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Benign prostatic hyperplasia
(BPH) is an enlarged
prostate gland. The prostate gland surrounds the
urethra, the tube that carries urine from the
bladder out of the body. As the prostate gets bigger,
it may squeeze or partly block the urethra. This often causes problems
BPH occurs in almost all men as they age. BPH is not
cancer. An enlarged prostate can be a nuisance. But it is usually not a serious
problem. About half of all men older than 75 have some symptoms.
Benign prostatic hyperplasia is also known as benign prostatic
Benign prostatic hyperplasia is probably a normal part of the aging
process in men, caused by changes in hormone balance and in cell growth.
urinary problems such as:
In a small number of cases, BPH may cause the bladder to be
blocked, making it impossible or extremely hard to urinate. This problem may
cause backed-up urine (urinary retention), leading to
bladder infections or
stones, or kidney damage.
BPH does not
cause prostate cancer and does not affect a man's ability to father children.
It does not cause
Your doctor can diagnose BPH by asking
questions about your symptoms and past health and by doing a physical exam.
Tests may include a urine test (urinalysis) and a
digital rectal exam, which lets your doctor feel the
size of your prostate. In some cases, a prostate-specific antigen (PSA) test is
done to help rule out prostate cancer. (Prostate cancer and BPH are not
related, but they can cause some of the same symptoms.)
doctor may ask you how often you have symptoms of BPH, how severe they are, and
how much they affect your life. If your symptoms are mild to moderate and do
not bother you much, home treatment may be all that you need to help keep them
under control. Your doctor may want to see you regularly to check on your
symptoms and make sure other problems haven't come up.
use this tool to help you think about how bothersome your symptoms are:
a rule, you don't need treatment for BPH unless the symptoms bother you or you
have other problems such as backed-up urine, bladder infections, or bladder
Although home treatment cannot stop your prostate from
getting larger, it can help reduce or control your symptoms. Here are some
things you can do that may help reduce your symptoms:
If home treatment does not help, BPH can be treated with
medicine. Medicine can reduce the symptoms, but it rarely gets rid of them. If
you stop taking medicine, symptoms return.
If your symptoms are
severe, your doctor may suggest surgery to remove part of your prostate. But
few men have symptoms or other problems severe enough to need surgery.
You cannot prevent BPH or
the urination problems it may cause. Some people believe that regular
ejaculations will help prevent prostate enlargement. But there is no scientific
proof that ejaculation helps.
Learning about benign prostatic hyperplasia (BPH):
Living with BPH:
Health Tools help you make wise health decisions or take action to improve your health.
Benign prostatic hyperplasia (BPH) is probably a normal part of the aging process in men. It is caused by changes in hormone balance and cell-growth factors. Genetics may also
play a role. This is especially true for severe BPH
requiring surgery in men younger than 60.
Men who are older than
50 have a higher chance of developing BPH. But why some men have more severe
symptoms than others is not known.
Many men with
benign prostatic hyperplasia (BPH) have no symptoms.
When symptoms (known as lower urinary tract symptoms, or LUTS) occur, they may
range from mild and barely noticeable to serious and disruptive. The amount of
prostate enlargement is not always related to the severity of the symptoms.
Some men with only slight enlargement have serious symptoms. And some men with
a great deal of enlargement have few symptoms.
Your symptoms may
become worse during cold weather or as a result of physical or emotional
Some medicines can make your symptoms worse. These
include over-the-counter cold medicines such as diphenhydramine
(Benadryl, for example), pseudoephedrine (such as Sudafed),
oxymetazoline spray (such as Afrin), and prescription medicines such as
antidepressants, water pills (diuretics), testosterone (gels, implants, or
injections), and pain medicines (narcotics).
The symptoms of BPH
may involve problems emptying the
bladder or problems with bladder storage.
Symptoms related to bladder emptying include:
Symptoms related to bladder storage include:
These symptoms are not always related to prostate
enlargement and can be caused by other conditions. BPH symptoms are often
balanced between the two types of symptoms. If symptoms come on rapidly, or if
you have more of one type of symptom than the other type, you may have another
condition. Other conditions that may cause similar symptoms include
urinary tract infections,
heart failure, and neurologic diseases.
You can use the
Interactive Tool: How Bad Are Your Urinary Symptoms From BPH? to evaluate how bad your symptoms are and, later, to judge how well
your treatment is working.
The prostate gland grows as
men age, with the fastest growth occurring at middle age. By age 50, 5 out of
10 men have an enlarged prostate. By age 80, up to 9 out of 10 men have an
enlarged prostate. Having an enlarged prostate does
not always cause symptoms.
As the prostate enlarges, the
urethra (the tube that carries urine from the
bladder out of the body) may become narrowed or
partially blocked. The narrowed or blocked urethra is what causes the symptoms
benign prostatic hyperplasia (BPH). By age 55, over 2
out of 10 men have some symptoms. By age 75, 5 out of 10 men complain of a
decrease in the force of their urine streams.1
In rare cases, severe obstruction of the urine flow occurs and may lead
to complications, including complete or partial blockage
urinary tract infection (UTI),
bladder stones, or visible blood in the urine.
Every man's experience with BPH is different. Symptoms may be stable, may
come and go, or may become more bothersome over time. Some men find the
symptoms to be mild and do not require treatment with medicines. Other men find
the symptoms bothersome and choose treatment with medicine or, less commonly,
BPH does not cause
prostate cancer. But prostate cancer may cause
symptoms similar to those of BPH. It is important to have your symptoms checked
by a doctor to be certain they are not caused by prostate
Men who are older than 50
have a higher risk for
benign prostatic hyperplasia (BPH).
testosterone, which is produced mainly by the
testicles, is needed in order for BPH to develop.
Men who have their testicles removed before puberty never develop BPH. Men who
have their testicles removed after puberty (but before they have symptoms of
BPH) rarely develop BPH.
A family history of BPH may increase your
risk for needing treatment for this condition, especially if a relative
needed treatment before age 60.
vasectomy does not increase your risk of BPH.
Call your doctor immediately if:
Call your doctor if you have painful urination and any of
the following signs of a possible
urinary tract infection or prostate infection that
last longer than 24 hours:
Call your doctor if you have urination problems that have
developed over a few weeks or a few months and are frequent.
If urinary symptoms are minor or they don't bother you too much, and you do not have prostate cancer or a prostate infection, it may
be appropriate to try watchful waiting or home treatment. Call a doctor if your symptoms
change or get worse or if you change your mind about treatment.
Mild and moderate urinary symptoms that are caused by
BPH can be evaluated and treated by any of the following health
If the symptoms are severe or if surgical treatment is
being considered, you probably need to see a urologist.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Your doctor will first want to make
sure that your urination problem is caused by
benign prostatic hyperplasia (BPH) and not by
something else. This can usually be determined from your
medical history, a physical exam that focuses on the
urinary tract, a urinalysis, and a blood test. A neurological exam should also
be done to determine whether your symptoms are related to a problem with the
nerves to the bladder. A questionnaire such as the
American Urological Association (AUA) symptom index
may be used to evaluate how bothersome your symptoms are. It is not used to
If your symptoms are
moderate to severe, additional tests, called urodynamic studies, may be
The following tests may be
done if you have
complications of BPH or if there is a need to look for
other causes of the symptoms.
Benign prostatic hyperplasia (BPH) cannot be cured, so treatment focuses on reducing your
symptoms. Treatment is based on how severe your symptoms are, how much they
bother you, and whether you have
Deciding how to treat BPH
is greatly influenced by how bothersome your symptoms are. The
American Urological Association (AUA) symptom index is
an interactive questionnaire that can help you tell how bad your symptoms are
and measure how well your treatment is working. This questionnaire ranks the
severity of your symptoms on a numerical scale. The higher the number, the more
you are bothered by your symptoms. The more your symptoms bother you, the more aggressive you may want to be in
The American Urological Association (AUA) makes the following treatment
benign prostatic hyperplasia (BPH) based on how bad your symptoms are.2
There are some things you can do that may help reduce how
much BPH affects your quality of life.
your symptoms of
benign prostatic hyperplasia (BPH) remain mild and not
bothersome, watchful waiting may be your best treatment. With this treatment,
you may make small changes to your lifestyle to control your symptoms. You
do not take medicines or have surgery. You have regular checkups to be
sure your symptoms are not getting worse.
If symptoms get worse or become bothersome, or if you
complications, you can consider medicine or
If any of the following occur, you will probably need
benign prostatic hyperplasia (BPH):
Unless surgery is required
because of a
complication, choosing a treatment is largely up to
you and your doctor. If complications arise, surgery may be needed.
The extent to which treatment improves your symptoms depends partly on
how bad your symptoms are and how much you are bothered by them. If you are not
bothered by your symptoms before treatment, you are less likely to notice much
improvement after treatment.
Surgery offers the best chance for
improving the symptoms but also has the risk of causing other problems.
The urination problems caused by
benign prostatic hyperplasia (BPH) cannot be
prevented. Some people believe that regular ejaculations will help prevent
prostate enlargement. But there is no scientific proof that ejaculation
If your urination problem caused by
benign prostatic hyperplasia (BPH) is mild to moderate
and does not bother you, home treatment may be all you need to help keep your
symptoms from interfering with your daily activities. Your doctor may want to
see you regularly to check on your symptoms.
The following tips
may help minimize your symptoms:
You may want to try an
herbal therapy for BPH, such as saw palmetto or
beta-sitosterol. Before you start an herbal therapy, talk to your doctor about
whether it might be helpful.
Medicines are sometimes used to help
relieve bothersome, moderate to severe urination problems caused by
benign prostatic hyperplasia (BPH). If you stop using
medicine, the symptoms will usually return.
American Urological Association (AUA) symptom index is
an interactive questionnaire that can help you determine how bad your urinary
symptoms are and check how well your treatment is working. But the most
important thing in deciding whether to use medicines is not your AUA score but
how much the symptoms bother you and affect your quality of life. A high score
on the AUA does not necessarily mean you need medicines.
In general, the side
effects of the most commonly used medicines are minor. And the side effects stop
when you stop taking the medicine.
Alpha-blockers and 5-alpha
reductase inhibitors affect different prostate tissues. How much your symptoms
improve may depend on which tissue is contributing most to your symptoms. None
of these medicines work for everyone.
Medicines used to treat urinary incontinence and overactive bladder may help BPH symptoms, too. And men with BPH can have multiple urinary problems.
If you have difficulty urinating because of
benign prostatic hyperplasia (BPH), you probably will
not need surgery unless you:
If you have no complications but have symptoms that bother
you or if other treatment has not worked, you may choose to have surgery. In
this case, think about:
For more information on this decision, see:
Surgery that does not require an incision through the
skin is usually used. The surgical instruments are passed up the urinary
opening in the penis to the location of the prostate. This is described as a
transurethral surgery of the prostate.
Transurethral resection of the prostate (TURP) is the
surgery for benign prostatic hyperplasia that has been studied the most. It is
the surgery that is used the most to treat symptoms of BPH. All other surgeries
are compared to TURP. In TURP, part of the prostate is removed.
Some of the other surgeries that have been studied and compared to TURP
In most cases, these treatments have been studied for
only a few years, so their long-term effectiveness is not yet known. There are
also some other surgeries.
The oldest surgical method to treat BPH is an
open prostatectomy, in which an incision is made
through the skin to reach the prostate. Doctors use this method less often now,
but it is still preferred if the prostate is very large.
Surgery is the most reliable way
to relieve symptoms. But surgery may not relieve all your symptoms. And it puts
you at risk for certain
surgical complications, including
erection problems (erectile dysfunction). Other
complications include the inability to control the release of urine (urinary
incontinence) and ejaculation of semen into the bladder instead of out through
the penis (retrograde ejaculation). The complication depends on which type of
surgery is used.
Men who have severe symptoms often notice great
improvement in the quality of life following surgery. Men whose symptoms are
mild may find that surgery does not greatly improve quality of life, and they
may want to think carefully before deciding to have surgery to treat
If you have decided to have surgery, or if there are clear
medical reasons to have surgery, the best surgical option depends on the size
and shape of your prostate and the experience of the surgeon.
Some men use herbal therapy for
difficulty urinating caused by
benign prostatic hyperplasia (BPH). Herbal therapy includes treatments such as saw
palmetto or beta-sitosterol. Talk with your doctor about how
herbal therapy may be used along with medical treatment for BPH.
Balloon dilation is no longer used to
treat prostate enlargement, because it was found to be ineffective.
The National Kidney and Urologic Diseases Information
Clearinghouse (NKUDIC) provides information about diseases of the
kidneys and urologic system to people with these problems and to
their families, to health professionals, and to the public. NKUDIC answers
inquiries; develops, reviews, and distributes publications; and works closely
with professional and patient groups and government agencies to
coordinate resources about kidney and urologic diseases.
NKUDIC, a federal agency, is a service of the National
Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). NIDDK is part
of the National Institutes of Health under the U.S. Department of Health and
Presti JC, et al. (2008). Benign prostatic hyperplasia
(BPH) section of Neoplasms of the prostate gland. In EA Tanagho, JW McAninch,
eds., Smith’s General Urology, 17th ed., pp. 348–370.
New York: McGraw-Hill.
AUA Practice Guidelines Committee (2010). AUA guideline on management of benign prostatic hyperplasia. Chapter 1: Guideline on the management of benign prostatic hyperplasia (BPH). Available online: http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines.cfm?sub=bph.
Roehrborn CG, et al. (2008). The effects of
dutasteride, tamsulosin and combination therapy on lower urinary tract symptoms
in men with benign prostatic hyperplasia and prostatic enlargement: 2-year
results from the CombAT study. Journal of Urology,
Liu L, et al. (2011). Phosphodiesterase-5 inhibitors for lower urinary tract symptoms secondary to benign prostatic hyperplasia: A systematic review and meta-analysis. Urology, 77(1): 123–130.
Other Works Consulted
Aho TF, Gilling PJ (2003). Laser therapy for benign
prostatic hyperplasia: A review of recent developments. Current Opinion in Urology, 13(1): 39–44.
Helfand M, et al. (2007). Benign prostatic hyperplasia (BPH). Management in primary care—Screening and therapy. Department of Veterans Affairs Health Services Research and Development Service. Available online: http://www.hsrd.research.va.gov/publications/esp/BPH-2007.pdf.
Murray MT, Pizzorno JE (2006). Serenoa repens (saw
palmetto). In JE Pizzorno Jr, MT Murray, eds., Textbook of Natural Medicine, 3rd ed., vol. 1, pp. 1245–1250. St. Louis: Churchill
Saw palmetto (2009). In A DerMarderosian et al., eds.,
Review of Natural Products. St. Louis: Wolters Kluwer
Soliman SA, et al. (2007). Rotoresection versus
transurethral resection of the prostate: Short-term evaluation of a prospective
randomized study. Journal of Urology, 177(3):
Wilt TJ, N'Dow J (2008). Benign prostatic hyperplasia. Part 1—Diagnosis. BMJ, 336(7636): 146–149.
November 7, 2013
E. Gregory Thompson, MD - Internal Medicine & J. Curtis Nickel, MD, FRCSC - Urology
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