Benign prostatic hyperplasia (BPH) is a noncancerous enlargement of the prostate gland. While BPH is not life-threatening, it can significantly affect quality of life. The prostate gland surrounds the urethra, the tube that carries urine from the bladder out of the body. As the prostate grows, it can compress the urethra and disrupt normal urine flow.

"BPH is something we as urologists discuss with our patients every single day. Most guys come in saying they're straining to void, waking up four or five times per night, or dealing with weak urinary stream,” said urologist Jeff Morrison, MD. “BPH very common, affecting more than half of men in their 60s. The good news is that now there are more effective treatment options than ever before."

BPH is one of the most common conditions in aging men. According to the National Institutes of Health, more than 50% of men in their 60s and up to 90% of men in their 70s and 80s have BPH. Understanding the signs and knowing your treatment options are important steps toward getting relief.

BPH is one of the most common conditions in aging men. According to the National Institutes of Health, more than 50% of men in their 60s and up to 90% of men in their 70s and 80s have BPH. Understanding the signs and knowing your treatment options are important steps toward getting relief.

Signs and Symptoms of BPH

“Common complaints we as providers hear from patients with BPH are weak stream, inability to urinate and waking up in the middle of the night to urinate,” said George Zlotchenko, MD, a CU Medicine interventional radiologist who treats the condition.

BPH symptoms often develop gradually and range from mild to severe. Common signs include:

• Frequent urination, especially at night (nocturia)
• Difficulty starting the urine stream
• A weak or interrupted urine stream
• A feeling of incomplete bladder emptying
• Urgency to urinate
• Dribbling at the end of urination
• Straining during urination

Not everyone with an enlarged prostate experiences symptoms. In some men, symptoms remain stable for years, while in others they worsen over time. Left untreated, severe BPH can lead to urinary tract infections, bladder damage or kidney problems.

BPH Risk Factors

Several factors can increase the likelihood of developing BPH. “BPH is very common in men in over 40,” said Jeff Morrison, MD, a urologist at CU Medicine. “If anything is keeping a man from urinating normally or causing discomfort, we want to hear about it.”

Common risk factors of BPH are:

Age - The risk of BPH increases significantly after age 50. The condition is rare in men younger than 40.

Family history - Men with a father or brother who had BPH are more likely to develop it themselves.

Diabetes and heart disease - Studies suggest these conditions, as well as the use of beta blockers, may be associated with a higher risk of BPH.

Obesity - Being overweight has been linked to an increased risk of BPH, while physical activity may lower risk.

Lifestyle factors - A sedentary lifestyle and diet high in red meat and fat have been associated with BPH development.

Treatment Options for BPH

Treatment for BPH depends on the severity of symptoms, the size of the prostate and overall health. Options range from lifestyle changes to minimally invasive procedures and surgery. Common BPH treatments are:

Watchful waiting - For mild symptoms, a provider may recommend monitoring without immediate treatment. Regular checkups track any changes in symptoms or prostate size.

Medications – Medications like alpha-blockers help relax the muscles of the prostate and bladder neck to improve urine flow. 5-alpha-reductase inhibitors work to shrink the prostate over time.

Minimally invasive procedures - For men who do not respond well to medication or prefer to avoid surgery, several outpatient options are available. Common procedures include Aquablation therapy, iTind, UroLift™, HoLep, robotic single-port prostatectomy and prostate artery embolization (PAE).

Surgical options - Transurethral resection of the prostate (TURP) is the most common surgical treatment and involves removing part of the prostate tissue. Other surgical approaches include laser therapy and transurethral incision of the prostate (TUIP).

When to Seek Medical Care for BPH

If you are experiencing frequent urination, difficulty starting your stream or a feeling of incomplete emptying, talk to your provider. Symptoms that worsen over time, or that are accompanied by pain, blood in the urine or inability to urinate at all, require prompt medical attention.

If you or a loved one are dealing with urinary symptoms of an enlarged prostate, please contact your primary care provider and consider reaching out to the specialists at CU Medicine Urology – South Denver at Highlands Ranch Specialty Care Center or CU Medicine Urology – UCHealth Cherry Creek Medical Center.