Prostate Enlargement: 5 Q&As

Read on the see if you are at risk of Benign Prostatic Hyperplasia (BPH)

Saw Palmetto: source of a traditional medicine for prostatic enlargement. Miguel Vieira;; Creative Commons 2.0 License


The prostate gland is a part of the male reproductive system that sits just below the urinary bladder, and secretes a fluid that is a component of semen, and hence critical to male fertility. The term "hyperplasia" refers to an increase in the size of a tissue due to increase in the number of its cells.  It differs from "hypertrophy" in the sense that these cells do not increase in size but just in their numbers.

 Take a look at this picture to further help you understand the difference.

So as the name suggests, prostatic hyperplasia refers to an abnormal increase in the size of the prostate gland because of an increase in the number of its cells.  The term "benign" further implies that this increase does not come from a cancer of the prostate gland.


Typically, the prostate gland undergoes two main phases in its growth.  The first increase occurs when a boy reaches puberty leading to a doubling in its size.  The second phase typically occurs in the mid 20s and continues for the rest of a man's life.  Eventually as men age, the prostate becomes big enough so that the gland starts to press against the urethra (the tube that leads urine from the bladder to the outside). Here is a helpful picture. This finally leads to a narrowing of the urethra to the extent where it is hard for urine to flow out easily and patients will have trouble emptying out the bladder completely.

 This phenomenon is the crux of benign prostatic hyperplasia.  

The reasons behind this increase in prostate size are hormonal and include abnormal levels of testosterone, dihydrotestosterone, etc.


Symptoms of enlargement typically begin to affect men as they approach their 50s.

 The chances of having BPH increase as men age, and up to 90% of men over 80 are likely to have BPH.

The typical symptoms include:

  • Urinary retention in the bladder
  • Frequent urination at night requiring one to wake up at night, or nocturia
  • Weak urine stream
  • Problem starting urine stream, or hesitancy
  • Frequent urination 
  • Urinary incontinence
  • Painful urination


In addition to the symptoms above, various tests and clinical findings can help confirm a diagnosis of BPH.  These include:


The treatment of prostatic hyperplasia should proceed along a graded step-by-step manner.  

  1. For mild symptoms, just lifestyle changes might be sufficient.  Something as simple as stopping fluid intake 4 hours before sleep time might help to reduce frequent nighttime awakening or nocturia.  
  1. Exercising the pelvic muscles and double voiding might help as well.
  2. Watch the medications that you take! Certain medications are known to worsen symptoms of prostatic enlargement. These include commonly available over-the-counter cough and cold remedies including decongestants and antihistaminics.  Remember that caffeine and alcohol could act as diuretics and therefore worsen symptoms of urinary frequency in people with prostatic enlargement.
  3. If the above don't work, medications might help.  Two of the most commonly prescribed class of medications for this include alpha blockers (eg. tamsulosin or Flomax, silodosin or Rapaflo) and 5-alpha reductase inhibitors (examples finasteride or Proscar.). Alpha-blockers help by relaxing the prostatic muscles and the bladder neck.  5-alpha reductase inhibitors act at a hormonal level and help in slowing down prostatic growth, or even shrink the gland to some extent.  Since their effect is hormonal, the benefit might not be apparent immediately and combination of these two classes of medications might help more than monotherapy with one medication alone
  4. The last resort for men who don't find relief with the above measures is surgery. Surgical options range from minimally invasive procedures like transurethral ablation and prostatic stent insertion, to more invasive procedures like TURP, or even an open prostatectomy where the gland is removed.

Continue Reading