What Is Benign Prostatic Hyperplasia (BPH)?

What it is

The prostate is a walnut-sized gland that sits just below the bladder in men, encircles the urinary passage (the urethra) like a ring and produces part of the seminal fluid. As the years pass, the number of cells in this gland increases and the gland grows. This is called benign prostatic hyperplasia (BPH), or simply age-related prostate enlargement.

The word "benign" matters here: BPH is not a cancer, it does not turn into cancer and it is not the same disease as prostate cancer. However, when the growing tissue presses on the urinary passage from the outside and the bladder has to work harder to empty, urinary complaints that affect daily life may appear. In medicine these are grouped under the heading lower urinary tract symptoms. Some degree of prostate growth is present in a large proportion of men over fifty, and it does not cause complaints in everyone.

Why it happens

The main factors behind prostate enlargement are age and hormonal change. The effect of male hormones on prostate tissue over many years leads to cell growth in the inner part of the gland. With ageing this process is slow but continuous, which is why BPH is described less as a preventable disease than as an age-related change.

Alongside age, several factors are associated with more pronounced complaints: a family history of prostate enlargement in first-degree relatives, excess weight, diabetes and metabolic syndrome, a sedentary lifestyle and smoking. None of these can be said to start the condition on its own, but general vascular and metabolic health is known to be linked with the course of urinary complaints.

It is not only the growth of the gland that produces the complaints but also the way the bladder responds to it. As resistance in the urinary passage rises, the bladder muscle begins to contract more forcefully; over time its wall thickens and the bladder may become overactive, signalling urgency even at small volumes. Frequency and sudden urgency therefore have as much to do with this change in the bladder as with the obstruction itself, which is why both sides are considered together when treatment is discussed.

Symptoms

BPH symptoms fall into two groups. Storage symptoms relate to the phase in which the bladder holds urine: passing urine frequently, a sudden urge that cannot be postponed, and above all waking at night to urinate (nocturia). Waking once or more each night is the complaint that most often brings men to a doctor and can noticeably affect quality of life by disrupting sleep.

Voiding symptoms relate to passing the urine out: hesitancy at the start, a weak and thin stream, an intermittent flow, dribbling at the end and the feeling that the bladder has not emptied completely. Over time, as the bladder muscle tires, urination may become more difficult still.

One point deserves emphasis: the size of the prostate is not always proportional to the severity of complaints. A markedly enlarged prostate may cause no complaints at all, while a smaller growth may cause significant problems depending on where the urinary passage is compressed. The same symptoms may also occur with urinary tract infection, bladder problems, diabetes and some neurological conditions, so the distinction is made by medical assessment.

When to see a doctor

Do not delay seeking care in the following situations: being unable to pass urine at all or sudden difficulty in doing so (acute urinary retention is an emergency), visible blood in the urine, urinary complaints together with fever and chills, frequently recurring urinary tract infection, burning and pain on urination, known kidney disease, and complaints that worsen rapidly.

Even when the situation is not urgent, urological assessment is advised for urinary complaints that break your sleep or restrict work and social life. Treating such complaints as "a natural part of getting older" and postponing them for years can delay the recognition of conditions that may affect bladder and kidney health.

Assessment and diagnosis

Assessment begins with a detailed history; a standard symptom score is used to measure how severe the complaints are, and other medicines being taken are reviewed. On examination, a digital rectal assessment gives information about the size and consistency of the prostate. Urinalysis shows whether infection or blood is present, and blood tests can be used to assess kidney function.

Where the physician considers it appropriate, a PSA blood test may be requested. A raised PSA does not on its own mean cancer; it also rises with benign growth, inflammation and after certain procedures. Interpreting the result and deciding on further investigation are matters for the physician. Measuring the urine flow rate and using ultrasound to measure the urine left in the bladder after voiding also give an idea of the degree of obstruction.

The treatment approach is determined by the severity of the complaints, the effect on the bladder and kidneys, age and accompanying conditions. In mild cases close follow-up may be enough, while in others medical treatment or procedural options come into consideration. Which route is appropriate is decided by a urologist together with the patient; there is no single option that suits everyone.

Follow-up and daily life

For those under medical follow-up, some general adjustments to daily habits help in managing the complaints: drinking enough fluid through the day but reducing intake in the evening, particularly in the two to three hours before bed; reviewing caffeine and alcohol intake; not postponing the urge to urinate and emptying the bladder unhurriedly and completely; avoiding constipation and keeping up regular physical activity.

A simple bladder diary kept for a few days before the appointment makes assessment easier: how many times urine is passed during the day, how often you wake at night, how much fluid you drink and when urgency occurs. Such a record shows objectively how often the complaint actually happens and makes it possible to follow change over time.

Some products sold without a prescription, such as cold remedies, can aggravate urinary complaints; asking your pharmacist before using them is advisable. Do not stop a treatment started by your physician on your own initiative because the complaints have eased. Regular check-ups relating to prostate health are also valuable for following the course of the complaints and for distinguishing different conditions such as prostate cancer.

This page is intended as general health information; consult your physician for diagnosis and treatment, and your pharmacist for questions about medicines.

Frequently asked questions

Is benign prostatic hyperplasia a cancer?

No. BPH is a benign growth; it is not cancer and does not turn into cancer. Because its symptoms can resemble those of prostate cancer, the distinction is made by medical assessment.

Which is the best medicine for an enlarged prostate?

There is no single option that suits everyone. The severity of the complaints, the effect on the bladder and kidneys, age and accompanying conditions are weighed together and the physician decides on treatment; your pharmacist can answer questions about medicines.

Is waking at night to urinate normal?

Waking once a night becomes more common with age. Waking twice or more and regularly losing sleep should be assessed, and the cause may not be the prostate alone.

Does an enlarged prostate resolve on its own?

Age-related growth does not reverse, but the severity of the complaints can vary over time. In mild cases a physician may prefer close follow-up.

Does every man with an enlarged prostate need treatment?

No. The decision is based not on the size of the prostate but on how much the complaints affect quality of life and on their consequences for the bladder and kidneys.

Which symptoms count as an emergency?

Being unable to pass urine, visible blood in the urine, and urinary complaints with fever and chills require urgent assessment.

Aymed İlaç Sanayi manufactures authorised medicinal products in urology and nephrology. This page does not provide diagnosis or treatment advice; it is intended as general health information.