Enlarged Prostate (BPH): Causes, Symptoms, Diagnosis and Treatment

An enlarged prostate is a common condition that affects men as they grow older. Doctors call this condition benign prostatic hyperplasia (BPH) or benign prostate enlargement (BPE). The word “benign” means that the enlargement is not cancer.

The prostate sits below the bladder and surrounds the upper part of the urethra, the tube that carries urine out of the body. As the prostate grows, it can narrow the urethra and make it harder for urine to pass. As a result, men may develop a weak urine stream, difficulty starting urination, frequent urination, urgency, or the need to wake up several times at night to urinate.

However, prostate size and urinary symptoms do not always match. Some men with a significantly enlarged prostate have only mild symptoms, while others can experience bothersome urinary problems despite having a less enlarged prostate. Therefore, urologists at Jyoti Hospital, Gurugram, assess both the symptoms and the underlying urinary problem before recommending treatment.

What Is an Enlarged Prostate?

The prostate is a gland that forms part of the male reproductive system. It sits just below the bladder and surrounds the urethra.

As men age, prostate tissue can gradually increase in size. This non-cancerous growth is known as benign prostatic hyperplasia (BPH).

When the prostate enlarges, it can affect urination in two ways:

1. Mechanical obstruction: Enlarged prostate tissue can narrow the passage through the prostate.
2. Muscle-related obstruction: Increased muscle tone around the prostate and bladder outlet can also contribute to difficulty passing urine.

The bladder may then have to work harder to push urine through the narrowed outlet. Over time, this can contribute to symptoms such as urgency, frequency and incomplete bladder emptying.

Importantly, BPH is not prostate cancer, although both conditions can occur in the same person. Our doctors therefore evaluate new urinary symptoms rather than automatically assuming that they result from BPH.

Why Does the Prostate Become Enlarged?

Doctors do not know one single cause of BPH. Age-related hormonal changes, tissue growth, inflammation and other biological changes may contribute to prostate enlargement.

BPH becomes increasingly common with age, and symptoms are uncommon before the age of 40 but become much more frequent in older men.

Factors associated with BPH include:

• Increasing age
• Family history of BPH
• Hormonal changes associated with ageing
• Certain metabolic and health conditions
• Obesity and reduced physical activity may also be associated with lower urinary tract symptoms

However, having one of these factors does not mean that a man will definitely develop troublesome urinary symptoms.

Symptoms of an Enlarged Prostate

An enlarged prostate can cause lower urinary tract symptoms (LUTS). These symptoms generally fall into two groups: difficulty emptying the bladder and problems with storing urine.

Common symptoms include:

• Difficulty starting urination
• Weak or slow urine stream
• Urine flow that starts and stops
• Straining to urinate
• Feeling that the bladder has not emptied completely
• Frequent urination
• Sudden urgency to urinate
• Waking at night to urinate
• Dribbling after urination
• Needing to urinate again shortly after going
• Difficulty delaying urination

Some men experience only one or two symptoms, while others develop several symptoms together.

What Is the IPSS Score for an Enlarged Prostate?

Doctors commonly use the International Prostate Symptom Score (IPSS) to assess the severity of urinary symptoms in men with an enlarged prostate.

The IPSS consists of 7 questions about urinary symptoms and an additional question that assesses the patient’s quality of life.

The seven symptom questions assess issues such as:

• Incomplete bladder emptying
• Frequency of urination
• Intermittency of urine flow
• Urgency
• Weak urine stream
• Straining to urinate
• Night-time urination

Each symptom receives a score, producing a total score from 0 to 35.

Understanding the IPSS Score

IPSS Score	Symptom Severity
0	No symptoms
1–7	Mild symptoms
8–19	Moderate symptoms
20–35	Severe symptoms

The IPSS score helps our urologist understand how strongly urinary symptoms affect you and can also help monitor whether treatment is improving your symptoms.

However, the IPSS score alone does not diagnose an enlarged prostate or determine which treatment you need. Our doctor considers the score together with your examination, prostate size, urine flow, residual urine, medical history and other test results.

The quality-of-life question is also important because two men with the same IPSS score may have very different levels of concern or disruption to their daily lives.

Weak Urine Stream

A weak urine stream is one of the common symptoms of bladder outlet obstruction.

You may notice that:

• Urine takes longer to come out.
• The stream feels weaker than before.
• The flow stops and starts.
• You need to strain to continue urinating.

However, a weak stream does not automatically mean that you have BPH. Urethral stricture, bladder problems, neurological conditions and other urinary disorders can cause similar symptoms.

Frequent Urination and Urgency

An enlarged prostate can affect bladder function. As the bladder works against resistance for a long period, it may become more sensitive or overactive.

You may therefore feel the need to urinate more frequently or suddenly.

Frequent urination can also result from conditions such as diabetes, urinary infection, overactive bladder and excessive fluid or caffeine intake. Our doctor therefore needs to identify the underlying cause rather than treating every case as BPH.

Frequent Urination at Night

Waking repeatedly to urinate is called nocturia.

BPH can contribute to nocturia, but it is not the only possible cause. Sleep disorders, diabetes, excessive evening fluid intake, certain medicines, kidney or heart problems and nocturnal polyuria can also contribute.

If night-time urination repeatedly interrupts your sleep, discuss it with our urologist rather than assuming that it is simply part of ageing.

Can an Enlarged Prostate Cause Urinary Retention?

Yes.

In some men, prostate enlargement can significantly obstruct urine flow and eventually lead to urinary retention.

Acute urinary retention means that you suddenly cannot pass urine despite having a full bladder. This can cause severe lower abdominal discomfort and requires urgent medical attention.

If you cannot urinate at all, seek medical care immediately. Our doctor may need to drain the bladder with a catheter before investigating and treating the underlying cause.

What Problems Can an Enlarged Prostate Cause?

Untreated bothersome or obstructive symptoms can sometimes lead to complications.

These may include:

• Recurrent urinary tract infections
• Bladder stones
• Persistent urinary retention
• Bladder dysfunction
• Blood in the urine
• Overflow urinary leakage
• In severe cases, deterioration of kidney function

Not every man with BPH develops these complications. Early assessment can help our doctors identify men who require closer monitoring or active treatment.

How Is an Enlarged Prostate Diagnosed?

Our urologist will first ask about your symptoms, medical history and medicines.

The doctor may then perform several tests depending on your symptoms and risk factors.

1. Symptom Assessment

Our doctors may use a structured questionnaire such as the International Prostate Symptom Score (IPSS).

The IPSS helps assess:

• How frequently you urinate
• How often you experience urgency
• Weakness of your urine stream
• Straining
• Incomplete emptying
• Night-time urination
• Overall impact on your quality of life

The score helps our doctor understand how bothersome your symptoms are and monitor changes over time.

2. Digital Rectal Examination

During a digital rectal examination (DRE), the doctor gently examines the prostate through the rectum.

This examination can provide information about:

• Prostate size
• Prostate consistency
• Possible abnormalities

A DRE does not diagnose BPH by itself. Our doctors interpret the findings alongside symptoms and other tests.

3. Urine Test

A urine test can help identify:

• Urinary tract infection
• Blood in the urine
• Other urinary abnormalities

This is important because urinary infections and other conditions can cause symptoms similar to BPH.

4. PSA Blood Test

Our doctor recommend a prostate-specific antigen (PSA) blood test.

PSA can increase with prostate enlargement, inflammation and prostate cancer. Therefore, a raised PSA does not automatically mean that you have cancer.

Our doctors interpret PSA together with your age, prostate examination, symptoms, prostate size and other clinical factors.

A PSA test can also help with treatment planning in men with suspected BPH.

5. Ultrasound

An ultrasound can assess:

• Prostate size
• Bladder condition
• Residual urine after urination
• Kidney and urinary tract abnormalities in selected cases

Prostate volume can help our doctors select an appropriate treatment, particularly when considering certain medicines or procedures.

6. Post-Void Residual Urine

A post-void residual (PVR) test measures how much urine remains in your bladder after you urinate.

A high residual volume may indicate that your bladder is not emptying properly.

However, our doctors interpret PVR together with symptoms and other findings rather than relying on one measurement alone.

7. Uroflowmetry

Uroflowmetry measures the rate and pattern of urine flow.

The test can help your doctor understand whether your urine flow is reduced.

A reduced flow can occur because of prostate obstruction, urethral narrowing or poor bladder contraction, so the result needs clinical interpretation.

8. Cystoscopy

In selected patients, our urologist recommend cystoscopy.

During cystoscopy, the doctor uses a thin instrument with a camera to examine the urethra and bladder.

This can help identify:

• Prostate-related obstruction
• Urethral stricture
• Bladder stones
• Other abnormalities

Our doctors do not need cystoscopy for every man with BPH.

Does Every Enlarged Prostate Need Treatment?

No.

If your symptoms are mild and do not significantly affect your quality of life, your urologist may recommend watchful waiting or active monitoring.

This approach can include:

• Regular follow-up
• Monitoring symptoms
• Lifestyle adjustments
• Reviewing medicines
• Reassessment if symptoms worsen

However, you should not simply ignore worsening urinary symptoms.

Lifestyle Changes for an Enlarged Prostate

Lifestyle changes cannot remove an enlarged prostate, but they may reduce urinary symptoms in some men.

Helpful measures may include:

• Reduce excessive fluid intake close to bedtime.
• Reduce caffeine if it worsens frequency or urgency.
• Limit excessive alcohol.
• Avoid deliberately holding urine for very long periods.
• Discuss medicines that may worsen urinary symptoms with your doctor.
• Maintain a healthy weight.
• Stay physically active.
• Manage constipation.
• Keep a record of urinary symptoms if your doctor recommends it.

Do not severely restrict fluids throughout the day simply because you urinate frequently. Your body still needs adequate hydration.

Medicines for an Enlarged Prostate

Our doctors select medicines according to your symptoms, prostate size, medical conditions and treatment goals.

Alpha-Blockers

Alpha-blockers relax smooth muscle around the prostate and bladder outlet. This can improve urine flow and reduce urinary symptoms.

Examples include:

• Tamsulosin
• Silodosin
• Alfuzosin
• Doxazosin
• Terazosin

Our doctors consider factors such as blood pressure, age, other medicines and possible sexual side effects when choosing an alpha-blocker.

5-Alpha Reductase Inhibitors

Medicines such as:

• Finasteride
• Dutasteride

can reduce the effect of hormones that contribute to prostate growth.

These medicines can gradually shrink the prostate in suitable men and can reduce the risk of urinary retention and future prostate-related surgery.

They generally work more slowly than alpha-blockers and are particularly useful when the prostate is demonstrably enlarged.

Combination Treatment

Some men benefit from a combination of an alpha-blocker and a 5-alpha reductase inhibitor.

Our doctors generally consider combination therapy when urinary symptoms occur along with demonstrable prostate enlargement and a meaningful risk of disease progression.

Tadalafil

Tadalafil, a PDE5 inhibitor, can improve lower urinary tract symptoms in some men with BPH.

It can be particularly relevant when a man also has erectile dysfunction.

However, tadalafil is not suitable for everyone. Our doctor needs to review your other medicines and cardiovascular health before prescribing it.

When Is Surgery Needed for an Enlarged Prostate?

Our urologist recommend an intervention when:

• Symptoms remain troublesome despite medicines.
• Medicines do not provide adequate improvement.
• You develop recurrent urinary retention.
• Recurrent urinary infections occur because of obstruction.
• Bladder stones develop.
• Significant bleeding occurs in selected cases.
• The urinary tract becomes significantly obstructed.
• The bladder does not empty adequately.
• You develop complications related to obstruction.

The choice of procedure depends on prostate size, prostate anatomy, bladder function, overall health, previous treatment and your personal priorities.

What Procedures Are Available for Enlarged Prostate?

Treatment for BPH has changed considerably. Doctors can now choose from traditional surgery, laser procedures, waterjet therapy and selected minimally invasive techniques.

There is no single procedure that is best for every man.

1. TURP — Transurethral Resection of the Prostate

TURP is one of the established surgical treatments for BPH.

The surgeon passes an instrument through the urethra and removes prostate tissue that is blocking urine flow.

Because the surgeon does not need to make an external incision, TURP is performed through the urinary passage.

It can provide significant and durable improvement in urinary symptoms in appropriately selected patients.

2. HoLEP — Holmium Laser Enucleation of the Prostate

HoLEP uses a holmium laser to separate and remove obstructing prostate tissue.

It can treat a broad range of prostate sizes and is an established alternative to TURP. HoLEP may offer advantages such as:

• Effective removal of obstructing tissue
• Good long-term symptom improvement
• Applicability to larger prostates
• Less dependence on prostate size than some other procedures

Our urologist will determine whether HoLEP is appropriate based on your prostate anatomy and overall condition.

3. Rezūm / Water-Vapour Therapy

Water-vapour thermal therapy uses steam energy to treat selected areas of enlarged prostate tissue.

The treatment can be performed through the urethra and aims to reduce obstruction while limiting the amount of tissue directly removed.

However, the availability of this treatment varies, and patient selection remains important.

Our urologist will discuss expected benefits, recovery and the possibility of needing further treatment.

4. UroLift

Prostatic urethral lift (UroLift) uses small implants to pull prostate tissue away from the urethra rather than removing prostate tissue.

It may suit selected men who want a minimally invasive approach and wish to preserve ejaculatory function.

However, UroLift is not appropriate for every prostate. Prostate size and anatomy, including the presence of an obstructing middle lobe, can affect suitability.

5. iTIND — Temporary Implantable Nitinol Device

iTIND is a minimally invasive treatment for selected men with symptoms caused by benign prostatic obstruction.

The procedure uses a small, temporary nitinol device that is positioned in the prostatic urethra. The device applies gentle radial force to remodel the prostatic urethral passage and create channels that can improve urine flow.

Unlike TURP or HoLEP, iTIND does not involve surgical removal or laser enucleation of prostate tissue.

The device is temporary and is generally removed after several days.

Potential advantages of iTIND include:

• Minimally invasive treatment
• No surgical removal of prostate tissue
• Short-term implantation
• Potential preservation of sexual and ejaculatory function in appropriately selected patients

However, iTIND is not suitable for every man with BPH. Prostate anatomy, prostate size, symptoms and individual treatment goals need to be considered.

Importantly, iTIND remains a relatively newer treatment compared with established procedures such as TURP and HoLEP. Our urologist should discuss the available evidence, expected benefits, limitations, retreatment considerations and availability before choosing this option.

Which Enlarged Prostate Treatment Is Best?

The appropriate treatment depends on the individual patient.

Our urologist consider:

• Prostate volume
• Prostate shape
• Presence of a median lobe
• Severity of symptoms
• IPSS score
• Urine flow
• Residual urine
• Bladder function
• Previous urinary retention
• Blood-thinning medicines
• Overall health
• Sexual and ejaculatory priorities
• Expected recovery time
• Availability and expertise at the treating centre

For example, prostate size and anatomy can influence whether a minimally invasive procedure is suitable.

Therefore, you should not select a procedure solely because it is newer or because someone else had a particular treatment.

Does a Larger Prostate Always Cause Worse Symptoms?

No.

This is an important point.

A large prostate does not necessarily produce severe urinary symptoms, while a man with a smaller prostate can sometimes experience significant obstruction.

The relationship between prostate size and urinary symptoms is therefore not straightforward.

Our doctors assess the entire clinical picture rather than treating prostate size alone.

Enlarged Prostate and Erectile Dysfunction

BPH and erectile dysfunction can occur together, particularly as men age.

They do not necessarily have the same underlying cause, but both can be associated with age, metabolic health and vascular risk factors.

Some BPH medicines can also affect sexual function.

For this reason, tell your urologist if you experience:

• Erectile difficulties
• Reduced sexual satisfaction
• Ejaculatory changes
• Reduced libido

Our doctor can consider these factors when selecting treatment.

Can an Enlarged Prostate Become Cancer?

BPH itself is not prostate cancer.

However, BPH and prostate cancer can occur in the same person.

Furthermore, both conditions can cause urinary symptoms, although prostate cancer does not always cause symptoms in its early stages.

Our doctor therefore recommend PSA testing, prostate examination or other investigations depending on your age, symptoms, risk factors and clinical findings.

Do not assume that urinary symptoms are automatically caused by either BPH or cancer. Proper evaluation is important.

Can an Enlarged Prostate Be Prevented?

There is no guaranteed method to prevent BPH.

However, maintaining overall health can support urinary and cardiovascular health.

Helpful habits include:

• Regular physical activity
• Healthy weight management
• Balanced nutrition
• Good control of diabetes and blood pressure
• Limiting excessive alcohol
• Avoiding smoking
• Discussing persistent urinary symptoms early

Researchers have not established a specific diet that reliably prevents prostate problems.

When Should You See a Urologist?

You should consider a urological evaluation if you notice:

• A progressively weaker urine stream
• Difficulty starting urination
• Frequent urination
• Urgency
• Repeated night-time urination
• Incomplete bladder emptying
• Persistent urinary dribbling
• Recurrent urinary infections
• Blood in the urine
• Increasing difficulty passing urine

Early evaluation can help identify whether BPH is responsible and whether you need monitoring, medication or an intervention.

When Is an Enlarged Prostate an Emergency?

Seek urgent medical attention if:

• You suddenly cannot urinate.
• You develop severe lower abdominal pain or bladder fullness.
• You have significant blood in the urine with other concerning symptoms.
• You develop fever and chills with severe urinary symptoms.
• You become very unwell while experiencing urinary obstruction.

Sudden inability to urinate requires urgent medical assessment.

How Jyoti Hospital Can Help With Enlarged Prostate

At Jyoti Hospital, Gurugram, our Urology team can evaluate men with urinary symptoms that may be related to an enlarged prostate.

Depending on your symptoms and clinical findings, evaluation may include:

• Detailed urinary symptom assessment
• IPSS assessment
• Prostate examination
• Urine testing
• PSA testing when appropriate
• Ultrasound and prostate assessment
• Post-void residual urine measurement
• Uroflowmetry
• Cystoscopy or additional testing when indicated

Based on the findings, our urologist can discuss appropriate options ranging from lifestyle measures and medicines to minimally invasive procedures and surgery.

The goal is not simply to treat the prostate size. Instead, treatment should address your symptoms, urinary function, prostate anatomy, complications and personal treatment priorities.

Final Thoughts

An enlarged prostate is common as men age, but urinary symptoms should not simply be dismissed as a normal part of getting older.

BPH can cause weak urine flow, difficulty starting urination, urgency, frequent urination, night-time urination and incomplete bladder emptying. In some men, significant obstruction can eventually lead to urinary retention or other complications.

Fortunately, treatment options have expanded considerably. Depending on your symptoms and prostate characteristics, treatment may include lifestyle changes, medicines, TURP, laser procedures such as HoLEP, Rezūm, UroLift, iTIND or other selected minimally invasive approaches.

The right treatment depends on the individual patient. A proper urological evaluation can help determine the cause of your symptoms and identify the most appropriate treatment approach.

If you have persistent urinary symptoms, consult our urologist rather than waiting for them to become severe.

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FAQs

1. What is an enlarged prostate?
   • An enlarged prostate, commonly called benign prostatic hyperplasia (BPH), is a non-cancerous increase in prostate tissue that can interfere with urine flow.
2. What are the first symptoms of an enlarged prostate?
   • Common early symptoms include a weaker urine stream, difficulty starting urination, increased urinary frequency, urgency, night-time urination and a feeling that the bladder has not emptied completely.
3. Does every enlarged prostate need surgery?
   • No. Men with mild symptoms may only need monitoring and lifestyle changes. Others may benefit from medicines. Surgery or a minimally invasive procedure may become appropriate when symptoms remain troublesome or complications develop.
4. Is HoLEP better than TURP?
   • Both can provide effective treatment for appropriately selected patients. HoLEP is an established alternative to TURP and can be particularly useful across a broad range of prostate sizes. The choice depends on prostate anatomy, symptoms, health, treatment goals and the surgeon’s expertise.
5. Can an enlarged prostate cause urinary retention?
   • Yes. Significant prostate obstruction can sometimes prevent the bladder from emptying. Sudden inability to urinate requires urgent medical attention.