Enlarged prostate (BPH)
Also called: benign prostatic hyperplasia, benign prostate enlargement (BPE), enlarged prostate gland, prostate enlargement, male lower urinary tract symptoms (LUTS)
An enlarged prostate (BPH) is a non-cancer growth of the prostate gland that is common in men over 50. It can cause a weak flow, straining and passing urine often, especially at night. Lifestyle changes, medicines or surgery can help.
General health information for Pakistan. It does not give doses or brand advice. If you are worried, or symptoms are severe, see a doctor. When to see a doctor
Overview
The prostate is a small gland found only in men. It sits just below the bladder and wraps around the urethra (the tube that carries urine out of the body). As men get older, the prostate often slowly grows bigger. This is called benign prostatic hyperplasia, or BPH. Benign means it is not cancer.
BPH is very common. Studies of the prostate show signs of it in about half of men in their sixties and in most men over 70. Many men with an enlarged prostate have no trouble at all. In others, the bigger gland presses on the urethra or affects how the bladder works. This causes lower urinary tract symptoms (LUTS), such as a weak flow, straining, or needing to pass urine often and at night.
An enlarged prostate does not turn into cancer and does not raise the chance of prostate cancer. Symptoms can stay the same, get worse or improve over time. Mild symptoms often need only simple changes and regular check-ups. Bothersome symptoms can be eased with medicines, and surgery is an option when medicines do not help or problems develop.
In Pakistan
In a review of prostate tissue reports at Jinnah Postgraduate Medical Centre, Karachi (2014 to 2018), about 6 in 10 samples showed BPH, while some men were found to have advanced prostate cancer at a younger age, so urinary symptoms in older men deserve a proper check-up.
Symptoms
- Difficulty or delay in starting to pass urine (hesitancy)
- A weak or slow urine flow, or needing to strain
- A flow that stops and starts (intermittency)
- Dribbling or leaking at the end of passing urine
- Feeling that the bladder has not fully emptied
- Needing to pass urine often during the day
- Waking at night to pass urine, often two or more times (nocturia)
- A sudden strong urge to pass urine that is hard to hold (urgency), sometimes with leaking
Causes and risk factors
Causes
- Normal hormone changes as men get older; the exact cause is not known
- Dihydrotestosterone (DHT), a strong form of the male hormone testosterone made inside the prostate, which drives the gland to grow
- Growth of the inner part of the prostate that surrounds the urethra, which can narrow the passage and block the flow (benign prostatic obstruction)
What makes it more likely
- Age: the strongest risk factor; BPH is common after 50 and becomes more common with every decade
- A father or brother with BPH
- Being overweight or obese
- Metabolic syndrome (a mix of a large waist, high blood pressure, high blood sugar and abnormal cholesterol)
- Diabetes
- Drinking a lot of alcohol or caffeine
Complications
Most men with BPH never have serious problems, but some do. The most important one is acute urinary retention, a sudden and painful inability to pass any urine, which needs emergency care. Urine can also build up slowly in the bladder over months (chronic retention). If the pressure backs up to the kidneys, it can cause swelling of the kidneys and kidney damage. Urine left in the bladder makes urinary tract infections and bladder stones more likely. The prostate can sometimes bleed, causing blood in the urine. Over a long time the bladder muscle can become weaker. Symptoms can come back even after surgery.
When to see a doctor
- You cannot pass any urine at all, with severe pain low in the belly or a swollen bladder you can feel: go to the emergency department straight away
- Fever, shivering or chills with urinary symptoms
- Blood or pus in the urine
- Pain in the back, side or lower belly with urinary symptoms
- Passing much less urine than usual
- Your bladder still feels full after passing urine, or symptoms have not improved after a couple of months of self-care
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Diagnosis
A doctor will ask about your symptoms, how much they bother you, how much and what you drink, other illnesses and all the medicines you take. You may be asked to fill in a short symptom questionnaire and to keep a bladder diary (a record of when and how much you drink and pass urine) for at least three days. The doctor will examine your belly and usually do a digital rectal examination, gently feeling the prostate with a gloved finger through the back passage. A urine test checks for infection, blood and sugar.
A PSA blood test (prostate-specific antigen) may be offered after the doctor explains what a high result could mean, because it is mainly used to look for prostate cancer. Other common tests are a urine flow test, an ultrasound scan to see how much urine stays in the bladder after you go, and a blood test for kidney function if kidney problems are suspected or surgery is planned. A scan of the prostate, a camera test of the bladder (cystoscopy) or detailed bladder pressure tests (urodynamics) are used for some men, for example before surgery.
Treatment
- Mild symptoms that do not bother you much: watchful waiting with lifestyle changes and regular check-ups
- Bothersome moderate or severe symptoms: an alpha-blocker is usually the first medicine, as it relaxes the muscle in the prostate and bladder neck and often works within days
- Larger prostate or higher risk of the problem getting worse: a 5-alpha reductase inhibitor to shrink the gland, often together with an alpha-blocker for long-term treatment; it takes at least six months to work
- Mainly urgency and passing urine often: your doctor may add a bladder-relaxing medicine (antimuscarinic) or a beta-3 agonist, after checking that your bladder empties well
- Men who also have erectile problems may be offered tadalafil, a PDE5 inhibitor, alone or with an alpha-blocker
- If medicines do not help, or if retention, repeated infections, bladder stones, bleeding or kidney damage develop: surgery, such as TURP (removing the inner part of the prostate through the urethra) or laser enucleation (HoLEP); open surgery may be used for a very large prostate
- Your doctor decides the medicine and dose and reviews your symptoms regularly; do not stop or change medicines without advice
Medicines in Pakistan
Medicines a doctor may use, by group. Read the role: some are only for special cases. Each link opens our page for that medicine, with every brand and its official DRAP price. Your doctor decides which medicine and dose are right for you.
- Cold and flu remedies with decongestants or antihistamines (Paracetamol Pseudoephedrine Chlorpheniramine, Ibuprofen Pseudoephedrine, Chlorpheniramine): over-the-counter cold, flu and sinus medicines containing a decongestant or an antihistamine can make it harder to pass urine; ask a pharmacist for a suitable alternative
| Group | Role | Medicines |
|---|---|---|
| Alpha-blockers | first choice for bothersome moderate or severe symptoms; relax the prostate and bladder neck and work within days; can cause dizziness or low blood pressure on standing and changes in ejaculation, and you must tell an eye surgeon before cataract surgery | Chosen by your specialist |
| 5-alpha reductase inhibitors | for men with a larger prostate or higher risk of progression; shrink the gland slowly over at least six months and lower the risk of retention and surgery; can reduce sex drive and cause erection problems; they lower the PSA level by about half, so tell any doctor checking your PSA | Chosen by your specialist |
| Antimuscarinics (bladder relaxants) | for mainly urgency and frequent passing of urine, alone or added to an alpha-blocker; not used if a lot of urine stays in the bladder after passing urine; can cause dry mouth and constipation | Chosen by your specialist |
| Beta-3 agonists | another option for urgency and frequent passing of urine, alone or with an alpha-blocker; not used in severe uncontrolled high blood pressure | Chosen by your specialist |
| PDE5 inhibitors | an option for urinary symptoms, especially in men who also have erectile dysfunction; must not be taken with nitrate heart medicines | Chosen by your specialist |
Also used (not yet in our price list): Tamsulosin (alpha-blocker), Alfuzosin (alpha-blocker), Silodosin (alpha-blocker), Finasteride (5-alpha reductase inhibitor), Dutasteride (5-alpha reductase inhibitor), Solifenacin (antimuscarinic), Tolterodine (antimuscarinic), Oxybutynin (antimuscarinic), Trospium (antimuscarinic), Mirabegron (beta-3 agonist), Tadalafil (PDE5 inhibitor)
Self-care and prevention
Self-care
- Cut down on tea, coffee, fizzy drinks, alcohol and drinks with artificial sweeteners, especially in the evening
- Spread your drinks through the day and drink less in the two hours before bed, but do not cut fluids so much that you become dehydrated
- Try double voiding: after passing urine, wait a moment and then try again to empty the bladder fully
- To stop after-dribble, gently press behind the scrotum and stroke forward along the urethra to empty it (urethral milking)
- Bladder training: with your doctor's guidance, slowly lengthen the time between visits to the toilet
- Treat constipation, because a full bowel can press on the bladder
- Exercise regularly, keep warm and find ways to manage stress
- Ask your doctor or pharmacist to review all your medicines, including water tablets (diuretics), some antidepressants and cold remedies
Prevention
- There is no proven way to stop the prostate growing with age
- Keeping a healthy weight and staying active may lower the risk of troublesome urinary symptoms
- Control your weight, blood sugar and blood pressure, as obesity, metabolic syndrome and diabetes are linked to BPH
- Limit alcohol and caffeine
- Avoid cold and sinus remedies with decongestants or antihistamines if you already have symptoms
Common questions
Is an enlarged prostate the same as prostate cancer?
No. BPH is a non-cancer growth and it does not turn into cancer or raise your risk of prostate cancer. But both conditions are common in older men and can cause similar symptoms, so a doctor should check any new urinary symptoms.
How quickly do BPH medicines work?
Alpha-blockers often ease symptoms within a few days to a week. 5-alpha reductase inhibitors work slowly, taking at least six months, and need to be taken long term. Your doctor will check how well a medicine is working.
Do BPH medicines affect sex?
Some can. Alpha-blockers can change ejaculation, and 5-alpha reductase inhibitors can lower sex drive or cause erection problems. Talk to your doctor if this happens rather than stopping the medicine yourself; there may be another option.
Will I need an operation?
Most men do not. Surgery is usually considered when symptoms are severe or not helped by medicines, or when problems such as urine retention, repeated infections, bladder stones, bleeding or kidney damage develop. Your doctor will explain the options and their side effects.
Can I take cold and flu medicines if I have an enlarged prostate?
Be careful. Many over-the-counter cold, flu and sinus products contain decongestants or antihistamines that can make it harder to pass urine and may lead to retention. Ask a pharmacist for a product that is safe for you.
Sources
- European Association of Urology (EAU). Disease Management - EAU Guidelines on the Management of Non-neurogenic Male LUTS - Uroweb (2026).
- European Association of Urology (EAU). Diagnostic Evaluation - EAU Guidelines on the Management of Non-neurogenic Male LUTS - Uroweb (2026).
- MedlinePlus (US National Library of Medicine). Enlarged prostate: MedlinePlus Medical Encyclopedia (2025).
- StatPearls (NCBI Bookshelf). Benign Prostatic Hyperplasia (2024).
- nidirect (Northern Ireland government health information). Benign prostate enlargement | nidirect (2025).
- Pakistan Journal of Medicine and Dentistry (via DOAJ). Frequency and Trends of Prostatic Diseases in a Subset of Karachi Population: A Retrospective Study (2024).
Prepared from the sources listed below by the MedInfoBase team. Last reviewed 16 October 2026. This page is general health information, not medical advice. It gives no doses and does not replace a doctor: talk to your doctor or pharmacist before starting, stopping or changing any medicine. How we write and check our pages.
Related conditions
Urinary tract infection (UTI)Kidney stonesChronic kidney diseaseConstipation