An enlarged prostate may cause problems urinating and other symptoms.

The prostate gland plays a significant role in the male reproductive system. About the size of a ping-pong ball or walnut, it sits between the base of your penis and rectum.

The prostate’s function is producing fluid that, when combined with sperm cells and other fluids, makes semen. It’s also responsible for changing the hormone testosterone to the biologically active form, dihydrotestosterone (DHT).

In many biological males, the prostate continues to grow throughout life. When your prostate becomes larger than typical, it’s an enlarged prostate or benign prostatic hyperplasia (BPH). An enlarged prostate is not cancerous.

BPH is more common as men age. According to the Prostate Cancer Foundation, about 20% of men in their 50s have an enlarged prostate, 60% of men in their 60s, and 70% of men by age 70.

Let’s examine the symptoms of an enlarged prostate, other conditions those symptoms might suggest, and when you should see a doctor.

As your prostate grows, it may squeeze the urethra, which may also affect the bladder. This can slow or prevent the passage of urine and make it difficult for you to urinate. Over time, the bladder muscle may even weaken and fail to completely empty, which can lead to bladder or kidney infections. Less commonly, the urine flow becomes completely blocked, which is a medical emergency.

Many BPH symptoms relate to urination, including:

  • feeling a frequent need to urinate
  • waking up many times throughout the night to urinate
  • frequently having trouble starting to urinate
  • a urine stream that is almost always weak, slow, or stops and starts again
  • dribbling following urination on a regular basis
  • the regular feeling that you can’t empty your bladder
  • the inability to urinate at all

Less common symptoms include:

  • pain during urination or following ejaculation
  • urine that smells unusual or has an unusual color

Some conditions bear a strong resemblance to an enlarged prostate and share symptoms. It’s possible to have more than one of these conditions at the same time, but one does not necessarily lead to another.

  • Prostatitis is inflammation of the prostate due to bacterial infection. There are three types of prostatitis:
    • Acute bacterial prostatitis develops rapidly from a bacterial infection.
    • Chronic bacterial prostatitis develops when the infection comes back repeatedly.
    • Chronic prostatitis, also known as chronic pelvic pain syndrome, commonly causes pain in the low back, groin, or tip of the penis.
  • Prostate cancer occurs when cancer cells develop in the prostate gland.
  • Urinary tract infections and kidney or bladder stones can cause pain and the need to urinate frequently.
  • Overactive bladder occurs due to spasms in the bladder that cause it to contract. This may happen even if you’ve just gone to the bathroom, giving you the urge to urinate again.
  • One sign of diabetes is the need to urinate frequently.
  • Obesity can place extra pressure on the bladder, causing the feeling of needing to urinate frequently.
  • Bladder cancer might be possible if blood is present in your urine along with frequent urination.
  • Interstitial cystitis creates the need to urinate urgently and frequently and also causes pelvic pain.

Anyone with symptoms of an enlarged prostate should see a doctor for an evaluation. Treatments can relieve symptoms.

See a doctor soon if there is blood in the urine, pain or burning with urination, or if you cannot urinate at all.

Medical emergency

Go to the nearest emergency room if you experience the following emergency symptoms:

  • you cannot urinate at all
  • you have fever and chills along with painful, frequent, urgent urination
  • there is blood in your urine
  • you have pain in your lower abdomen and urinary system

An enlarged prostate is not cancer and does not mean you are more likely to develop cancer. About one-quarter of men with BPH in the United States will experience problems urinating that will require treatment. Here are some common questions about the condition.

What happens when a man’s prostate is enlarged?

The prostate gland continues to grow throughout life. For some, it becomes large enough to press on the bladder and pinch the urethra. This can slow or stop the flow of urine.

There are two types of prostate growth. With one type, cells grow around the urethra, squeezing it off. With the other type, cells grow into the outlet of the bladder, known as the bladder neck. The second type, called middle-lobe prostate growth, usually requires surgery.

Can an enlarged prostate go back to normal?

Once a prostate has become enlarged, certain medications can help shrink it. They work to stop the prostate from growing, reduce the current size, and relax the urinary tract to help improve urine flow.

These medications include:

  • alpha-blockers to relax muscles
  • 5-alpha reductase inhibitors to prevent the prostate from converting testosterone to DHT (DHT may contribute to prostate growth)

Several types of surgery are also available to remove portions of an enlarged prostate or widen the urethra.

What causes an enlarged prostate?

Researchers are not clear about the cause of prostate enlargement. They think hormone changes during aging play a role. As men age, testosterone levels decrease, but estrogen levels do not. These changing hormone levels might cause too much cell growth.

Another idea focuses on the role of DHT, a hormone that’s critical in the development of the prostate. Some 5-alpha reductase inhibitor medications shrink the prostate by slowing the production of DHT.

An enlarged prostate is a common problem in men as they age. Although researchers are unclear on the cause, they believe age-related hormone changes play a role.

An enlarged prostate can pinch off the urethra and put pressure on the bladder, making urination difficult. A doctor should check most symptoms. If you have fever or chills, or blood in your urine, you should see a doctor immediately. The complete inability to urinate also needs to be treated as a medical emergency.

Treatment for an enlarged prostate includes medications or surgery, depending on the severity and where the obstruction occurs.