Learn more about difficulty passing urine: introduction
Benign prostate enlargement (BPE) is the medical term to describe an enlarged prostate, a condition that can affect how you pee (urinate).
BPE is common in men aged over 50. It's not a cancer and it's not usually a serious threat to health.
Many men worry that having an enlarged prostate means they have an increased risk of developing prostate cancer. This is not the case.
The risk of prostate cancer is no greater for men with an enlarged prostate than it is for men without an enlarged prostate.
The prostate is a small gland, located in the pelvis, between the penis and bladder.
If the prostate becomes enlarged, it can place pressure on the bladder and the urethra, which is the tube that urine passes through.
This can affect how you pee and may cause:
- difficulty starting to pee
- a frequent need to pee
- difficulty fully emptying your bladder
In some men, the symptoms are mild and do not need treatment. In others, they can be very troublesome.
The cause of prostate enlargement is unknown, but it's believed to be linked to hormonal changes as a man gets older.
The balance of hormones in your body changes as you get older and this may cause your prostate gland to grow.
You might have several different tests to find out if you have an enlarged prostate.
A GP may do some of these tests, such as a urine test, but others might need to be done at a hospital.
Some tests may be needed to rule out other conditions that cause similar symptoms to BPE, such as prostate cancer.
Treatment for an enlarged prostate will depend on how severe your symptoms are.
If you have mild symptoms, you do not usually need immediate treatment, but you'll have regular prostate check-ups.
You'll probably also be advised to make lifestyle changes, such as:
- drinking less alcohol, caffeine and fizzy drinks
- limiting your intake of artificial sweeteners
- exercising regularly
- drinking less in the evening
Medicine to reduce the size of the prostate and relax your bladder may be recommended to treat moderate to severe symptoms of an enlarged prostate.
Surgery is usually only recommended for moderate to severe symptoms that have not responded to medicine.
Benign prostate enlargement can sometimes lead to complications, such as:
- a urinary tract infection (UTI)
- acute urinary retention
Acute urinary retention (AUR) is the sudden inability to pass any urine.
Symptoms of AUR include:
- suddenly not being able to pee at all
- severe lower tummy pain
- swelling of the bladder that you can feel with your hands
Go immediately to your nearest A&E if you experience the symptoms of AUR.
Learn more about difficulty passing urine: symptoms
Symptoms of an enlarged prostate include:
- finding it difficult to start peeing
- straining to pee
- having a weak flow of urine
- "stop-start" peeing
- needing to pee urgently and/or frequently
- needing to get up frequently in the night to pee
- accidentally leaking urine (urinary incontinence)
Leaking urine can happen when you feel a sudden need to pee and cannot stop some pee leaking out before you get to a toilet. This is called urge incontinence.
Leaking urine can also happen when you strain. For example, when you cough, sneeze or lift a heavy object. This is called stress incontinence.
The most common form of leaking is when a small amount of urine dribbles into your underwear after peeing.
Find out more about urinary incontinence.
See a GP if you have any of the symptoms of an enlarged prostate .
Even if the symptoms are mild, they could be caused by a condition that needs to be investigated.
Any blood in your urine must be investigated by a GP to rule out other more serious conditions.
Learn more about difficulty passing urine: diagnosis
To find out whether your prostate gland is enlarged, you'll need to have a few tests.
Some tests will be done by a GP and, if needed, others will be carried out by a doctor who specialises in urinary problems (urologist).
A GP will ask about your symptoms and concerns, and their impact on your quality of life.
You may be asked to complete a chart that records how much liquid you usually drink, how much urine you pass, how often you have to pee on a daily basis and whether you have any leakage.
The GP may do a physical examination. They may examine your stomach and genital area.
They may also feel your prostate gland through the wall of your bottom (rectum). This is called a rectal examination.
The GP may order a blood test to check that your kidneys are working properly.
They may advise you to have a prostate-specific antigen (PSA) blood test to rule out prostate cancer.
You may be offered a urine test, for example to check for sugar (glucose) or blood in your pee. This is to see if you have diabetes or an infection.
The GP may refer you to a urologist or other appropriate specialist if:
- previous treatments have not helped your urinary problems
- a urinary infection does not go away or comes back regularly
- you cannot fully empty your bladder
- you have kidney problems
- you have stress incontinence, which is when urine leaks out at times when your bladder is under pressure; for example, when you cough or laugh
You should also see a specialist if the GP is concerned that your symptoms could be caused by cancer, although for most men this is not the cause.
To help find out what might be causing your symptoms and decide how to manage them, you should be offered extra tests to measure:
- how fast your urine flows
- how much urine is left in your bladder after you have peed
You may also be offered other tests, depending on your symptoms or the treatment you and your doctor are considering.
Learn more about difficulty passing urine: treatment
The treatment for an enlarged prostate gland will depend on how badly the symptoms are affecting your qualify of life.
The main treatments are:
- lifestyle changes
- surgery and other procedures
You might be able to relieve the symptoms by making some simple changes to your lifestyle.
Drink fewer fizzy drinks and less alcohol, caffeine and artificial sweeteners
Fizzy drinks and drinks that contain alcohol, caffeine (such as tea, coffee or cola) and artificial sweeteners can irritate the bladder and make urinary symptoms worse.
Drinking less fluid in the evening
Try to reduce the amount of fluids you drink in the evening and avoid drinking anything for 2 hours before you go to bed. This might help you avoid getting up in the night. Make sure you're still drinking enough fluid earlier in the day.
Remember to empty your bladder
Remember to go to the toilet before long journeys or when you know you will not be able to reach a toilet easily.
Double voiding involves waiting a few moments after you have finished peeing before trying to go again. It can help you empty your bladder properly. But take care not to strain or push.
Checking your medicines
Check with your doctor whether any medicines you take, such as antidepressants or decongestants, might be making your urinary symptoms worse.
Eating more fibre
Eating more fibre (which is found in fruit, vegetables and wholegrain cereals) can help you avoid constipation, which can put pressure on your bladder and make the symptoms of an enlarged prostate worse.
Using pads or a sheath
Absorbent pads and pants can be worn inside your underwear, or may replace your underwear altogether. These will soak up any leaks.
Urinary sheaths can also help with dribbling. They look like condoms with a tube coming out of the end. The tube connects to a bag that you can strap to your leg under your clothing.
Bladder training is an exercise programme that aims to help you last longer without peeing and hold more pee in your bladder.
You'll be given a target, such as waiting at least 2 hours between each time you pee.
It's a good idea to use a bladder training chart to record each time you pass urine and the volume of urine passed. You can download a bladder training chart (PDF, 115KB) from Bladder Matters. You'll need a plastic jug to measure this. Your doctor should also give you a chart to take home.
You'll also be taught several exercises, such as breathing, relaxation and muscle exercises, to help take your mind off the need to pee.
Over time your target time will be increased, and at the end of the programme you should find you're able to last longer without peeing.
Ask your doctor or specialist nurse for more information about any of these lifestyle changes.
If lifestyle changes do not help, or are not suitable for you, you may be offered medicine.
Alpha blockers relax the muscle in your prostate gland and at the base of your bladder, making it easier to pee. Commonly used alpha-blockers are tamsulosin and alfuzosin.
Anticholinergics relax the bladder muscle if it's overactive.
5-alpha reductase inhibitors
5-alpha reductase inhibitors shrink the prostate gland if it's enlarged. Finasteride and dutasteride are the two 5-alpha reductase inhibitors available.
Diuretics speed up urine production. If taken during the day, they reduce the amount of urine you produce during the night.
Desmopressins slow down urine production so less urine is produced at night.
This is because there is not enough reliable evidence about how well they work or how safe they are.
Herbal treatments may also cause side effects or interact with other medicines.
If you continue to have trouble peeing, a condition called chronic urine retention, you may need a catheter to drain your bladder.
A urinary catheter is a soft tube that carries urine out of the body from the bladder. It can be passed through your penis, or through a small hole made in your tummy, above your pubic bone.
You may be recommended a removable catheter, or a catheter that stays in your bladder for a longer period of time.
Most men with urinary symptoms do not need to have surgery, but it may be an option if other treatments have not worked.
Transurethral resection of the prostate (TURP)
TURP involves removing part of the prostate gland using a device called a resectoscope that's passed through the urethra (the tube through which urine passes out of the body). It's suitable for men who have an enlarged prostate.
During an open prostatectomy, the prostate gland is removed through a cut in your body. It's suitable for men who have an enlarged prostate over a certain size.
Prostatic urethral lift (PUL) implants
A surgeon inserts implants that hold the enlarged prostate away from the urethra, so it is not blocked. This helps to relieve symptoms such as pain or difficulty when peeing.
Cystoplasty is a procedure to increase the size of the bladder by sewing a piece of tissue from the intestine into the bladder wall. This may help men whose bladder muscle contracts before it's full.
Prostate artery embolisation
A catheter is inserted into an artery in your groin or wrist. Using X‑ray guidance, it's passed into the blood vessels that supply the prostate gland.
Tiny plastic particles are injected into these vessels to reduce the prostate gland's blood supply, which shrinks it.
The potential benefits of prostate artery embolisation compared with surgery are fewer complications and you can have this procedure under local anaesthetic as an outpatient.
This procedure involves injections of botulinum toxin into the walls of your bladder. It may help men whose bladder muscle contracts before the bladder is full.
Implanted sacral nerve root stimulation
A small electrical device is implanted under your skin and sends bursts of electrical signals to your bladder and urine system for better control. This is suitable for men whose bladder muscle contracts before their bladder is full.
Urinary diversion involves linking the tubes that connect your kidneys to your bladder directly to the outside of the body, so urine can be collected without flowing into your bladder.
This is suitable for men whose symptoms cannot be managed by self-management and medicine, and who cannot have – or do not want – cystoplasty or sacral nerve root stimulation.
Water ablation is a new treatment for prostate enlargement. There are 2 types of water ablation procedure. In the first, water is injected into the prostate using a probe passed up the urethra. The pressure of the water is then used to destroy some of the prostate tissue, making it smaller.
The second type is very similar except steam, rather than water, is used to destroy prostate tissue.
Water ablation is probably less likely to cause side effects than a transurethral resection of the prostate (TURP).
However, not all NHS surgeons are currently trained to do these procedures, so access to these procedures may be limited and waiting lists for them may be longer than for other surgical options.