Overview
Benign prostate enlargement (BPE) is the medical term to describe an enlarged prostate, a condition that can affect how you pass urine.
BPE is common in men aged over 50. It is not a cancer and it isn't usually a serious threat to health.
Symptoms of benign prostate enlargement
The prostate is a small gland, located in the pelvis, between the penis and the bladder.
If the prostate becomes enlarged, it can place pressure on the bladder and urethra (the tube through which urine passes).
This can affect how you pee and may cause:
- difficulty starting to pee
- a frequent need to pee
- difficulty fully emptying your bladder
In some men, the symptoms are mild and don't need treatment. In others, they can be very troublesome.
Many men worry that having an enlarged prostate means they have an increased risk of developing prostate cancer. This isn't the case.
The risk of prostate cancer is no greater for men with an enlarged prostate than it is for men without an enlarged prostate.
Causes of benign prostate enlargement
The cause of prostate enlargement is unknown, but it is believed to be linked to hormonal changes as a man gets older.
The balance of hormones in your body changes as you get older and this may cause your prostate gland to grow.
Diagnosing benign prostate enlargement
You might have several different tests to find out if you have an enlarged prostate.
Your GP may do some of these tests, like a urine test, but others might need to be carried out at a hospital.
Some tests may be needed to rule out other conditions that cause similar symptoms to BPE such as prostate cancer.
Treating benign prostate enlargement
Treatment for benign prostate enlargement will depend on the severity of your symptoms.
If you have mild symptoms, you won't usually need immediate treatment but you'll have regular prostate check-ups.
You'll probably also be advised to make lifestyle changes, such as:
- drinking less alcohol, caffine and fizzy drinks
- limiting intake of artificial sweeteners
- excercising regularly
- drinking less in the evening
Medication to reduce the size of the prostate and relax your bladder may be recommended to treat moderate to severe symptoms of BPE.
Surgery is usually only recommended for moderate to severe symptoms of BPE that have failed to respond to medication.
Complications of prostate enlargement
Benign prostate enlargement can sometimes lead to complications such as:
- urinary tract infection
- acute urinary retention
Acute urinary retention (AUR) is the sudden inability to pass any urine.
Symptoms of AUR include:
- suddenly not being able to pee at all
- severe lower abdominal pain
- swelling of the blasser that you can feel with your hands
Go immediately to your nearest accident & emergency department if you experience the symptoms of AUR.
Diagnosis
To find out whether your prostate gland is enlarged, you'll need to have a few tests.
Some tests will be carried out by your GP and , if needed, others will be carried our by a specialist in urinary problems (urologist).
GP examinations and tests
Your GP will ask about your symptoms and your concerns, and their impact on your quality of life.
You may be asked to complete:
- A urinary frequency-volume chart
This will give a record of how much water you normally drink, how much urine you pass, and how often you empty your bladder on a daily basis, as well as any leakage you have. Download a chart (PDF, 115kb) from the Bladder Matters website.
The IPSS (International Prostate Symptom Score) questionnaire allows your doctor to better understand how serious your symptoms are. Download a version of the questionnaire (PDF, 180kb) from the Royal United Hospital Bath NHS Trust.
Your GP should perform a physical examination. They may examine
your stomach and genital areas.
They may also feel your prostate gland through the wall of the back passage (rectum). This is called a digital rectal examination (DRE).
Your GP may order a blood test to check that your kidneys are
working properly.
They may advise you to have a prostate-specific antigen (PSA) blood test to rule out prostate cancer.
You may be offered a urine test, for example to test for glucose (sugar) or blood. This is to see if you have diabetes or an infection.
Referral to a urologist
Your GP may refer you to a urologist or other appropriate specialist if:
- previous treatments have not helped your urinary problems
- a urinary infection does not go away or comes back regularly
- you cannot fully empty your bladder
- you have kidney problems
- you have stress incontinence: when urine leaks out at times when your bladder is under presure; for example, when you cough or laugh
You should also see a specialist if your GP is concerned that your symptoms could be caused by cancer, although for most men cancer is not the cause.
To help find out what might be causing your symptoms and decide how best to manage them, you should be offered additional tests to measure:
- how fast your urine flows
- how much urine is left in the bladder after you have peed
You may also be offered other tests, depending on your symptoms or the treatment you and your doctor are considering.
Treatment
The treatment for an enlarged prostate gland will depend on the severity of your symptoms.
The main treatments are:
Lifestyle changes
You might be able to relieve the symptoms by making some simple changes to your lifestyle.
Drink fewer fizzy drinks and less alcohol, caffeine and artificial sweeteners
Fizzy drinks and drinks that contain alcohol, caffeine (like tea, coffee or cola) and artificial sweeteners can irritate the bladder and make urinary symptoms worse.
Drinking less in the evening
Try to reduce the amount you drink in the evening and avoid drinking anything for 2 hours before you go to bed. This might help you avoid getting up in the night. Make sure you're still drinking enough fluid earlier in the day.
Remembering to empty your bladder
Remember to go to the toilet before long journeys, or when you
know you will not be able to reach a toilet easily.
Double voiding
This involves waiting a few moments after you have finished
passing urine before trying to go again. It can help you to empty
your bladder properly. But take care not to strain or push.
Checking your medicines
Check with your doctor whether any medicines you take, such
as anti-depressants or decongestants, may be making your
urinary symptoms worse.
Eating more fruit and fibre
This will help you avoid constipation, which can put pressure on
the bladder and worsen symptoms of an enlarged prostate.
Using pads or a sheath
Absorbent pads and pants can be worn inside your underwear,
or may replace your underwear altogether. These will soak up
any leaks.
Urinary sheaths can also help with dribbling. They look
like condoms with a tube coming out of the end. The tube
connects to a bag that you can strap to your leg, under your
clothing.
Bladder training
Bladder training is an exercise programme that aims to help you go for longer without peeing and hold more pee in your bladder.
You'll be given a target, such as waiting at least 2 hours between each time you pee.
It's a good idea to use a bladder training chart (PDF, 115kb), which allows you to record each time you pass urine and the volume of urine passed – you'll need a plastic jug to measure this. Your doctor should give you a chart to take home.
You'll also be taught a number of exercises, such as breathing, relaxation and muscle exercises, to help take your mind off the need to urinate.
Over time your target time will be increased, and at the end of the programme you should find that you're able to go for longer without peeing.
Ask your doctor or specialist nurse for more information about any of these lifestyle changes.
Medicines
If lifestyle changes don't help or aren't suitable for you, you may be offered medicine:
Alpha blockers relax the muscle in the prostate gland and at the base of the bladder, making it easier to pass urine. Common alpha blockers used are tamsulosin and alfuzosin.
Anticholinergics relax the bladder muscle if it is overactive.
5-alpha reductase inhibitors shrink the prostate gland if it is enlarged. Finasteride and dutasteride are the two 5-alpha reductase inhibitors available.
Diuretics speed up urine production. If taken during the day, it reduces the amount of urine produced overnight.
Desmopressins slow down urine production so less urine is produced at night.
Alternative treatments
Your doctor shouldn't offer you homeopathy, herbal treatments or acupuncture to treat urinary symptoms.
This is because there isn't enough reliable evidence about how well they work or how safe they are.
Herbal treatments may also cause side effects or interact with other medicines.
Catheters
If you continually have trouble peeing, a condition called chronic urine retention, you may need a catheter to drain your bladder.
A catheter is a soft tube that carries urine to the outside of the body from the bladder. It can pass through your urethra, or through a small hole made in the abdomen above your pubic bone.
You may be recommended a removable catheter or a catheter that stays in your bladder for a longer period of time.
Surgery
Most men with urinary symptoms do not need to have surgery, but it may be an option if other treatments have not worked.
Transurethral resection of the prostate (TURP)
TURP involves removing part of the prostate gland, generally using a tube that passes through the urethra. TURP is suitable for men who have an enlarged prostate.
Open prostatectomy
An open prostatectomy involves removing the prostate gland through a cut in your body. This procedure is suitable for men who have an enlarged prostate, over a certain size.
Prostatic urethral lift (PUL) implants
A surgeon inserts implants that hold the enlarged prostate away from the urethra so it isn't blocked. This helps to relieve symptoms like pain or difficulty when peeing.
Cystoplasty
Cystoplasty is a procedure to increase the size of the bladder by sewing a piece of tissue from the intestine into the bladder wall. This intervention may help men whose bladder muscle contracts before it is full.
Prostate artery embolisation
A catheter is inserted into an artery in your groin or wrist. Using X-ray guidance, it's passed into the blood vessels that supply the prostate gland.
Tiny plastic particles are injected into these vessels to reduce the prostate gland's blood supply, which shrinks it.
Potential benefits of prostate artery embolisation compared with surgery are fewer complications and you can have the procedure under local anaesthetic as an outpatient.
Botulinum toxin
This procedure involves injections of botulinum toxin into the walls of the bladder. This intervention may help men whose bladder muscle contracts before the bladder fills.
Implanted sacral nerve root stimulation
A small electrical device is implanted under the skin and sends bursts of electrical signals to the bladder and urine system for better control. This is suitable for men whose bladder muscle contracts before the bladder fills.
Urinary diversion
Urinary diversion involves linking the tubes connecting the kidneys to the bladder directly to the outside of the body, so the urine can be collected without flowing into the bladder. This method is suitable for men whose symptoms cannot be managed by self-management and medicine, and who cannot have, or do not want, cystoplasty or sacral nerve root stimulation.
Water ablation
Water ablation is a new treatment for prostate enlargement. There are 2 types of water ablation procedure. In the first, water is directly injected into the prostate using a probe passed up the urethra. The pressure of the water is then used to destroy some of the prostate tissue, making it smaller.
The second type is very similar except steam, rather than water, is used to destroy prostate tissue.
Water ablation is probably less likely than a TURP to cause side effects.
But not all NHS surgeons are currently trained to carry out the procedures. So access to these procedures may be limited and waiting lists for them may be longer than for other surgical options.