Overview
Benign prostatic hyperplasia (BPH) is non-cancerous enlargement of the prostate gland, a very common age-related condition. As the prostate enlarges, it can compress the urethra and obstruct urine flow. BPH does not increase the risk of prostate cancer. Symptoms are called lower urinary tract symptoms (LUTS).
How common is it?
An enlarged prostate becomes more common with age, particularly after 50. Some people have few or no urinary symptoms, while others need treatment.
Causes and risk factors
BPH results from proliferation of stromal and epithelial cells in the periurethral zone of the prostate, driven by androgens and ageing.
Common risk factors
- Age (BPH is an almost universal feature of male ageing)
- Testosterone and DHT (dihydrotestosterone) stimulation of prostate growth
- Family history
- Obesity and metabolic syndrome
- Type 2 diabetes
Symptoms
- Voiding symptoms: weak urinary stream, hesitancy, straining to start, intermittent stream, prolonged voiding
- Storage symptoms: urinary urgency, frequency, nocturia (waking at night to urinate)
- Post-micturition: terminal dribbling, feeling of incomplete emptying
- Urinary retention (complete inability to void) in severe cases — a urological emergency
When to see a doctor
See a GP for significant urinary symptoms. Seek emergency assessment for complete inability to urinate, or urinary retention with lower abdominal pain and distension.
Diagnosis
Assessment includes a symptom questionnaire, urine testing and examination. A PSA test may be offered after discussing its benefits and limitations. Kidney tests, flow measurements, residual urine checks or cystoscopy are selected according to symptoms and specialist assessment.
Treatments
Watchful waiting and lifestyle advice
For mild to moderate symptoms. Reduce fluid intake in the evening, limit caffeine and alcohol, and void when first feeling the urge. Bladder training and pelvic floor exercises help storage symptoms.
Alpha-1 blockers
Tamsulosin, alfuzosin, or doxazosin relax smooth muscle in the prostate and bladder neck, improving flow rate within days. First-line pharmacological treatment. Side effect: postural hypotension (doxazosin more than tamsulosin).
5-alpha reductase inhibitors
Finasteride or dutasteride reduce prostate size by blocking DHT production. They take several months to help and may reduce retention and surgery risk. Clinicians select them for an enlarged prostate with risk of progression. Possible effects include reduced libido and erectile dysfunction.
Surgical treatment (TURP)
Transurethral resection of the prostate (TURP) removes obstructing tissue endoscopically. Gold standard surgical treatment. Laser procedures (Holmium laser enucleation) are increasingly used and have less bleeding risk.
Self-care and lifestyle
- Reduce fluid intake in the 2 to 3 hours before sleep to reduce nocturia
- Limit caffeine and alcohol, which have diuretic effects
- Double voiding (urinating twice) reduces post-void residual
- Avoid cold and cough medications containing antihistamines or decongestants which can worsen retention
Prevention
BPH becomes more common with age, but not everyone develops troublesome symptoms. There is no proven way to prevent it. Maintaining a healthy weight and staying active may help urinary symptoms.
Sources for targeted updates
Updated: 24 October 2026. Targeted corrections to prevention, key facts, diagnosis, treatment, frequency. This update covers the named sections; a full review of the remaining guide is pending.