What is an enlarged prostate?

What is the prostate?

The prostate is a small gland shaped like a ping pong ball, and it’s located deep inside the groin between the penis and bladder. 

It’s essential for reproduction as it produces the fluid that transports sperm (seminal fluid) and helps it survive.

What causes an enlarged prostate?

The exact cause of an enlarged prostate isn’t known. But many factors can contribute, like increasing age and hormonal changes as men get older.

Other factors that increase your risk include: 

• high blood pressure (hypertension)
• abnormal cholesterol and triglyceride levels
• obesity
• diabetes
• An unbalanced diet - low in fibre and high in red meat

Other factors might also worsen your symptoms (problems with sex or peeing) if your prostate is already enlarged. These include: 

• erectile dysfunction
• stress
• anxiety
• depression 
• smoking

What are the symptoms of an enlarged prostate?

The most common symptoms of an enlarged prostate include:

• difficulty starting to pee
• needing to pee more often
• struggling to empty your bladder fully

These symptoms can happen due to the pressure placed on your bladder and urethra (the tube that urine travels through).

The symptoms of an enlarged prostate are typically mild, with no need for treatment. But the severity of symptoms differs from person to person. Some men might find their symptoms lead to lots of discomfort. 

How to get a diagnosis for a prostate enlargement

If you’re experiencing the symptoms of an enlarged prostate, you should see your GP for advice. 

Typically, your doctor will ask about your symptoms, perform a physical exam, and might also arrange for blood and urine tests. 

Your GP will ask about your symptoms and the effect they have on your life, as well as:

• how much liquid you drink
• how much urine you pass
• how often you pee daily 

A physical exam typically involves:

• looking at your stomach and genital area
• a rectal exam — a doctor or nurse checks for any problems inside your bottom

You might also have a blood test to check your kidneys are working correctly and to help guide your treatment.

A urine test checks if there’s any blood or sugar (glucose) in your pee to help rule out diabetes or an infection. 

In some cases, a GP might refer you to a doctor at a hospital who specialises in urinary conditions (urologist).

Does an enlarged prostate affect a man sexually?

Some men find that lower sex drive (libido) often accompanies an enlarged prostate. This might be due to fluctuating testosterone levels or difficulties passing urine normally. Some medicines used to treat BPH can also affect sexual function.

Studies show that an enlarged prostate can also be linked to erectile dysfunction — when you find it challenging to get and maintain an erection. 

But it’s important to remember that other psychological and lifestyle factors affect your libido, including:

• side effects of medication
• mental health — like depression and stress
• chronic illness
• sleep problems
• relationship problems
• lifestyle — like diet, drugs, and how much alcohol you drink

Is there treatment for an enlarged prostate? 

While the symptoms of an enlarged prostate can be upsetting and cause discomfort, there are many things you can try to reduce your symptoms — like lifestyle changes, medication, and catheters. 

Lifestyle changes

Some useful lifestyle changes you could try to manage your symptoms include:

• avoiding or reducing drinks that make you pee more often — like fizzy drinks, alcohol, caffeine, and artificial sweeteners 
• avoiding drinking anything 2 hours before going to bed — this might reduce how many times you wake in the night to pee
• going to the toilet regularly without straining or pushing — and waiting a moment to try and go again (double voiding)
• pelvic floor muscle training, particularly if you suffer from urgency
• eating more fibre to prevent constipation, which can worsen your symptoms — like fruit, vegetables, beans, and whole-grain cereals 

Some other tips include:

• checking with your GP to see if any medication you’re taking might make your symptoms worse
• wearing pads in your underwear in case you have any leaks
• using a bladder-training chart to keep track of how much urine you pass — you can ask your GP for advice on this
• avoiding medications that can worsen your symptoms — like antihistamines and decongestants 

Healthy lifestyle changes that help prevent BPH from developing or progressing include:

• exercising more — this is consistently associated with a reduced risk of developing BPH
• eating more vegetables — nutrients like carotene and lycopene (found in red fruits and vegetables) can also help reduce your risk of urinary symptoms
• maintaining a healthy weight — this will also help reduce your risk of developing diabetes 
• good diabetes control 

Medication

Your GP might recommend medication if lifestyle changes don’t improve your symptoms. 

The most common medication used for an enlarged prostate include:

• alpha-blockers — relaxes the muscle in your prostate gland and bladder, helping you pee more easily
• anticholinergics — relaxes your bladder muscle if it's abnormally active 
• 5-alpha reductase inhibitors — helps to shrink your prostate gland 
• diuretics — speeds up how quickly you produce urine and reduces how much urine you produce at night
• desmopressins — slows down how much urine you produce at night

Urinary catheters

If you’re still struggling to pee (chronic urine retention), your doctor might recommend a urinary catheter. 

A catheter is a soft tube that helps empty your bladder and collects urine in a drainage bag. It can be passed through your penis (urethral catheter), or through a small hole made in your tummy (suprapubic catheter). They’re usually inserted by a doctor or nurse.

Depending on your symptoms, your GP will either recommend a removable catheter or one that stays in your bladder for longer. 

Surgery

If other methods haven’t worked, your doctor might recommend surgery or other procedures to manage your symptoms. Depending on the severity of your symptoms, your GP will consider your preference when looking at the best option for you.

The most common types of surgeries offered include:

• transurethral resection of the prostate (TURP) — removing part of your prostate gland using a device called a resectoscope that's passed through your urethra
• open prostatectomy — if an enlarged prostate is over a certain size, the prostate gland is removed through a cut in your body
• prostatic urethral lift (PUL) implants — holds the enlarged prostate from your urethra so it’s not blocked to relieve painful symptoms when you pee
• cystoplasty — increases the size of your bladder which might help men whose bladder muscle contracts before it's full
• prostate artery embolisation — a catheter’s inserted into an artery in your groin or wrist. This is performed with an injection of medicine that numbs the area (local anaesthetic) 
• botulinum toxin — an injection that may help men whose bladder muscle contracts before the bladder is full
• implanted sacral nerve root stimulation — a small electrical device that’s inserted into your skin to send electrical signals to your bladder and urine system for better control
• urinary diversion — linking the tubes that connect your kidneys to your bladder so that urine can be collected without flowing into your bladder