Benign Prostatic Hyperplasia

Benign prostatic hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland that commonly occurs with increasing age in men, causing symptoms related to urination as the enlarged prostate presses on the urethra.

• Difficulty starting to urinate, or a weak or interrupted urine stream
• Frequent urination, particularly at night (nocturia)
• A feeling of incomplete bladder emptying
• Urgency to urinate
• In severe cases, complete inability to pass urine (acute urinary retention), which is a medical emergency

• Results from age-related enlargement of the prostate gland, likely influenced by hormonal changes that occur with ageing.
• Risk increases with age and is extremely common among older men.

• Diagnosed clinically based on urinary symptoms in an older man, together with a digital rectal examination to assess the size, shape, and consistency of the prostate.
• Urinalysis and blood tests for kidney function help exclude other causes and assess for complications.
• Prostate-specific antigen (PSA) testing, where available, may be used to help assess for the possibility of prostate cancer, particularly with concerning examination findings.
• Ultrasound may be used to assess prostate size and check for bladder or kidney complications in more significant cases.

Mild symptoms may only require reassurance, monitoring, and simple measures such as reducing evening fluid intake.

Moderate to significant symptoms are treated with an alpha-blocker medicine (such as tamsulosin), which relaxes muscle around the bladder outlet to improve urine flow; a 5-alpha-reductase inhibitor may be added for larger prostates to shrink the gland over time.

Men who develop acute urinary retention (sudden inability to pass urine) require emergency bladder catheterisation and urgent referral.

Men with severe symptoms not controlled by medicine, recurrent urinary retention, or complications such as kidney damage are referred to a specialist, where surgical treatment of the prostate may be considered.

• Reduce fluid intake in the evening to lessen nighttime urination.
• Avoid or limit caffeine and alcohol, which can worsen urinary symptoms.
• Seek prompt medical assessment for new or worsening urinary symptoms rather than assuming they are simply a normal part of ageing.
• Seek immediate care for sudden inability to pass urine, as this is a medical emergency.