About Enlarged Prostate (BPH)

BPH, or benign prostatic hyperplasia, describes a harmless yet progressive enlargement of the prostate gland. Situated between the bladder and penis, a growing prostate may obstruct the urinary pathway, triggering problems with urine flow and ejaculation. The exact cause is uncertain, but BPH is strongly associated with aging and hormonal imbalances, such as lower testosterone and higher DHT. Heredity and lifestyle choices may also play a role. If untreated, complications like infections, bladder stones, blood in urine, or kidney damage can develop over time.

Signs and Symptoms of an Enlarged Prostate

Common symptoms of an enlarged prostate include:

• Increased Urinary Frequency: More frequent trips to the restroom
• Difficulty Starting Urination: Discomfort or struggle when initiating urination
• Weak Urinary Stream: Noticeable reduction in the strength of the urine flow
• Interrupted Urination: Inconsistency in urine flow during urination
• Frequent Nighttime Urination: Repeatedly waking up at night to urinate
• Urinary Incontinence: Unintentional urine leakage due to loss of bladder control
• Post-Ejaculation Pain: Discomfort or pain after ejaculation
• Painful Urination: Stinging or burning sensation during urination
• Urinary Retention: Inability to completely empty the bladder

For patients with mild benign prostatic hyperplasia, active treatment may not be urgent. Instead, doctors often recommend simple lifestyle tweaks, including a diet tailored for prostate well-being. If symptoms become more bothersome, a mix of medications and lifestyle changes is usually advised. Regardless of therapy type, following dietary recommendations is key to aiding recovery and preserving prostate health over time.

Causes of Hormonal Changes

The development of benign prostatic hyperplasia (BPH), or an enlarged prostate, is closely linked to hormonal imbalances. As men grow older, natural hormone levels shift, which can trigger the growth of prostate tissue. In particular, a decline in testosterone and increased activity of DHT, a powerful androgen, are known to contribute. These age-related hormonal factors play a key role in prostate enlargement.

• Increase in Dihydrotestosterone (DHT): A strong byproduct of testosterone, DHT is created in the prostate via the 5-alpha-reductase enzyme. While aging may lower testosterone, DHT often stays high or becomes more active. It binds to androgen receptors in the prostate, encouraging tissue expansion and triggering overgrowth in glandular and stromal structures. This hormonal effect is a primary cause of benign prostate enlargement. This hormonal trigger is a key driver of BPH.
• Testosterone-Estrogen Imbalance: Testosterone is more prominent in younger males, with estrogen levels staying minimal due to limited conversion. Over time, testosterone levels fall, but estrogen may rise or hold steady, particularly in men with more fat tissue, where aromatization is higher. This relative estrogen increase can amplify the prostate's response to DHT, promoting enlargement. The shifting hormonal balance gradually impairs normal prostate control, leading to BPH.
• Other Hormonal Factors: Age-related shifts also alter key growth factors and inflammatory responses tied to hormone activity. Elevated insulin-like growth factor (IGF) and ongoing mild inflammation can boost DHT’s action, leading to steady and gradual prostate enlargement in aging men.

This hormonal cascade doesn’t happen overnight—it’s a gradual process, often starting in a man’s 30s or 40s, with symptoms becoming noticeable later in life.

Enlarged Prostate (BPH) Risk Factor: 

• Age
  Age is the leading and most consistent risk factor for benign prostatic hyperplasia (BPH), with its prevalence rising steeply as men advance in years.
• Age Threshold: The risk of prostate enlargement significantly increases after age 50. Research shows that nearly half of men in their 50s have some prostate growth, which rises to 70–80% by the time they reach 70, and up to 90% by age 85. Symptoms typically begin surfacing after 50, making BPH a common age-related condition.
• Why Age Matters: Hormonal changes that come with age alter the body’s balance of growth signals and inflammation. Increased levels of insulin-like growth factor (IGF) and chronic low-level inflammation enhance the effect of DHT (dihydrotestosterone), promoting continuous prostate growth over time.
• Cumulative Exposure: As men age, the prostate is subjected to long-term hormonal, dietary, and inflammatory influences. These prolonged exposures contribute to the gradual and progressive nature of BPH, unlike sudden-onset conditions.
• Not Universal: While aging is the primary risk factor, not every man develops noticeable symptoms. Factors like heredity, lifestyle choices, and general health influence individual outcomes—though age remains the most powerful predictor of BPH development.

Complications of Enlarged Prostate (BPH)

If untreated, an enlarged prostate can lead to serious complications by obstructing urine flow or straining the urinary system:

• Urinary Retention: The prostate’s pressure on the urethra can block urine outflow, causing acute urinary retention (sudden inability to urinate)—a painful emergency requiring catheterization—or chronic retention, where the bladder never fully empties, raising infection risk.
• Bladder Damage: Incomplete emptying over time weakens the bladder muscle, reducing its ability to contract effectively. This can lead to a distended, flabby bladder that worsens urinary symptoms.
• Urinary Tract Infections (UTIs): Stagnant urine in the bladder breeds bacteria, increasing UTI frequency. Recurrent infections may spread to the kidneys if severe.
• Bladder Stones: Concentrated urine from poor emptying can crystallize into stones, causing pain, bleeding, or further obstruction.

Diagnosis of Enlarged Prostate (BPH)

Medical History Review:

• Doctor asks about symptoms (e.g., difficulty urinating, frequent urination, weak stream), medical history, and family history of prostate issues.

Symptom Assessment:

• Often uses the International Prostate Symptom Score (IPSS), a questionnaire to evaluate the severity of urinary symptoms.

Physical Examination:

• Digital Rectal Exam (DRE): Doctor manually checks the prostate through the rectum to assess its size, shape, and consistency.

Urine Test (Urinalysis):

• Analyzes a urine sample for signs of infection, blood, or other abnormalities that might

Blood Test:

• Prostate-Specific Antigen (PSA) Test: Measures PSA levels; elevated levels may indicate BPH, inflammation, or rule out prostate cancer.

Urine Flow Test (Uroflowmetry):

• Measures the speed and volume of urine flow to assess if the enlarged prostate is obstructing the urethra.

Post-Void Residual Volume Test:

• Uses ultrasound or a catheter to check how much urine remains in the bladder after urination, indicating obstruction severity.

Imaging Tests (if needed):

• Ultrasound: Visualizes the prostate and bladder to confirm enlargement or detect complications.
• CT/MRI: Rarely used, but may help in complex cases to rule out other conditions.

Cystoscopy (optional):

• A scope inserted through the urethra examines the bladder and prostate for blockages or structural issues.

Enlarged Prostate (BPH) Treatment

The doctor might opt for enlarged prostate or BPH medications for the followings reasons:

Your symptoms are moderate and they are getting worse instead of getting better.

Adoption of lifestyle changes didn’t show any results.

Your BPH might be causing complications.

The doctor might suggest one of the following categories of BPH Drugs to treat your symptoms. It is advisable to take these drugs only if your doctor prescribes you to take them.

Doctors use Alpha Blockers to relax muscles of the bladder neck muscles and prostate muscles, so that the patient can urinate with ease.

5-alpha reductase inhibitors (5-ARIs) prevent hormonal changes which cause prostate growth. Therefore, they effectively prevent the growth of the prostate. 5-ARIs also help to shrink the prostate.

It is observed that Phosphodiesterase 5 inhibitors (PDE5 inhibitors) are often used to treat erectile dysfunction, improve Benign Prostatic Hyperplasia symptoms and increase flow rate. Therefore, they are sometimes used to treat Prostate Enlargement.

*Consumption of medications under the advice of a doctor only.

Combination Drug Therapy

When symptoms of BPH persist despite using Alpha Blockers or 5-ARIs alone, specialists may advise taking both together. Known as Combination Drug Therapy, this strategy uses two different medications to better control prostate growth and symptoms. Though it may reduce surgical intervention, this treatment may also increase the chances of side effects related to both medications.

*Consumption of medications under the advice of a doctor only.

Hormone Reduction Medications

Sometimes, the doctor might prescribe medications that reduce the levels of hormones produced by the prostate gland. These medications may make the prostate smaller and improve urine flow. They also lower the levels of testosterone as a result they may cause side effects like decreased sex drive and impotence.

Antibiotics

Chronic Bacterial Prostatitis is a condition where the prostate gets infected, as a result, you can see swelling, inflammation and frequent Urinary Tract Infections (UTIs). In such a situation, doctors use antibiotics to improve the symptoms of BPH by reducing the inflammation.

Surgical Management of BPH

If the symptoms persist even after the medical treatment of BPH, then doctors might opt for surgical intervention. There are multiple minimally invasive and surgical therapies that you can choose from, they are:

1. Transurethral Resection of the Prostate (TURP)

Transurethral Resection of the prostate (TURP) is a surgical procedure where the surgeon removes the excess prostate tissue which is blocking the urine flow. After the TURP surgery, the patient will get quick relief from the symptoms. The surgeon might place a catheter to drain your bladder after the surgery which will be removed after a couple of days.

2. Transurethral Incision of the Prostate (TUIP)

Unlike in TURP, In TUIP, There is no removal of tissue. In TUIP, the surgeon inserts a combined visual and surgical instrument (Resectoscope) into the urethra through penis. Then the surgeon makes one or two small grooves in the bladder neck area (the area where the prostate connects to the bladder). This relaxes the opening to the bladder hence allowing for urine to pass more easily.

3. Holmium Laser Enucleation of the Prostate (HoLEP)

HoLEP is a minimally invasive treatment for an Enlarged Prostate. HoLEP can be used effectively to treat even the largest of prostate glands. In HoLEP the surgeon uses LASER to remove all the prostate tissues that are blocking urine flow. Then the surgeon uses another instrument to cut the prostate into smaller removable fragments.

4.Urolift

A urologist inserts a small device through the urethra to access the prostate.

Tiny implants (typically 2–6, depending on prostate size) are placed to lift and hold the enlarged prostate tissue away from the urethra, opening the urinary passage.

The device is then removed, leaving the implants in place permanently to maintain urine flow.

5.Bladder Neck Incision (BNI)

Used when the prostate enlargement causes significant bladder outlet obstruction, leading to symptoms like difficulty urinating, weak stream, or incomplete bladder emptying.

Often considered for smaller prostates or when preserving sexual function (e.g., ejaculation) is a priority, as it’s less invasive than procedures like TURP (Transurethral Resection of the Prostate).

Open Surgery – Prostatectomy

In Prostatectomy, surgeons remove either part or all of the prostate. This surgery is classified into Simple Prostatectomy and Radical Prostatectomy. Simple Prostatectomy is used for non-cancerous issues like BPH, removing only the obstructing tissue. Radical Prostatectomy is performed to remove the entire prostate, seminal vesicles, and vas deferens in cancer cases. All major treatment choices for BPH are discussed above. Visit our experts to find the most suitable approach for you.