-urethral resection of the prostate (TURP). Performed under either a general anaesthetic or a local anaesthetic that numbs lower half of your body, a scope with an electric wire loop is inserted through the urethra, and heated by radio waves to slice away excess tissue.


Another procedure, Transurethral incision of the prostate (TUIP), is similar to TURP, but rather than removing prostate tissue, two small cuts are made in the prostate to allow the urethra to be widened, making it easier to pass urine.


There are now some new minimally invasive surgical options for BPH that fill the gap between medication and the more invasive procedures to remove prostate tissue. These newer procedures can usually be done as a day case and have a much more rapid recovery with preservation of sexual function. The Rezum procedure involves shrinking the prostate gland through transurethral water vapour (steam) injection and the Urolift procedure involves inserting several clips to hold the prostate tissue open. Suitability for these procedures needs to be determined by investigations to look at the prostate size and shape.