Enlarged Prostate (BPH)

Benign prostatic hyperplasia (BPH) — an enlarged prostate — is a very common, non-cancerous condition in older men. It squeezes the urethra and causes urinary symptoms. About half of men over 50 and 80% of men over 80 have some BPH. It is manageable, and most men never need surgery.

Common symptoms

• Storage symptoms: urinary frequency, urgency, nocturia (waking at night to urinate).
• Voiding symptoms: weak stream, hesitancy in starting, intermittent stream, dribbling at the end, feeling of incomplete emptying.

Diagnosis

• History + digital rectal examination.
• IPSS (International Prostate Symptom Score) — an 8-question scoring system; rates severity and helps track improvement with treatment.
• Uroflowmetry + post-void residual ultrasound — how fast and fully you empty.
• Ultrasound KUB + prostate — prostate size, bladder thickness, stones, hydronephrosis.
• PSA blood test — helps rule out prostate cancer; also used to estimate risk of progression. Discuss benefits and limitations with the urologist — PSA has false positives (BPH, prostatitis, recent sex/catheterisation) and false negatives.

Treatment — stepwise

• Mild symptoms (IPSS < 8): watchful waiting, lifestyle changes.
• Moderate symptoms: alpha-blocker class (improves flow quickly), 5-alpha-reductase inhibitor class (shrinks the prostate over months); sometimes combined.
• PDE5 inhibitor class — in men with BPH + erectile dysfunction, one tablet can address both.
• Minimally invasive procedures — Rezum, UroLift, prostate artery embolisation.
• Surgery (TURP, HoLEP, GreenLight laser) — for severe symptoms, complications, or failure of medicines. Day-care or short-stay at most urology centres in India.

Lifestyle

• Reduce evening fluids to cut nocturia.
• Limit caffeine and alcohol.
• "Double voiding" — urinate, wait a minute, try again.
• Manage constipation; treat UTIs promptly.
• Review medicines — some cold remedies (decongestants, antihistamines) and bladder-relaxant drugs worsen retention.

Red flags — see a urologist urgently

• Acute urinary retention — sudden inability to pass urine with painful bladder — go to hospital.
• Blood in urine.
• Recurrent UTIs, fever, flank pain.
• Kidney dysfunction, bladder stones.
• Hard or irregular prostate on examination; fast-rising PSA — rule out cancer.