Condition guide
Enlarged Prostate (BPH)
Also known as: Benign prostatic hyperplasia, BPH, Benign prostatic enlargement
In brief
Benign prostatic hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland that is very common as men age. It can narrow the urethra and cause bothersome urinary symptoms, which can usually be improved with lifestyle measures, medication or, if needed, a procedure.
Medically reviewed by Dr. Atip Chatsudthipong, MD on
Written by Editorial teamPublished Updated
What is an enlarged prostate?
The prostate is a walnut-sized gland that sits below the bladder and surrounds the urethra, the tube that carries urine out of the body. In many men the prostate gradually grows with age. This growth is called benign prostatic hyperplasia (BPH) — "benign" because it is not cancer.
Because the prostate surrounds the urethra, enlargement can squeeze the urinary channel and make the bladder work harder. The size of the prostate does not always match the severity of symptoms: some men with large glands have few symptoms, and some with modest enlargement are very bothered.
What are the symptoms of BPH?
Symptoms are known as lower urinary tract symptoms (LUTS) and include:
- A weak or interrupted urine stream
- Difficulty or delay starting to urinate, or straining
- A feeling that the bladder has not emptied completely
- Needing to urinate more often, especially at night (nocturia)
- Urgency — a sudden strong need to urinate
- Dribbling at the end of urination
These symptoms are not specific to BPH — similar symptoms can be caused by bladder problems, infection, diabetes, some medicines or, less commonly, prostate cancer. That is why a proper assessment matters.
What causes BPH?
The exact cause is not fully understood, but age-related hormonal changes play a central role. The likelihood of BPH increases steadily from middle age onward. Family history, obesity, type 2 diabetes, cardiovascular disease and physical inactivity have also been associated with bothersome symptoms.
How is an enlarged prostate assessed?
- A detailed history, including fluid intake, medicines and how much the symptoms affect daily life
- A symptom questionnaire such as the International Prostate Symptom Score (IPSS)
- Physical examination, which may include a digital rectal examination to assess the prostate
- Urine test to check for infection or blood
- A PSA blood test in appropriate men, after discussion of its benefits and limitations — see Understanding your PSA test
- Measurement of urine flow and of urine left in the bladder after voiding (post-void residual), often by ultrasound
- A bladder diary, particularly when getting up at night is the main problem
Further tests such as prostate imaging, cystoscopy or urodynamic studies are used selectively, for example before surgery.
What are the treatment options for BPH?
Treatment is guided by how bothersome the symptoms are, prostate size, any complications, and your priorities — including the preservation of sexual function.
| Approach | Examples | Notes |
|---|---|---|
| Watchful waiting and lifestyle | Adjusting evening fluids, reducing caffeine and alcohol, bladder training, reviewing medicines | Suitable when symptoms are mild and not bothersome |
| Medication | Alpha-blockers (e.g. tamsulosin), 5-alpha reductase inhibitors (e.g. finasteride, dutasteride), tadalafil, combination therapy | Alpha-blockers act within days to weeks; 5-alpha reductase inhibitors shrink larger prostates over months |
| Minimally invasive procedures | Prostatic urethral lift (UroLift), Rezūm water vapour therapy | Options for selected prostate sizes and shapes, often aiming to preserve ejaculation |
| Surgery | Transurethral resection of the prostate (TURP), laser enucleation or vaporisation of the prostate, simple prostatectomy for very large glands | Most durable relief; side effects such as retrograde ejaculation are discussed in advance |
For many men who want to avoid long-term medication or the sexual side effects of traditional surgery, UroLift offers a minimally invasive option, typically as a day procedure. Dr. Atip also performs Rezūm water vapour therapy and TURP. For a side-by-side comparison of the main procedures, see the prostate care overview and Rezūm vs TURP.
When should you see a doctor?
Seek emergency care if you:
- Suddenly cannot pass urine, especially with lower abdominal pain (acute urinary retention)
- Have fever, chills or back pain with urinary symptoms
- Pass large amounts of blood or clots in the urine
Book a consultation if urinary symptoms affect your sleep, work or quality of life, if you see blood in your urine, or if you have repeated urinary infections. Untreated, significant obstruction can lead to bladder stones, infections, retention and, rarely, kidney damage.
How Dr. Atip can help
Prostate enlargement is a central part of Dr. Atip's practice. He treats BPH with medication and minimally invasive procedures including UroLift, at Bumrungrad International Hospital — the first hospital in Thailand to use UroLift technology. He will assess whether your symptoms are due to the prostate or another cause, explain the realistic benefits and side effects of each option, and tailor treatment to your goals.
Frequently asked questions
Does an enlarged prostate mean I have prostate cancer?
No. BPH is a non-cancerous condition and does not turn into prostate cancer. However, both are common in older men and can occur together, so your urologist may discuss PSA testing as part of the assessment.
Can BPH be treated without surgery?
Yes. Many men are well managed with lifestyle changes and medication. Procedures are generally considered when symptoms remain bothersome despite medication, when side effects of medication are a problem, or when complications such as urinary retention, bladder stones or recurrent infections occur.
Will BPH treatment affect sexual function?
Some treatments can affect ejaculation or, less commonly, erections or libido. The likelihood varies between medicines and procedures, so this should be discussed openly before choosing a treatment.
Why do I get up at night to urinate?
Night-time urination (nocturia) can be caused by the prostate, but also by drinking late in the evening, caffeine or alcohol, sleep apnoea, heart conditions, diabetes or the kidneys producing more urine at night. A bladder diary helps identify the cause.
References
- 1.Lerner LB, et al. Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA Guideline Part I — Initial Work-up and Medical Management. J Urol. 2021;206(4):806–817. (opens in a new tab)
- 2.European Association of Urology. EAU Guidelines on Management of Non-neurogenic Male LUTS. (opens in a new tab)
- 3.NIDDK. Prostate Enlargement (Benign Prostatic Hyperplasia). (opens in a new tab)
This information is for general education and does not replace a consultation with a qualified doctor. If you have severe symptoms, seek emergency care (in Thailand, call 1669). See our medical disclaimer.