Enlarged prostate
The prostate grows with age in almost every man, and in itself that is not an illness. It turns into a problem when the extra tissue squeezes the urethra and…
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Medicines commonly prescribed for Enlarged prostate
For informational purposes only. Always consult a doctor before using any medicine.
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The prostate grows with age in almost every man, and in itself that is not an illness. It turns into a problem when the extra tissue squeezes the urethra and passing urine becomes hard work: the stream weakens, you have to wait for it to start, and at night you have to get up. Doctors call this benign enlargement, and the word "benign" is the key one here. The condition has nothing to do with prostate cancer and does not raise the risk of it. What it can do is spoil sleep and much else for years, and occasionally it leads to the bladder ceasing to empty at all.
Why the prostate grows
The prostate is a gland about the size of a walnut. It sits under the bladder and wraps around the start of the urethra. It makes the fluid part of semen, in which sperm live and travel; the sperm themselves are produced in the testicles, not in the prostate.
Over the years, under the influence of male hormones, the inner part of the gland proliferates. It presses on the urethra from inside and makes the bladder muscle work under strain until, in time, that muscle loses power. From this comes a conclusion that surprises many people: the size of the prostate and the severity of the symptoms match each other poorly. A small gland with awkwardly placed nodules causes more trouble than a large one growing outwards.
Growth begins after about the age of forty, by seventy changes are found in most men, and the likelihood is higher if a father and brothers went the same way. Diet, sexual abstinence, cycling and cold weather do not enlarge the prostate.
How it shows itself
The complaints fall into two groups, and treatment depends on which group is the greater nuisance.
Difficulty emptying:
- a wait of several seconds before the urine comes;
- a weak, stop-start stream that takes longer than it used to;
- dribbling at the end, so that underwear is wet after you have left the toilet;
- a lingering sense that the bladder has not emptied fully.
Bladder irritation:
- needing to go often during the day;
- an urge that is hard to hold;
- getting up at night, sometimes the only thing that bothers a man.
It all develops slowly, and men adapt to the symptoms for years without regarding them as an illness. The opposite is worth knowing too: getting up at night may have nothing to do with the prostate and everything to do with heart failure, diabetes, sleep apnoea or simply the habit of drinking a lot in the evening. Do not put it all down to the gland in advance, because a doctor works through all the causes at once.
Signs that need urgent care
Go to hospital without delay if:
- you cannot pass urine at all and pain and pressure in the lower abdomen are building up: this is acute retention of urine, a painful state that needs the bladder drained with a catheter straight away;
- blood or clots appear in the urine, which is never blamed on an enlarged prostate without investigation;
- a fever with shivering sets in along with burning on passing urine and pain in the perineum or the lower back, the picture of an infection that turns severe quickly;
- you have stopped passing urine while drinking as usual, and sickness, swollen ankles or confusion have appeared.
The painless version deserves a separate mention. A bladder can go for years without emptying properly, stretching and overfilling with no pain at all; urine then leaks continuously, especially at night, while the kidneys quietly lose function. Constant dribbling in a man with long-standing urinary symptoms is not "a weak bladder" but a reason to be investigated within days.
It is not cancer, but the PSA needs discussing
Benign enlargement and prostate cancer are different diseases. The first does not turn into the second and does not make it more likely. The trouble is that early prostate cancer produces exactly the same symptoms, or none at all, so a man with these complaints is investigated in a way that tells the two apart.
The PSA test is part of that work-up, but it is neither a sentence nor a clean bill of health. The level is pushed up by the enlargement itself, by inflammation, by cycling, by recent sex and by a catheter, so the sample is not taken on any random day but according to rules the doctor will explain. What to do next is decided together, weighing up the benefits against the drawbacks.
A practical point that is often forgotten: drugs from the 5-alpha-reductase inhibitor group roughly halve the PSA level. If the doctor does not know you are taking one, a "normal" result may be falsely reassuring. Always name these medicines when you have the test.
What the assessment involves
The assessment is straightforward and almost entirely done as an outpatient.
- Talking and a questionnaire. You will be asked to score each symptom, which gives a baseline against which the result of treatment is later compared.
- A bladder diary over three days: how much you drink, when you pass urine and how much. A simple table that explains more than many investigations, particularly when the nights are the problem.
- Examination. The abdomen, the genitals and a rectal examination with a finger: it takes half a minute, tells the doctor the size and consistency of the gland and should not hurt.
- Tests. Urine, to exclude infection and blood; creatinine, to check the kidneys; PSA where appropriate and after a conversation.
- An ultrasound scan of the kidneys and bladder, with the residual volume measured immediately after passing urine.
- Flow rate measurement: you pass urine into a device that draws a curve of the speed of the stream. If needed, a look inside the bladder with a camera is added.
The doctor will also go through everything else you take. Passing urine is made worse by allergy and cold remedies with a decongestant effect, by some antispasmodic and mood drugs, by water tablets and by opioid painkillers. Sometimes changing one of them is enough.
What you can change yourself
With mild symptoms this is exactly where treatment starts, and often it is all that is needed.
- Cut down on coffee, strong tea, fizzy drinks and above all alcohol: they both produce more urine and irritate the bladder.
- Drink the bulk of your fluid in the first half of the day and limit it three or four hours before bed. Do not cut the total: concentrated urine irritates the bladder even more and makes infection likelier.
- Learn double voiding: when you have finished, wait half a minute and try again, as a noticeable amount often follows.
- Do not strain and do not rush. A relaxed stream is more effective than a forced one.
- Keep the bowels regular, since a full bowel presses on the bladder.
- Lose weight and move more, both of which have a noticeable effect on symptoms.
- Use the toilet before a long journey or a long meeting.
Herbal supplements for the prostate are sold everywhere, but they have no convincing evidence of benefit and may interact with prescribed medicines. Before spending money on them, mention them to your doctor.
Medicines and surgery
Treatment is matched to what is getting in the way, how badly, and what the assessment showed.
- Alpha blockers relax the smooth muscle at the bladder neck and work within a few days. They can cause dizziness on standing and a "dry" orgasm, with the semen passing into the bladder. That is neither dangerous nor permanent, but it is better to know about it beforehand. Do tell the eye surgeon that you take one of these drugs if you are due to have cataract surgery — they change how the iris behaves during the operation, and the surgeon needs to be ready for it even if you stopped taking them long ago.
- 5-alpha-reductase inhibitors shrink the gland itself, but they act slowly and the effect is judged after about six months. They are prescribed when the prostate is genuinely large and they lower the risk of retention and of surgery. Their side effects concern sexual function and are worth asking about separately.
- Bladder-directed drugs are added when frequent, urgent trips are the main problem. Where a large residual volume remains, they are used cautiously and under review.
- Surgery is needed if medicines have failed, if symptoms are severe, or if there has already been retention, stones, bleeding, repeated infections or damage to the kidneys. The classic operation removes part of the tissue through the urethra with no cuts on the outside; there are also gentler techniques using a laser, steam or an implant, each with its own limits. Put the main practical question to the surgeon: what it will do to ejaculation. A "dry" orgasm after the commonest operation is more the rule than the exception, while erections are usually unaffected.
Sometimes the right answer is to prescribe nothing and keep watch: if the symptoms are mild and do not get in the way of living, the doctor will suggest a review once a year. That is a proper plan, not a refusal to help.
Online consultation
Many men put off the conversation about passing urine for years out of embarrassment, and a remote appointment helps here: asking from home is easier. The doctor will go through the questionnaire score and the diary with you, explain which tests are needed, whether a PSA test makes sense for you and how to prepare for it, and help review the medicines you already take. Online is a comfortable place to discuss how well a drug is tolerated, the side effects that are awkward to mention, and how to approach the conversation about surgery with a urologist. The urgent signs listed above are not assessed remotely: an inability to pass urine, blood in the urine or a fever with shivering need to be seen in person the same day.
This material is for information only and does not replace medical advice.
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Online doctors for Enlarged prostate
Discuss your symptoms and possible next steps for Enlarged prostate with a doctor online.
