Benign Prostatic Hyperplasia (BPH)

What is BPH?

Benign prostatic hyperplasia (BPH) is the name given to enlargement of the prostate gland. This enlargement is believed to be caused by the effects of male sex hormones. More than 50% of men in their 60s and as many as 90% of men in their 70s and 80s have some symptoms of BPH. It is rare for symptoms to occur before the age of 40. In some men the first symptom is having difficulty in urinating, because the enlarged prostate gland squashes the urethra, the tube leading from the bladder. This causes the urethra to narrow, obstructing urine flow from the body. Your doctor will check your symptoms and examine you to check the size of your prostate and may carry out a blood test.

What is the prostate gland?

The prostate is a small gland found at the base of men's bladders. It is about the size of a chestnut and sits around the urethra through which urine passes. The role of the prostate is not understood fully but it is believed to assist in the production of semen.

What are the symptoms of BPH?

  • Having to rush to the toilet

  • Difficulty in starting to urinate

  • A weak stream of urine

  • Stopping and starting urinating

  • Dribbling in underwear

  • Discomfort when urinating

  • Urinary incontinence

  • Having to urinate more often

  • Feeling that your bladder has not emptied properly

  • Having to get up several times at night to urinate

  • Sudden inability to urinate

Is BPH a type of cancer?

BPH is not a type of cancer. Some of the symptoms of BPH and prostate cancer are similar but, having BPH does not mean that you have cancer of the prostate or that you will develop this type of cancer later on. However, if ever you notice blood in your urine or semen, you should tell your doctor.

Can BPH be treated?

If symptoms of BPH are interfering with your life, there are several drugs your doctor can prescribe to try to improve them.

Alpha-blockers are a type of drug that relax the muscle in the urethra, opening up the tube and letting urine flow out more easily. This type of medicine works within weeks. Examples include alfuzosin (eg, Besavar® XL, Xatral®), doxazosin (eg, Cardura®, Doxadura®, Raporsin® XL), indoramin (eg, Doralese®), prazosin (eg, Hypovase®), tamsulosin (eg, Contiflo® XL, Cositam® XL, Flomaxtra® XL, Losinate®, Pinexel® PR, Stronazon® MR, Tabphyn® MR) and terazosin (eg, Hytrin®).

If you have symptoms of urinary frequency and urgency as well as problems passing urine, and alpha-blockers alone are ineffective, a combination tablet (Vesomni®) containing tamsulosin and the anticholinergic solifenacin may be tried.

A group of drugs known as the 5-alpha reductase inhibitors (eg, dutasteride [Avodart®] and finasteride [Proscar®]) may also be used to treat BPH. With this type of medicine, at least six months' treatment may be necessary to assess whether a beneficial effect has been achieved.

A combination tablet containing the alpha-blocker tamsulosin and the 5-alpha reductase inhibitor dutasteride is also available (Combodart®).

Another drug that may be used for BPH is tadalafil (Cialis®), which is thought to act by increasing blood flow to the prostate.

Some men with BPH suddenly find they are completely unable to empty their bladder, even though they feel like they want to urinate. If this happens to you, you may need to go to hospital so that a catheter or tube can be inserted into your bladder to let the urine flow out. You may need drug treatment (as described above) or an operation to relieve the blockage. The most common operation for BPH is a transurethral resection of the prostate (TURP). Under anaesthetic, an instrument is passed up the tube towards the bladder and part of the prostate gland is removed from the inside.

Will BPH affect my sex life?

There is no reason why you should not continue having sex. BPH is unlikely to affect your sex drive. However, if you do experience problems, you should always see your doctor.

Help yourself

  • If you need to go to the toilet often, don't drink before going to bed, an important meeting or event, or travelling
  • When going to a new place or travelling, try to locate where the toilets are as soon as you can, in case you need them quickly
  • Keep a note of the number of times you have to go to the toilet, especially how often you have to get up during the night to urinate, in case your doctor asks for this information
  • Take all medicines exactly as directed by your doctor and do not share them with anyone else

Further information available from:

Prostate Help Association

Fact sheet provided by MIMS

Date last reviewed: July 2014

Register or Subscribe to MIMS

GPs can get MIMS print & online and GPonline for free when they register online – take 2 minutes, and make sure you get your free MIMS access! If you're not a GP, you can subscribe to MIMS for full access.

Register or subscribe

MIMS bulletins

News and updates straight to your inbox.

Prescribing Update: Fortnightly news bulletin
Urgent prescribing updates
Spotlight: Disease-themed monthly round-up

Sign me up

MIMS Dermatology

Read the latest issue online exclusively on MIMS Learning.

Read MIMS Dermatology

Mobile apps

MIMS: access the full drug database and quick-reference tables on the go

MIMS Diagnosis and Management: concise information on signs and symptoms, investigations and diseases

Promo Image

Clinical calculators

Handy calculators and conversions for primary care.