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Benign prostatic hyperplasia

BPH

Detail level

A non-cancerous growth of the prostate, a small gland below the bladder that makes semen and controls the flow of urine. It often causes difficulty starting to urinate, a weak stream and frequent urination, especially at night. According to the NHS it does not cause prostate cancer or raise the risk of it.

According to NIDDK, benign prostatic hyperplasia affects 5% to 6% of men aged 40 to 64 and 29% to 33% of those 65 and over, and it is the most common prostate problem after age 50 and rarely causes symptoms under 40. Factors include age, family history, type 2 diabetes, obesity, heart and vascular disease, chronic kidney disease, erectile dysfunction and physical inactivity. It may cause urinary retention, urinary tract infection, bladder stones and kidney damage.

MedlinePlus states that the actual cause is unknown, and that factors linked to ageing, changes in the cells of the testicles and testosterone level may contribute. Assessment includes a digital rectal exam, measuring the urine flow rate and post-void residual urine by ultrasound, urinalysis and culture, a PSA test and cystoscopy. Options range from watchful waiting and lifestyle measures to medicines (alpha blockers, 5-alpha reductase inhibitors, phosphodiesterase-5 inhibitors), minimally invasive procedures (water vapour therapy and urethral lift) and surgery (transurethral resection, laser, robotic surgery). The enlargement may return over time even after surgery (MedlinePlus).

In one minute¹²³

What is it?: A benign enlargement of the prostate gland that presses on the urethra.
Who is usually affected?: Men over 40, with the proportion rising after 65.
Acute or chronic?: Chronic and variable; ranges from watchful waiting to medicine or procedure treatment.
Main symptoms: Difficulty starting urination, weak flow, stop-start urination, frequent urination and waking at night, a feeling of incomplete bladder emptying.
Red flags?: Yes: inability to pass urine, or blood or pus in the urine, or fever and chills with back or side pain.
Preventable?: This page does not cover proven prevention; NIDDK lists physical inactivity and obesity among risk factors.

What is it?

According to the NHS: an enlarged prostate (also called benign enlargement) is when the prostate gland grows bigger; it is a small gland below the bladder that makes semen and controls urine flow. The NHS stresses that the enlargement is not caused by prostate cancer and does not raise the risk of getting it.

According to NIDDK: it affects 5% to 6% of men aged 40 to 64 and 29% to 33% of those 65 and over, and it is the most common prostate problem in men over 50, and rarely causes symptoms in those under 40.

Causes

The NHS states that the enlargement is thought to result from changes in hormone levels with ageing. MedlinePlus says the actual cause is unknown, and that factors linked to ageing, changes in the cells of the testicles and also testosterone level may play a role in the gland's growth.

Risk factors

According to NIDDK: age 40 and over, family history of enlargement, heart and vascular disease, type 2 diabetes, obesity, chronic kidney disease, erectile dysfunction and physical inactivity. The NHS states that risk rises after age 50 and with a family history.

Symptoms

According to the NHS: difficulty starting urination or needing to push and strain, a weak flow that stops and starts, a feeling of not emptying the bladder completely, dribbling after finishing, and needing to urinate more often or urgently including waking at night to urinate.

NIDDK adds pain on urinating, and MedlinePlus adds urinary incontinence, needing to urinate twice or more a night, blood in the urine, and inability to urinate (urinary retention).

How is it diagnosed?

According to the NHS, assessment may include: a review of symptoms, an examination of the abdomen and genitals, a rectal examination, a urination diary, a urine sample, a PSA blood test, a urine flow test, ultrasound and cystoscopy.

MedlinePlus lists: a digital rectal exam, measuring the urine flow rate, measuring post-void residual urine by ultrasound, pressure-flow studies, urinalysis and culture, a PSA test, cystoscopy, BUN and creatinine tests, and symptom scoring questionnaires. This page does not cover reference values for the results of these tests.

Treatment

The treatment categories usually used are listed here; this is not a prescription. The doctor chooses the plan according to each person's condition; do not change any medicine or dose without a specialist.

Treatment categories according to NIDDK: non-surgical (watchful waiting, alpha blockers, 5-alpha reductase inhibitors, phosphodiesterase-5 inhibitors), minimally invasive (transurethral water vapour therapy and prostatic urethral lift), and surgical (transurethral resection, laser surgery, electrovaporisation and robotic surgery). The doctor chooses the suitable category with the patient according to symptoms and condition.

The NHS lists: lifestyle changes, medicines (tamsulosin, doxazosin, oxybutynin and finasteride are mentioned), surgery (transurethral resection TURP, laser or implants), and supportive products and bladder training. MedlinePlus lists watchful waiting, lifestyle changes, alpha-1 blockers, finasteride/dutasteride, a saw palmetto supplement and surgery. Do not start or stop a medicine without the doctor.

Follow-up

MedlinePlus advises seeing a care provider if the bladder does not empty completely, when taking medicines that affect urination, or if self-care does not work after two months. This page does not cover specific periodic follow-up intervals.

Complications

According to NIDDK: urinary retention, blood in the urine, urinary tract infection, kidney disease and bladder stones. MedlinePlus adds urinary stones, kidney damage and sudden inability to urinate.

Living with it

MedlinePlus states that in most men who have prostate surgery, urine flow rates and symptoms improve, but the enlargement may return over time even after surgery. This page does not cover specific success rates or recurrence rates.

When do you need urgent help?

Call emergency services now 998

Complete inability to urinate, or fever and chills with back, side or abdominal pain, or blood or pus in the urine: seek urgent medical care or the emergency department. (NHS, MedlinePlus)²³

See your doctor within days

Difficulty urinating or frequent urination, or pain on urinating, or blood in the urine: see your primary care provider.²

Educational content only — no diagnosis, and no substitute for a clinician.

Common questions

Does benign prostatic hyperplasia mean cancer?

The NHS states that an enlarged prostate is not caused by prostate cancer and does not raise the risk of getting it; even so, doctors use tests such as PSA in the assessment (NHS, MedlinePlus).²³

What are its complications if neglected?

According to NIDDK: urinary retention, blood in the urine, urinary tract infection, kidney disease, bladder stones.¹

Questions for your doctor

Are my symptoms due to an enlarged prostate or another cause?
Do I need a PSA test or an ultrasound to measure residual urine?
Which treatment category suits my condition and what are its side effects?
Do my current medicines affect urination?
When do I need a procedure or surgery?

References

1
NIDDK / NIH. Enlarged Prostate (Benign Prostatic Hyperplasia) — overview. www.niddk.nih.gov/health-information/urologic-diseases/prostate-problems/prostate-enlargement-benign-prostatic-hyperplasia
Health agencies & guidelines · Accessed 2026-10-06
2
NHS. Enlarged prostate. www.nhs.uk/conditions/prostate-enlargement/
Health agencies & guidelines · Accessed 2026-10-06
3
MedlinePlus. Enlarged prostate (Medical Encyclopedia). medlineplus.gov/ency/article/000381.htm
Health agencies & guidelines · Accessed 2026-10-06

Review status: Edited content · Last updated: 2026-10-06

Change log

2026-10-06 — Page created.