Benign prostate enlargement

Symptoms

The prostate is a small gland, located in the pelvis, between the penis and bladder.

If the prostate becomes enlarged, it can place pressure on the bladder and the urethra, which is the tube that urine passes through.

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 do not need treatment. In others, they can be very troublesome.

Causes

The cause of prostate enlargement is unknown, but it's 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.

Diagnosis

To find out whether your prostate gland is enlarged, you'll need to have a few tests.

Some tests will be done by a GP and, if needed, others will be carried out by a doctor who specialises in urinary problems (urologist).

GP examination and tests

A GP will ask about your symptoms and concerns, and their impact on your quality of life.

You may be asked to complete a chart that records how much liquid you usually drink, how much urine you pass, how often you have to pee on a daily basis and whether you have any leakage.

The GP may do a physical examination. They may examine your stomach and genital area.

They may also feel your prostate gland through the wall of your bottom (rectum). This is called a rectal examination.

The 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.

You may be offered a urine test, for example to check for sugar (glucose) or blood in your pee. This is to see if you have diabetes or an infection.

Referral to a urologist

The 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, which is when urine leaks out at times when your bladder is under pressure; for example, when you cough or laugh
• your prostate-specific antigen (PSA) level is raised
• your prostate feels abnormal when you have a rectal examination

You should also see a specialist if the GP is concerned that your symptoms could be caused by cancer, although for most men this is not the cause.

To help find out what might be causing your symptoms and decide how to manage them, you should be offered extra tests to measure:

• how fast your urine flows
• how much urine is left in your 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 Options

Treatment for an enlarged prostate will depend on how severe your symptoms are.

If you have mild symptoms, you do not usually need immediate treatment. Your doctor will agree with you if and when you need more check-ups.

You'll probably be advised to make lifestyle changes, such as:

• drinking less alcohol, caffeine and fizzy drinks
• limiting your intake of artificial sweeteners
• exercising regularly
• drinking less in the evening

Medicine to reduce the size of the prostate and relax your bladder may be recommended to treat moderate to severe symptoms of an enlarged prostate.

Surgery is usually only recommended for moderate to severe symptoms that have not responded to medicine.

Complications

Benign prostate enlargement can sometimes lead to complications, such as:

• a urinary tract infection (UTI)
• chronic urinary retention
• acute urinary retention

Chronic urinary retention

Chronic urinary retention is when you cannot empty your bladder fully but you can still pee a little.

Symptoms of chronic urinary retention can include:

• a weak flow when you pee
• leaking pee at night
• feeling that your stomach is swollen or that you're not emptying your bladder fully

Chronic urinary retention is usually painless but can slowly stretch your bladder muscle and make it weaker.

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 tummy pain
• swelling of the bladder that you can feel with your hands

When To See A Doctor

See a GP if you have any of the symptoms of an enlarged prostate.

Even if the symptoms are mild, they could be caused by a condition that needs to be investigated.

Any blood in your urine must be investigated by a GP to rule out other more serious conditions.