Benign enlarged prostate

If the prostate is very enlarged, it pushes against the bladder and urethra (the tube that urine leaves your body through). This can cause various problems:

• The urge to urinate is more frequent and stronger than before, especially at night.
• It takes a while for the urine to start flowing.
• The stream of urine is weaker than before, and it takes longer to urinate.
• After going to the toilet, more urine leaks out and the bladder doesn't feel empty.

The medical term for this enlargement of the prostate gland is "benign prostatic hyperplasia" (BPH). The word "benign" means that it is not cancer.

The size of the prostate and the severity of the symptoms aren't always directly related. Some men with a very enlarged prostate have few symptoms, while others have a lot of problems even though their prostate is only slightly enlarged.

The prostate is located right underneath the bladder, and surrounds part of the urethra. If the prostate becomes enlarged, it may push against the bladder, urethra and bladder muscles. This means that men might feel the need to urinate even though their bladder isn't at all full. The constant pressure can also weaken the bladder muscles. As a result, the bladder can no longer empty itself completely. The pressure on the urethra may prevent urine from flowing out normally, too.

This slow prostate growth is a normal part of aging, but in some men it grows too large. The reasons for this are not clear.

It is rare for men under the age of 40 to have an enlarged prostate. About 20 out of 100 men between the ages of 50 and 59 are affected. In older age the typical symptoms become increasingly common: Up to 70 out of 100 men over the age of 70 have a benign enlarged prostate.

Most of the men who are affected have mild to moderate symptoms, and cope with them quite well in everyday life. Sometimes the symptoms improve on their own again. But they usually tend to get a little worse over the years, even if this happens very gradually. It takes some time to see whether the symptoms will stabilize at a manageable level or become too severe to cope with.

Some men with an enlarged prostate keep on getting urinary tract infections.

Rarely, men with an enlarged prostate quite suddenly have difficulties urinating, or can't urinate at all. Known as acute urinary retention (anuria), this occurs in about 1 to 3 out of 100 men with a benign enlarged prostate every five years.

This condition is an emergency and needs to be treated immediately. First, a catheter is used to relieve the bladder. A few days later, part of the prostate is surgically removed to allow the urine to flow normally.

Although problems with urination are most commonly caused by an enlarged prostate, they can be caused by other things too. To narrow down the possible causes, a doctor will ask how often you have to urinate. Many people find it difficult to say exactly how often they go to the toilet, so it might be helpful to keep track for one or two days before going to the doctor. It also makes sense to tell the doctor what medications you take because some medications can actually cause urinary problems.

The prostate gland is checked during a physical examination. To do so, the doctor puts on disposable gloves and gently inserts a finger into the rectum to feel the size and structure of the prostate gland (digital rectal exam).

A urine test can be done to help detect signs of a prostate infection or urinary tract infection. Both cause similar symptoms to those of an enlarged prostate. Urine can be tested for a variety of other illnesses, too.

A blood test is often done to check the man's PSA levels (PSA = prostate-specific antigen). Prostate cancer can increase the PSA levels. But high PSA levels can be caused by many other things too – including a benign enlarged prostate. For this reason, and because the PSA test isn't very reliable anyway, its use in men with an enlarged prostate is controversial. So it's a good idea to carefully consider the pros and cons.

A urine flow test (uroflowmetry) can be done to see how much urine flows out per second. To do this test, you urinate with a full bladder into a special instrument that can measure the speed of the urine flow.

Ultrasound scans can be used to see how large the prostate is. They can also be done to see how much urine is left over in the bladder after urinating (residual urine).

The choice of treatment for a benign enlarged prostate mostly depends on how bad the symptoms are, whether there are complications such as frequent urinary tract infections (UTIs), and what you think about the advantages and disadvantages of having treatment.

The treatment options include:

• Active monitoring of symptoms (often called “watchful waiting”): If the symptoms are mild and there are no complications, it may be enough to change a few things in everyday life and go in for a check-up about once a year. This strategy helps in about 30 out of 100 men who seek medical help because of an enlarged prostate.
• Herbal medicine products: There are several over-the-counter herbal products for the relief of symptoms associated with a benign enlarged prostate. Most of these products haven't been well studied. Others have been studied, but weren't found to reduce prostate symptoms. So the German Society of Urology doesn't generally recommend them for the treatment of benign enlarged prostates.
• Medication: About 70 out of 100 men who seek medical advice for an enlarged prostate opt for medication. The most commonly used medication is called tamsulosin. It relaxes the prostate and bladder muscles, making it easier to urinate.
• Surgical procedures to reduce the size of the prostate: Various surgical procedures can be used to remove or destroy prostate tissue. Possible reasons for having surgery include urinary retention, recurring infections and severe symptoms that can't be relieved in any other way. Some men make a conscious decision to have surgery after they have considered the advantages and disadvantages of different treatment options. Ejaculation problems are one common side effect of these procedures. Incontinence or erection problems are rare.

Prostate problems typically develop gradually over many years. This slow development makes it easier to adjust to them. But many men find them unpleasant, and feel embarrassed about needing to go to the toilet a lot and having problems that are closely related to their sexual organs.

An enlarged prostate need not get in the way of a fulfilled sex life for men and their partners, though. The important thing is to talk openly about these age-related changes, and develop strategies together to adapt to them.

When people are ill or need medical advice, they usually go to see their family doctor first. You can read about how to find the right doctor in our "Health care in Germany" topic, and our list of questions can help you to prepare for your appointment.