Benign prostate enlargement

Also called BPH, Enlarged prostate

The prostate grows with age and squeezes the urethra. Very common, not cancer, and retention is the emergency.

What it is

The prostate enlarges in most men with age. By 60, around half have symptoms; by 80, most do.

It is not cancer and it does not become cancer, though the two can coexist, which is why symptoms still deserve assessment.

The enlarged gland squeezes the urethra, so emptying becomes harder. Over time the bladder muscle thickens and becomes irritable, which adds urgency and frequency on top of the flow problem.

The complication to know is acute urinary retention: a sudden complete inability to pass urine, with a painfully full bladder. It is an emergency, and it is one of the commonest urological emergencies in older men.

Signs you might notice

A weak or intermittent stream. Difficulty starting. Straining.

Dribbling at the end. A feeling of not emptying.

Needing to go more often, urgently, and repeatedly at night.

Acute retention: unable to pass urine at all, with lower abdominal pain and a palpable bladder. Emergency.

Chronic retention can be painless, which is more dangerous: the bladder never empties, pressure backs up, and kidney damage follows silently.

How it can affect day-to-day life

Nocturia is the symptom that most affects quality of life. Getting up four times a night causes exhaustion and substantially raises falls risk in older men.

Anticholinergic medicines, some cold remedies and some antidepressants can precipitate retention. Constipation and alcohol also contribute.

In care settings, an older man who becomes confused, agitated or unwell should have his bladder checked. Retention is a classic and easily missed cause of delirium.

Supporting someone well

Check the bladder in any older man with new confusion or agitation. A bladder scan takes a minute.

Review medication for anything anticholinergic, and treat constipation.

Reduce evening fluid and caffeine, without reducing total daily intake.

Use double voiding: pass urine, wait, and try again.

Ask about medication such as tamsulosin or finasteride, and about surgery if symptoms are severe.

Treat acute retention as an emergency; it is painful and it damages kidneys.

Do not assume symptoms are just BPH without assessment, since prostate cancer needs excluding.

Where to get help

A GP can assess with a symptom score, examination, urine test and PSA discussion.

Prostate Cancer UK's specialist nurses also advise on benign enlargement: 0800 074 8383.

Inability to pass urine with pain is a 999 or urgent same-day matter.