Benign Prostatic Hyperplasia
Benign prostatic hyperplasia (BPH) is a common, non-cancerous enlargement of the prostate that occurs with age. As the gland grows, it can press on the urethra and cause urinary symptoms such as a weak stream, frequent urination (especially at night), or incomplete emptying. BPH is not prostate cancer, and many men manage it with lifestyle changes or medication, while others may benefit from simple procedures if symptoms become bothersome.
Overview | Symptoms & Causes | Diagnosis | Treatment Options
The Prostate Gland
The prostate is a small, walnut-sized gland located just below the bladder. It surrounds the first part of the urethra - the tube that carries urine from the bladder out of the body. The prostate’s main job is to produce some of the fluid that makes up semen. Because the urethra passes directly through the centre of the prostate, any change in the size of the gland can affect how easily urine flows.
Benign prostatic hyperplasia (BPH) refers to a non-cancerous enlargement of the prostate gland. This enlargement is extremely common with age and occurs as the prostate tissue gradually grows and becomes more bulky. As the prostate enlarges, it can press on the urethra or push upward against the bladder, leading to symptoms such as a weak stream, urgency, or difficulty emptying the bladder fully.
Although BPH can cause significant urinary symptoms, it is not prostate cancer, and it does not increase the risk of developing cancer. Symptoms and severity vary widely - many men have mild symptoms, while others may find the condition more bothersome.
Understanding Benign Prostatic Hyperplasia
BPH affects urinary function because the enlarged prostate presses on or narrows the urethra. Symptoms typically develop gradually and vary from mild to more troublesome. They can be grouped into “voiding” symptoms (difficulty passing urine) and “storage” symptoms (related to bladder irritation).
Common symptoms include:
- Weak or slow urine flow
- Difficulty starting urination (hesitancy)
- Straining to pass urine
- A feeling that the bladder does not empty fully
- Dribbling at the end of urination
- Increased frequency of urination, especially during the day
- Waking at night to pass urine (nocturia)
- Sudden, strong urges to urinate (urgency)
- Accidental leakage of urine, particularly with urgency
While BPH is common and usually manageable, certain symptoms require prompt medical assessment:
- Inability to urinate at all (acute urinary retention)
- Blood in the urine
- Recurrent urinary tract infections
- Severe lower abdominal discomfort
- Fevers or chills with urinary symptoms
These may indicate complications or a different underlying condition.
Causes & Risk Factors
The exact cause of prostate enlargement isn’t fully understood, but it is strongly linked to age-related hormonal changes. As men get older, shifts in the balance of testosterone, dihydrotestosterone (DHT), and oestrogen appear to stimulate the growth of prostate tissue. This gradual enlargement is a normal biological process for many men and is not related to prostate cancer.
| Age | Most significant factor; uncommon before 40, increasingly common after 50, and affects the majority of men over 70. |
| Family history | Having a father or brother with BPH increases the likelihood of developing it. |
| Hormonal changes | Higher levels of DHT and shifts in the testosterone–oestrogen balance can promote prostate growth. |
| Obesity & metabolic syndrome | Abdominal fat, insulin resistance, and high blood pressure are linked to increased BPH risk and more severe urinary symptoms. |
| Low physical activity | Sedentary lifestyles increase the risk of prostate enlargement and urinary issues. |
| Erectile dysfunction | Often coexists with BPH due to shared hormonal and vascular mechanisms. |
| Certain medications | Drugs with anticholinergic effects and decongestants with pseudoephedrine may temporarily worsen urinary symptoms. |
Diagnosing BPH
Diagnosing BPH involves assessing urinary symptoms, checking prostate size and health, and ruling out other causes of similar symptoms such as infection or prostate cancer. Evaluation is usually straightforward and can be done using a combination of clinical assessment, urine and blood tests, and imaging.
| Urine & Blood Tests | These often include kidney function tests (to check for any impact from long-standing urinary problems) and may include PSA (prostate-specific antigen) when appropriate. PSA is not a cancer test, but prostate enlargement, prostatitis, and age can all influence its level, so it may help guide further investigation. Urine tests may be used to check for signs of infection or blood in the urine. |
| Ultrasound | An ultrasound scan can measure prostate size, assess how well the bladder empties, and identify complications such as bladder wall thickening, residual urine, or hydronephrosis (swelling of the kidneys caused by back pressure). This is particularly helpful if symptoms are significant or other conditions need to be ruled out. |
| Uroflowmetry | This non-invasive test measures the speed and pattern of your urine stream. A reduced flow rate can support a diagnosis of BPH and help assess the severity of obstruction. |
| Cystoscopy (where needed) | A small camera is passed into the bladder to directly examine the prostate and urinary tract. This is not routine for BPH but may be used when symptoms are complex, blood is present in the urine, or surgery is being considered. |
Treatment Options
Treatment for BPH focuses on relieving symptoms, improving bladder emptying, and preventing complications. The best option depends on symptom severity, prostate size, overall health, and personal preference. Many people start with lifestyle measures and progress to medication or procedures only if needed.
Conservative Management
| Monitoring | For mild symptoms that are not bothersome, regular check-ups may be all that is required. Many people stay stable for years without medication or surgery. |
| Lifestyle measures | - Reducing caffeine and alcohol, which can worsen urgency and frequency - Avoiding drinking fluids late in the evening - Bladder training and timed voiding - Regular physical activity and weight management - Reviewing medications that may worsen symptoms (e.g., some decongestants or antihistamines) |
| Medications | Medications are commonly used and can be very effective: - Alpha-blockers (e.g., tamsulosin): Relax prostate and bladder neck muscles to improve urine flow. They act quickly, usually within days to weeks. - 5-alpha reductase inhibitors (e.g., finasteride): Shrink the prostate over several months and are most useful when the prostate is larger. - Combination therapy: Using both drug types together can offer added benefit in moderate to severe symptoms. - Other options: Medications such as PDE-5 inhibitors may be used in selected cases, especially when erectile symptoms coexist. |
Procedural Options
| Minimally invasive procedures | For persistent symptoms not responding to medication, several lower-risk procedures can improve flow by reducing obstruction. These include thermal or mechanical techniques to shrink or displace prostate tissue. Suitability depends on prostate size and anatomy. |
| Surgical treatment | When symptoms are severe, bladder emptying is poor, or complications arise (such as repeated urinary retention or recurrent infections), surgery may be recommended. - TURP (transurethral resection of the prostate) remains the standard surgical approach for many men. - Other methods (laser enucleation, bipolar resection, or open/robotic simple prostatectomy for very large glands) may be considered depending on individual circumstances. |
Your clinician will help you choose the most appropriate treatment based on your prostate size, symptom pattern, general health, and personal preferences. The goal is to improve quality of life while minimising side effects or risks.
How can Lanthorn help?
Urinary Tract Ultrasound - £300
We offer detailed ultrasound assessment of the prostate, bladder, and kidneys. This can help measure prostate size, check how well the bladder empties after urination, and look for any signs of obstruction or complications such as residual urine, bladder wall thickening, or hydronephrosis (pressure on the kidneys).
Kidney Function Blood Test - £99
We can arrange tests to assess kidney function and screen for complications of long-standing prostate obstruction. This helps ensure that the urinary system is working well and guides decisions about treatment or monitoring.
Specialist referral
If medication, procedural treatment, or surgical assessment is required, we can organise referral to a trusted urologist. This ensures you receive the right expertise quickly, whether for ongoing management or more advanced interventions.
