What Is an Enlarged Prostate (BPH)?

Getting up twice — then three times — a night. A stream that starts slowly and stops and starts again. If you're a man in your fifties or beyond, there's a good chance an enlarged prostate is behind it. The medical name is benign prostatic hyperplasia, shortened to BPH: "benign" because it isn't cancer, and "hyperplasia" because the gland has grown through extra cells. The eight-minute video above explains it in those terms — a build-up of cells within the prostate that gradually enlarges the gland. Here's what to expect, from the first symptoms to the check-up and beyond.

Expect the changes to creep up slowly

The prostate sits just below the bladder and wraps around the urethra, the tube urine passes through. When it enlarges, it squeezes that tube and presses on the bladder outlet. That is why the earliest signs are usually about flow and urgency rather than pain: taking longer to start, a weaker stream, dribbling at the end, needing to go more often — especially at night — and sometimes a feeling that the bladder hasn't quite emptied. Symptoms tend to arrive gradually over years, and their severity doesn't always match the gland's size, which is why two men with similar scans can feel very differently affected. Similar urinary symptoms can also come from other causes, such as the infections covered in our guide to urinary tract infections, so guessing isn't a substitute for being checked.

Expect a straightforward check-up

A BPH assessment is mostly conversation at first: your clinician will ask how the symptoms affect your sleep and daily life, and may use a short symptom questionnaire. Expect a physical examination, which can include feeling the prostate's size and smoothness through the rectal wall — brief and routine. Urine and blood tests often follow; a blood test may include PSA, a prostate-related marker your clinician interprets in context rather than as a stand-alone verdict. Sometimes a flow test or a bladder scan to measure leftover urine is added. The aim is twofold: confirm that enlargement explains the symptoms, and rule out anything else that needs different care.

Expect management to start gently

Not every enlarged prostate needs a procedure. When symptoms are mild, monitoring with periodic review — often called watchful waiting — may be all that's recommended, along with practical steps like easing off fluids late in the evening. If symptoms interfere with life, medicines are usually the next step: some relax the muscle within the prostate and bladder neck so urine flows more easily, others gradually shrink the gland over time. The site's "Non-Surgical Treatment of Benign Prostatic Hyperplasia" video (just over a minute) is candid about the trade-off: oral therapy can relieve symptoms without surgery, but it means ongoing medication and possible side effects. When medicines aren't enough, or complications appear, procedures to remove or reduce the obstructing tissue enter the discussion — the best-known is covered in our guide to TURP surgery for an enlarged prostate. Your own urologist will weigh the options against how much the symptoms actually bother you. That bother factor, honestly reported, is what drives the plan.

MedicalVideos.com has published trusted medical videos since 2007. The site was founded by Dr. Mohamed Ibrahim, MD, PhD — physician-scientist.

Frequently Asked Questions

Is an enlarged prostate the same as prostate cancer?
No. BPH is non-cancerous growth of the prostate, and having it doesn't mean you have cancer. The two can exist in the same gland, though, which is one reason new urinary symptoms in older men should always be checked rather than assumed to be "just BPH".

At what age does BPH usually start?
Prostate growth is a normal part of ageing for many men, typically becoming noticeable from middle age onwards, with urinary symptoms becoming more common with each decade. Not everyone develops bothersome symptoms, even when the gland has enlarged.

Will I definitely need surgery?
No. Many men are managed with monitoring alone or with medication, and procedures are generally reserved for symptoms that remain troublesome despite medicines, or for complications such as repeated retention or infections. The decision is made with your urologist, based largely on how much the symptoms affect you.

What should I mention at my appointment?
How often you get up at night, how weak or stop-start the stream is, any urgency or leakage, medicines you're taking (some common ones worsen urinary symptoms), and whether you've ever been unable to pass urine — that last one needs urgent care the same day if it happens.

Educational only — this article is general information about benign prostatic hyperplasia (an enlarged prostate), not medical advice and not a diagnosis. If you have urinary symptoms, blood in the urine, or difficulty passing urine, discuss them with your own clinician, who can examine you and arrange the right tests.