Enlarged Prostate

Medically Reviewed By William C. Lloyd III, MD, FACS
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What is enlarged prostate?

An enlarged prostate is the slow growth of the prostate gland, which is involved in the production of seminal fluid and reproductive function in men. An enlarged prostate is also known as benign prostatic hyperplasia (BPH). BPH is generally not caused by infection or cancer. It is very common for the prostate gland to become enlarged as a man ages.

As a man matures, the prostate grows. At puberty, the prostate doubles in size. At about age 25, the prostate gland grows again, and this can lead to an enlarged prostate as a man enters his 40s, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

An enlarged prostate may not cause any symptoms or noticeable problems in some men. However, as men age, an enlarged prostate may grow to the point where it presses on the bladder and urethra, causing urine flow to be slower and less forceful. Symptoms of enlarged prostate are very common in men in their 60s and extremely common in men over 70.

If an enlarged prostate prevents complete emptying of the bladder, it may lead to a urinary tract infection or permanent damage to the bladder. This can include the inability to control urination (incontinence). The earlier doctors can diagnose an enlarged prostate, the more effective treatment can be, lowering the risk for complications.

A healthcare provider must determine whether your symptoms are due to an enlarged prostate or are the result of other prostate diseases and disorders, such as an infection or cancer.

Seek immediate medical care (call 911) for a high fever (higher than 101°F), severe rectal pain, or the inability to urinate. Seek prompt medical care for other symptoms along with enlarged prostate, including burning or pain during urination, cloudy urine, or lower back pain, or if you are being treated for an infection or prostate cancer but mild symptoms recur or are persistent.

What are the symptoms of an enlarged prostate?

Symptoms of enlarged prostate generally include the blockage of the urethra, a gradual loss of bladder function, and incomplete emptying of the bladder. The severity of the symptoms will vary from person to person.

Symptoms also are not directly linked to the size of the prostate. Some men with very enlarged prostates have few or no symptoms, while those with a lesser degree of prostate enlargement may experience more severe symptoms.

Common symptoms of enlarged prostate

You may experience enlarged prostate symptoms daily or just occasionally. At times, any of these symptoms can be severe:

  • Frequent urination at night

  • Frequent urination that often produces only a small amount of urine

  • Hesitant or interrupted urine stream

  • Leaking or dribbling urine

  • Sudden and urgent need to urinate

  • Weak urine stream

Symptoms that might indicate a serious condition

In some cases, enlarged prostate can be related to a serious condition that requires prompt evaluation by a healthcare professional.

Seek immediate medical care (call 911) for any of these serious symptoms including:

  • Abdominal or rectal pain that can be severe

  • High fever (higher than 101°F)

  • Inability to urinate

What causes enlarged prostate?

The prostate naturally grows over time. At puberty, the prostate doubles in size, and at about age 25, the prostate gland grows again. After age 40, this continued growth can lead to an enlarged prostate.

Experts do not know exactly what causes the prostate to grow. Scientific research has focused on several theories for enlarged prostate, including changes in hormone levels. These possible hormonal causes include:

  • Continuing accumulation of a growth hormone (dihydrotestosterone, or DHT)

  • Deficiency in male hormones (testosterone) and excess of female hormones (estrogen)

  • Inactive growth hormones that are “reawakened” at an older age

Enlarged prostate may also be a symptom of a more serious prostate disease or disorder, including prostate cancer. Your healthcare professional can perform a full evaluation to diagnose the cause of your enlarged prostate.

What are the risk factors for an enlarged prostate?

The risk factors for enlarged prostate are not known. Not all people with risk factors will develop an enlarged prostate. Risk factors for enlarged prostate include:

  • Age

  • Changes in hormonal levels

How do you prevent an enlarged prostate?

Although you cannot change the major risk factors for enlarged prostate, which are advancing age and changes in hormones, you can modify some lifestyle habits linked to enlarged prostate.

You may be able to lower your risk of enlarged prostate by:

  • Avoiding or limiting dairy, red meat, sodium, alcohol and caffeine

  • Eating a balanced diet that includes fresh fruits and vegetables and whole grains 

  • Getting regular physical exercise

  • Performing Kegel exercises designed to strengthen the pelvic floor

What are the diet and nutrition tips for enlarged prostate?

There is no specific diet that can prevent or treat enlarged prostate. However, healthy nutrition habits can benefit prostate health, including:

  • Avoiding alcohol and caffeine, which can increase urine production

  • Focusing on fresh fruits, vegetables and whole grains 

  • Following a low-sodium diet by avoiding processed foods and not adding salt to your meals

  • Including healthy fats, such as those found in avocado, chia seeds, olive oil, and fatty fish like salmon

  • Limiting red meat in favor of lean poultry, fish, and plant-based proteins

  • Reducing dairy, especially whole-fat varieties of milk, cheese, and butter

Ask your healthcare provider for guidance before making significant changes to your diet.

How do doctors diagnose enlarged prostate?

Diagnosing enlarged prostate (BPH) before an advanced stage can lower the risk of developing complications. A delay in treatment could lead to permanent bladder damage.

To diagnose an enlarged prostate, a healthcare provider will take a medical history and perform a physical exam. This evaluation will likely include digital rectal examination (DRE), an exam to feel if the prostate is enlarged, is painful, or if there are irregularities.

Based on the physical exam and medical history, your doctor may refer you to a urologist, a specialist in diagnosing and treating problems with the urinary system. A urologist may order any of the following medical tests:

  • Urinalysis to check for signs of infection

  • Prostate-specific antigen (PSA) blood test 

  • Ultrasound imaging, including transabdominal or transrectal ultrasound (TRUS)

  • Urodynamic tests to determine how well the urinary system is storing and releasing urine

  • Cystoscopy to examine the inside of the urethra and bladder

Some signs of enlarged prostate and prostate cancer are the same, but having BPH does not seem to increase the chances of developing prostate cancer. A man who has BPH may also have undetected prostate cancer at the same time or may develop prostate cancer in the future.

The National Cancer Institute and the American Cancer Society recommend prostate cancer screening after age 50. This typically includes an annual digital rectal examination (DRE) and a PSA blood test every 2 to 4 years. Because the DRE can falsely elevate PSA levels, the DRE and PSA test should be performed on separate visits.

What are the treatments for enlarged prostate?

A mild enlargement of the prostate gland may not require treatment, since research has shown that in mild cases, some symptoms of enlarged prostate go away on their own. Your physician will evaluate your individual symptoms and advise on treatment options. In the case of watchful waiting, you will have regular checkups to monitor your condition.

When an enlarged prostate does require treatment, options will vary depending on the severity of the symptoms. Your healthcare provider may start with drug treatment before considering more invasive options, such as surgery.

Medications

Medications for enlarged prostate inhibit hormone production, and this can cause the prostate to stop growing. These medications include:

  • Dutasteride (Avodart)

  • Finasteride (Proscar)

Other medications for enlarged prostate work by relaxing the prostate muscle and bladder neck to improve urine flow. These drugs are called alpha blockers and include:

  • Alfuzosin (Uroxatral)

  • Doxazosin (Cardura)

  • Tamsulosin (Flomax)

  • Terazosin (Hytrin)

Minimally invasive therapy

Doctors may recommend minimally invasive therapy if medications are not effective. These treatment options use heat, light or water to destroy excess prostate tissue. Procedures include:

  • Transurethral microwave procedures 

  • Transurethral needle ablation

  • Water-induced thermotherapy

Surgical treatment

For long-term treatment of enlarged prostate, doctors often recommend surgical removal of the enlarged portion of the prostate. Your doctor can talk you through the benefits and risks of surgery. Some types of surgical treatment for enlarged prostate are associated with post-treatment complications, such as incontinence, bleeding, and changes in sexual function.

What you can do to improve your enlarged prostate

You can maintain good prostate health by having your prostate examined annually by your healthcare provider. Tell your doctor about any changes in your urinary flow or any difficulties you are having with urination.

You can improve your symptoms by:

  • Avoiding or reducing intake of alcohol and caffeine, as these can stimulate urine production

  • Avoiding over-the-counter decongestant or antihistamine medications, as these can slow urine flow and worsen symptoms

  • Eating a healthy diet

  • Exercising regularly

  • Managing stress

  • Performing Kegel exercises. These pelvic strengthening exercises involve repeatedly tightening and releasing the pelvic muscle to prevent urine leakage. For BPH, experts recommend 5 to 15 contractions, holding each for 10 seconds, three to five times a day.

  • Talking with your doctor about all your medications as some, including antidepressants and diuretics, can aggravate symptoms. If a medication is causing a problem, your doctor may adjust the dose or switch to another drug.

  • Urinating when you first feel the need

How does enlarged prostate affect quality of life?

The symptoms of enlarged prostate (BPH)—including difficulty urinating, urgency with leaking, dribbling urine, and waking at night with the urge to urinate—can have a negative effect on quality of life. Side effects of some treatments may result in sexual dysfunction.

Fortunately, effective treatment can manage BPH symptoms, along with lifestyle changes, such as diet, exercise and stress reduction. The earlier doctors can diagnose an enlarged prostate, the more effective treatment can be, lowering the risk for complications and preserving quality of life.

It’s important to have an honest conversation with your doctor about all symptoms you may be experiencing and how they affect your daily activities and sexual health. You and your doctor can tailor a treatment plan specifically for your conditions, symptoms and concerns.

What are the potential complications of an enlarged prostate?

Left untreated, an enlarged prostate can prevent complete emptying of the bladder. This may lead to permanent damage to the urinary system. With early diagnosis, effective treatment can help manage symptoms and lower the risk of serious complications.

You can help minimize your risk by following the treatment plan you and your healthcare professional design specifically for you. Complications of enlarged prostate include:

  • Kidney or bladder damage

  • Kidney or urinary tract stones

  • Urinary retention

  • Urinary tract infections
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Jan 9
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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