Benign Prostatic Hyperplasia Care (Enlarged Prostate)

You can get help for bothersome urinary conditions, even as you age. Our experts specialize in treating symptoms of an enlarged prostate, such as frequent trips to the bathroom, dribbling, or a weak stream.

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If you often need to get up during the night to urinate, or if your urine stream seems weaker than it once was, you may have benign prostatic hyperplasia (BPH)—otherwise known as an enlarged prostate. It’s a common condition in men, especially men over age 40.

BPH can be bothersome, but it’s usually not serious. Many men assume the symptoms are simply a part of aging. But if BPH symptoms are disrupting your life, it’s important to see a doctor.

A doctor can help you understand how your prostate works, how it affects urination, and what treatments are available to reduce or eliminate your symptoms. A doctor can also check to see if those symptoms are a sign of a more serious condition.

At University of Iowa Health Care, our fellowship-trained urologists are experts in providing personalized care to determine and treat the symptoms of BPH. They offer all the most advanced treatments available and will work with you to design a treatment plan that meets your needs.

Symptoms of benign prostatic hyperplasia

The prostate is a gland in the reproductive system that produces a fluid that, along with sperm, makes up semen. The prostate is just below the bladder. It’s donut-shaped and surrounds the urethra, which is the tube that moves urine out of your bladder when you urinate.

Your prostate grows as you age. As it grows, it may begin to press against the bladder or squeeze the urethra, resulting in a slowed or blocked flow of urine.

Symptoms associated with an enlarged prostate include:

Frequent or urgent need to urinate
Waking up many times in the night to urinate
Pain when urinating or after ejaculation
Urine that has an unusual color or smell
Urine flow issues, such as:
- A weak, slow, or irregular stream of urine
- Feeling that you are unable to empty your bladder
- Unable to control your urination (also known as urinary incontinence)
- Dribbling after urination
- Trouble starting to urinate

Causes of benign prostatic hyperplasia

While the exact cause of an enlarged prostate is unknown, you are more likely to develop BPH if you:

Are over age 40
Have family members with BPH
Lead a sedentary life
Have other health conditions, such as:
- Obesity
- Heart disease
- Type 2 diabetes
- Erectile dysfunction

How benign prostatic hyperplasia is diagnosed

Your evaluation will begin with a physical examination, a review of your medical history, and a discussion about your family health history. If necessary, your provider may also order additional tests, including:

Urine test
Blood test, including a prostate-specific antigen (PSA) test
A cystoscopy to view your bladder and urethra
Urodynamic test to measure how well you can hold and release urine
Ultrasound of your prostate
Prostate biopsy

Benign prostatic hyperplasia treatments

Not everyone with an enlarged prostate needs treatment. Treatment often depends on the severity of your symptoms, whether your BPH is contributing to other health complications, and the size of your prostate. Your provider will work with you to determine which treatment or combination of treatments can best help alleviate your symptoms.

Lifestyle changes

Your provider may recommend making lifestyle changes to help you manage enlarged prostate symptoms, including:

Reducing your intake of liquids, especially before bed
Reducing your intake of caffeinated beverages
Reducing your intake of alcohol
Exercising the pelvic floor muscles
Training the bladder to hold urine longer
Preventing or treating constipation

Medications

Medications may be prescribed to help manage symptoms and reduce the size of your prostate. These include:

Alpha blockers: These medications relax the musclar tissue within your prostate, helping to reduce pressure on your urethra and prevent bladder blockage.
5-alpha reductase inhibitors: These medications lower levels of dihydrotestosterone (DHT), an androgen hormone that plays a role in the development of male characteristics. This can prevent further growth or even shrink the prostate.
PDE5 inhibitors: These medications help relax the smooth muscle in the bladder and within the prostate to improve urinary symptoms. These medications may also help improve erectile quality.
Combination medications: Some studies have shown that combining these types of medication can be more effective in managing and reducing your symptoms than using just one.

Procedures

Several procedures—including minimally invasive options—can help restore your flow of urine and relieve your symptoms. These include:

Transurethral incision of the prostate (TUIP): This treatment involves widening the urethra by making small cuts on the inside of the prostate. TUIP typically can be done as an outpatient procedure but may require overnight hospitalization.
Transurethral resection of the prostate (TURP): This treatment is considered the gold standard for BPH care. It involves shaving the inside of the prostate. TURP requires overnight hospitalization.
GreenLight™ laser photovaporization of the prostate (PVP): This treatment involves the use of a special laser that vaporizes the prostate tissue. This typically requires overnight hospitalization.
Holmium laser enucleation of prostate (HoLEP): This treatment involves removing prostate tissue using a laser. HoLEP can provide a more complete tissue removal for those who have larger prostates. HoLEP requires overnight hospitalization.
Robot-assisted simple prostatectomy (RASP): This treatment involves making five small incisions in the abdomen to open the top of the bladder and remove tissue from the inside of the prostate. RASP requires overnight hospitalization.
Rezūm™ therapy: This treatment involves injecting steam into the prostate to break up the surrounding tissue. It is an outpatient procedure and usually does not require overnight hospitalization.

Which procedure is right for you depends on many factors, including your overall health and the size of your prostate. Your provider will work with you to determine which treatment option will work best for you.