Enlarged Prostate in Men: Causes, Symptoms and Treatment Options

What is benign prostatic hyperplasia (BPH)?

Benign prostatic hyperplasia (BPH) refers to the non-cancerous enlargement of the prostate gland that occurs naturally with age. The prostate is located just below the bladder and surrounds the urethra — the tube through which urine exits the body. As the prostate grows, it may begin to compress the urethra, making it harder to urinate.

This condition affects more than 90% of men over the age of 80, though not all experience symptoms. However, from around the age of 50, many men begin to notice signs of urinary difficulty. In Belgium, thousands of men seek treatment for urinary problems linked to prostate enlargement every year.

Common symptoms of BPH

Prostate enlargement may cause:

• a weak or slow urine stream,
• frequent urination, especially at night,
• urgency or difficulty delaying urination,
• involuntary leakage or dribbling,
• straining to start urination,
• a sensation that the bladder is not fully emptied,
• in some cases, blood in the urine.

Interestingly, the severity of symptoms does not always match the size of the prostate. Some men with significantly enlarged prostates have mild symptoms, while others with smaller glands experience major discomfort. In rare cases, complications such as urinary retention, bladder infections, kidney issues or bladder stones may arise.

Diagnosis and assessment

When symptoms interfere with daily life, a healthcare professional can assess the situation through a series of steps. A standardised questionnaire, such as the IPSS (International Prostate Symptom Score), helps measure symptom frequency and severity. A physical exam — including a digital rectal exam — is used to check the prostate’s size and consistency. Blood tests may be performed to assess PSA (Prostate-Specific Antigen) levels and kidney function. Ultrasound imaging of the bladder and kidneys may also be recommended.

Treatment options

Medical treatments

Several medications can help manage prostate-related urinary issues:

• Alpha-blockers to relax the muscles around the bladder neck and ease urine flow,
• 5-alpha-reductase inhibitors to reduce the size of the prostate over time,
• Herbal therapies as a natural alternative in mild cases.

Each medication has its own profile and possible side effects, such as reduced ejaculation or erectile issues. In cases of urgency-related incontinence, anticholinergic drugs may also be prescribed. The main goal is to relieve symptoms and improve day-to-day comfort — ideally without relying on incontinence products.

Surgical treatments

If medication fails to bring relief or if complications arise, surgical intervention may be necessary. Common procedures include laser resection of the prostate, incision of the bladder neck, or open prostatectomy. These surgeries aim to restore better urine flow by widening the narrowed passage in the prostate.