Benign prostatic hyperplasia

A frequent need to urinate, nighttime trips to the toilet, and the feeling that the bladder is never completely empty: these are typical symptoms of a benign enlarged prostate. The symptoms usually begin after the age of 50 and men who are affected can find it a great nuisance.

At a glance

  • The typical symptoms of a benign enlarged prostate are a frequent need to urinate, a weak urine stream, taking longer to pass urine, and a feeling that the bladder is never empty.
  • Older men, in particular, are affected by this benign enlarged prostate.
  • A benign enlarged prostate is usually harmless, but it can badly affect the quality of life of men who are affected.
  • Various measures are available to treat a benign enlarged prostate.

Note: The information in this article cannot and should not replace a medical consultation and must not be used for self-diagnosis or treatment.

Benign prostate enlargement (benign prostatic hyperplasia): middle-age man sitting on the edge of a hospital bed. He has his hands entwined and is looking thoughtfully out of the window.

What is a benign enlarged prostate?

A man is standing up and bent over slightly. He is clutching each leg with his hands in the groin region. The man is clearly experiencing urinary urgency.

When men often need to pass urine, need to go to the toilet a lot during the night, and have the feeling that their bladder is never really empty, a benign enlarged prostate may be the reason. A benign enlarged prostate usually occurs after the age of 50. The symptoms get more common with age.

Many men cope very well with the symptoms. For others they are more troublesome. Because they have to go to the toilet so often during the night, they don't sleep enough and are very tired during the day. The frequent visits to the toilet can also disrupt everyday life if meetings or other activities keep needing to be interrupted.

Benign prostatic hyperplasia (BPH) is the medical term for a benign prostate enlargement. The word “benign” indicates that it is not prostate cancer. Hyperplasia describes the enlargement of the prostate.

Important: A benign prostate enlargement can be a great nuisance. But it is usually harmless. If treatment is required there is usually no need to hurry. Before a man concerned decides on a treatment he should calmly consider the pros and cons of the different options. This is a good idea in relation to an operation, in particular, because this type of intervention might have long-term complications.

For more detailed information, for example on how a prostate works, go to

What are the symptoms of a benign prostate enlargement?

When the prostate is significantly enlarged, it presses on the bladder and urethra. Typical symptoms are then:

  • a frequent, strong need to pass urine, particularly at night.
  • it takes a while to start urinating.
  • the urine stream is weak.
  • urinating takes longer than it used to.
  • dribbling after finishing urinating.
  • a feeling that the bladder is never really empty.

The prostate size and the severity of the symptoms are not necessarily linked directly. There are men who have a very much enlarged prostate and only mild symptoms. In other men, a slightly enlarged prostate causes great problems.

What are the causes of a benign enlarged prostate?

The man's prostate (prostatic gland) is located beneath the urinary bladder and encloses part of the urethra. It consists of many small glands and produces some of the sperm.

An enlarged prostate can press on the bladder, the urethra, and the bladder muscles. This can create a need to urinate even though the bladder is not yet full. The ongoing pressure can also weaken the bladder muscles and lead to the bladder never being completely emptied. The prostate's pressure on the urethra can also prevent the urine flow.

It is normal for the prostate to get bigger with age. However, in some men it gets too big. Why this happens is unknown.

How common is a benign enlarged prostate?

A benign enlarged prostate rarely occurs in men below the age of 40. Around 20 in 100 men are affected between the ages of 50 to 59. An enlarged prostate occurs more and more frequently with increasing age. Up to 70 in 100 men over the age of 70 get symptoms.

Around 20% of people aged from 50 to 59 and up to 70% of those over 70 have an enlarged prostate.

How does a benign enlarged prostate develop?

Most men have mild to medium-severe symptoms. They can usually adapt to them in everyday life. Symptoms can also sometimes improve. The condition usually only progresses slowly. It can take a long time before it becomes clear whether the symptoms are at a level that the person affected can live with, or whether their quality of life is going to be badly affected.

Some men with an enlarged prostate often suffer from recurring urinary tract infections. A man may also become entirely unable, or almost unable, to urinate. This type of urinary retention is an emergency, and it needs to be treated quickly. A catheter is then used to relieve the bladder. An operation is then usually carried out a few days later to reduce the size of the prostate. This measure enables the urine flow to become normal once more. Such urinary retention is quite rare – one to 3 men in every 100 with a benign enlarged prostate are affected within 5 years.

How is a benign enlarged prostate diagnosed?

A benign enlarged prostate is the most common reason for difficulty with urinating. But there may be other reasons and, to rule them out, the doctor will also ask how often the man has to pass urine. Many of those affected then realize that this is not very easy to answer. So it can be useful to keep count for one or two days before visiting the doctor. When talking to the doctor, the person affected also needs to say which medication he is taking, because urinary tract problems may also be a side effect of some medication.

The first step of the physical examination consists of the doctor feeling the prostate by inserting a finger while wearing a disposable glove. This enables them to judge the size and consistency of the prostate.

Indications of a prostate or urinary tract infection can be identified from a urine sample. They can cause symptoms that are similar to those that come with an enlarged prostate. A urine test can also indicate some other illnesses.

Important: The blood test often measures the PSA level (PSA = prostate-specific antigen). PSA is a protein that is only formed in the prostate. When the PSA level is high, prostate cancer is suspected. However, there can be other reasons for a high level, such as a benign enlarged prostate. So the PSA test is regarded as unsound and is controversial. The pros and cons should be properly thought through.

Another procedure is a urinary flow rate measurement. This measures how much urine per second is excreted. When the patient's bladder is as full as possible, he urinates into a special device that measures the flow speed of the urine.

An ultrasound examination can clarify how enlarged the prostate is. The ultrasound can also identify how much urine remains in the bladder after emptying it (residual urine measurement).

How is a benign enlarged prostate treated?

Which therapy is best depends on the enlarged prostate symptoms. One factor is whether there are any complications such as frequent urinary tract infections, and how affected men and their doctors assess the pros and cons of the treatment.

The possible therapies include:

  • Actively monitoring symptoms: in around 30 out of 100 men with mild symptoms and no complications, it is enough to adapt their everyday life and have a checkup about once a year.
  • Herbal remedies: most of these products have not been well researched, but there are various herbal remedies that are said to alleviate BPE symptoms. They can be obtained without a prescription. As some products show no impact on prostate problems, as a rule the German Society of Urology does not recommend their use in treatment.
  • treatment using drugs: around 70 in 100 men who seek medical advice opt to be treated with drugs. Normally, tamsulosin is used. It gets the prostate and bladder muscles to relax, making urination easier.
  • An operation: various surgical techniques can be used to remove or destroy prostate tissue to reduce the size of the prostate.

What can be done if living with a benign enlarged prostate?

Prostate problems normally develop over a number of years. Because of the slow progression, many men find it easier to adjust to the change. However, some men still find it unpleasant and embarrassing when they need to go to the toilet frequently and have problems that are associated with their sexual organ.

The sufferer's love life can still be satisfying. Couples should talk openly about age-related changes. In this way they can develop shared strategies to deal better with the situation.

In cooperation with the Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen) (IQWiG). As at:

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