Urinary Symptoms and Enlarged Prostate (BPH): Frequency, Nocturia and Weak Stream

What the symptoms are

Doctors group these changes as lower urinary tract symptoms. In plain words:

• Frequency: needing to pass urine more often than usual.
• Nocturia: waking at night to pass urine.
• Weak or interrupted stream: a slow flow, stopping and starting, dribbling at the end, or trouble starting. [1]

None of these proves a particular cause. NIDDK says the same symptoms can come from bladder problems, urinary tract infections (UTIs), prostatitis or prostate cancer. [1] MedlinePlus adds that some medicines, nerve problems, scar tissue in the urethra and some vitamins and supplements can also cause difficulty starting or keeping a stream. [2]

Benign prostatic hyperplasia (BPH)

The prostate is a small gland below the bladder that makes fluid for semen and surrounds the urethra, the tube that carries urine out. [3][4] In BPH (also called an enlarged prostate), the gland grows larger than normal and the growth is not cancer. [1] The NHS adds that an enlarged prostate does not increase the risk of prostate cancer. [3]

How common is it? Experts estimate BPH affects 5% to 6% of men aged 40 to 64 and 29% to 33% of men 65 and older. [1] The cause is not fully known; aging and changing hormone levels are thought to play a part. [1]

Symptom severity does not always match prostate size: a large prostate may cause few symptoms, and a slightly enlarged one can cause many. [1]

Why it is worth getting checked

The NHS stresses that these symptoms should be checked because they can sometimes have more serious causes such as prostate cancer, and early detection can make treatment easier. [3] A doctor typically asks about your symptoms, fluid intake, caffeine and alcohol and medicines, may do a digital rectal exam, and may order a urine test and a PSA blood test. [1][3] The NHS asks you to keep a record for at least 3 days of how much you drink and how often and how much you pass urine. [3]

PSA testing has trade-offs: the result can be inaccurate and you may be offered tests or treatment you do not need, so it is a shared decision. [5]

What helps

Everyday steps (the NHS and NIDDK lists overlap):

• Cut down alcohol and caffeine, which make you pass more urine. [3]
• Drink less in the hours before bed or before going out, but do not cut back too much overall, because that can cause UTIs. [3]
• Stay active and keep a healthy weight; eat enough fiber to avoid constipation. [1][3]
• Take a moment after you finish and try again to empty fully; do not strain. [3]
• Ask a pharmacist whether any medicine you take could be making symptoms worse. NIDDK names cold and cough medicines (decongestants, antihistamines), tranquilizers, antidepressants and diuretics. [1]

Medical treatment depends on severity: watchful waiting, medicines (alpha blockers that relax the bladder neck and prostate, 5-alpha reductase inhibitors that shrink or slow the growth of the prostate, and PDE5 inhibitors), minimally invasive procedures, and surgery. [1] A combination of an alpha blocker and a 5-alpha reductase inhibitor may work better than one alone. [1] Surgery can cause side effects, including sexual problems such as ED, retrograde ejaculation and infertility. [1]

Supplements: the best-known herb for BPH is saw palmetto. The NIH's National Center for Complementary and Integrative Health concludes it is probably not helpful for urinary symptoms of BPH. See Saw palmetto and prostate supplements. [6]