An enlarged prostate – the symptoms, and what can be done

The prostate sits below the bladder and surrounds the tube urine passes through. It enlarges with age in most men, and when it presses on that tube it changes how you pass urine. This is benign enlargement — a different thing from prostate cancer, though the symptoms overlap enough that it is worth being assessed rather than assumed.

• A weaker stream, or one that starts and stops.
• Difficulty getting started, and straining.
• Dribbling at the end.
• Needing to go more often, and urgently.
• Getting up at night, often the symptom that finally prompts a visit.
• A feeling that the bladder has not emptied.

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A clinician will usually ask about the pattern, examine the prostate, test the urine to exclude infection, check kidney function, and discuss whether a PSA blood test is right for you.

PSA is a decision rather than a routine — it can be raised by benign enlargement, infection, recent ejaculation or a bike ride, and it can lead to investigating and treating cancers that would never have caused harm. That trade-off is worth a real conversation, particularly for men of African ancestry, in whom prostate cancer is more common and more aggressive, and for anyone with a family history.

1. 1Stop fluids two hours before bed, and empty the bladder before sleeping.
2. 2Cut evening alcohol and caffeine, both of which increase urine production and irritate the bladder.
3. 3Do not cut daytime fluids drastically — concentrated urine makes urgency worse.
4. 4Try double voiding: pass urine, wait a moment, and try again.
5. 5Check your other medicines. Decongestants and some antihistamines can worsen retention markedly, and are worth asking a pharmacist about.
6. 6Treat constipation, which presses on the bladder.

One group relaxes the muscle at the bladder outlet and works within days; the other shrinks the prostate over months. They are often used together. Surgery is effective for symptoms that do not respond, and is far less drastic than it was.

• The relaxing medicines can cause dizziness on standing, especially with the first doses — take them at night and get up slowly.
• They can also cause a dry orgasm, which is harmless but alarming if unexpected.
• The prostate-shrinking medicines lower PSA readings, which the person interpreting the test needs to know.
• They can reduce libido or cause erectile difficulty in a minority.
• Tell any eye surgeon you are on or have taken these before cataract surgery — they affect the pupil during the operation.