If you find yourself getting up multiple times during the night to urinate, or you feel like you can never fully empty your bladder, you are not alone. For millions of men over 50, these frustrating urinary symptoms stem from a common and treatable condition called benign prostatic hyperplasia, or BPH. Understanding the causes, recognizing the symptoms, and knowing your treatment options can help you take control of your quality of life.
What Is Benign Prostatic Hyperplasia (BPH)?
BPH is a non-cancerous enlargement of the prostate gland, a walnut-sized organ that sits below the bladder and surrounds the urethra. As the prostate grows, it can compress the urethra and obstruct the normal flow of urine, leading to a range of bothersome lower urinary tract symptoms (LUTS).
BPH is extremely common and strongly associated with aging. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), about 50% of men between ages 51 and 60 have histological evidence of BPH, and that figure rises to approximately 90% by age 85. While not all men with an enlarged prostate develop symptoms, a significant number experience urinary difficulties that affect their daily activities, sleep, and overall well-being.
Recognizing the Symptoms: Lower Urinary Tract Symptoms (LUTS)
BPH-related symptoms typically develop gradually and can range from mildly annoying to significantly disruptive. The most common lower urinary tract symptoms include:
- Urinary frequency — needing to urinate more often than usual, especially during the day
- Urgency — a sudden, strong need to urinate that is difficult to postpone
- Nocturia — waking up two or more times per night to urinate
- Weak urine stream — a noticeably reduced force of flow
- Intermittent stream — flow that stops and starts during urination
- Hesitancy — difficulty initiating the urine stream
- Straining — needing to push or bear down to urinate
- Incomplete emptying — the sensation that the bladder has not fully drained after urinating
- Post-void dribbling — continued leaking or dripping after finishing urination
The AUA/IPSS Symptom Score
Healthcare providers frequently use the American Urological Association Symptom Index (AUA-SI), also known as the International Prostate Symptom Score (IPSS), to quantify the severity of your symptoms. This validated seven-question survey scores symptoms from 0 to 35. Scores of 0 to 7 indicate mild symptoms, 8 to 19 indicate moderate symptoms, and 20 to 35 indicate severe symptoms. Your score helps guide treatment decisions and allows your provider to track your response to therapy over time.
Lifestyle Modifications: The First Line of Defense
For men with mild BPH symptoms, behavioral and lifestyle changes can provide meaningful relief without medication. Even men on medical therapy benefit from incorporating these strategies:
Fluid Management
Reducing fluid intake in the two to three hours before bedtime can significantly decrease nocturia. Aim for steady hydration throughout the day rather than consuming large volumes at once. Total daily fluid intake does not typically need to be restricted unless directed by your provider.
Dietary Adjustments
Caffeine and alcohol are both bladder irritants that can worsen urinary frequency and urgency. Limiting or avoiding coffee, tea, carbonated beverages, and alcoholic drinks, particularly in the evening, may reduce symptom severity. Spicy foods and artificial sweeteners can also irritate the bladder in some individuals.
Bladder Training
Timed voiding and bladder training techniques involve gradually increasing the intervals between bathroom trips. By consciously delaying urination when urgency strikes, you can retrain the bladder to hold larger volumes and reduce the overall frequency of voiding.
Physical Activity and Weight Management
Studies have shown that regular physical activity is associated with reduced risk of BPH progression. Maintaining a healthy weight through diet and exercise may also help, as obesity has been linked to increased prostate growth and more severe LUTS.
Medications for BPH
When lifestyle modifications alone are not enough to manage symptoms, several medication classes have proven effective for BPH treatment.
Alpha-Blockers
Alpha-adrenergic blockers are typically the first-line pharmacologic therapy for BPH. These medications relax smooth muscle in the prostate and bladder neck, improving urine flow and reducing obstructive symptoms. They generally provide noticeable improvement within days to weeks.
- Tamsulosin (Flomax) — the most commonly prescribed alpha-blocker for BPH. It is prostate-selective, meaning it has fewer cardiovascular side effects than older agents.
- Alfuzosin (Uroxatral) — another prostate-selective option with a favorable side effect profile.
- Silodosin (Rapaflo) — highly selective for the prostate with rapid onset of action.
Common side effects include dizziness, lightheadedness, retrograde ejaculation, and nasal congestion. Men taking alpha-blockers should rise slowly from sitting or lying positions to avoid orthostatic hypotension.
5-Alpha Reductase Inhibitors (5-ARIs)
5-ARIs work by blocking the conversion of testosterone to dihydrotestosterone (DHT), the hormone primarily responsible for prostate growth. These medications can shrink the prostate by 20% to 30% over six to twelve months, and they are most effective in men with significantly enlarged prostates.
- Finasteride (Proscar) — inhibits type 2 5-alpha reductase. Also available at a lower dose (1 mg) for hair loss treatment under the brand name Propecia.
- Dutasteride (Avodart) — inhibits both type 1 and type 2 5-alpha reductase, resulting in a more complete suppression of DHT.
Because 5-ARIs take several months to reach full effect, they are often combined with alpha-blockers for more immediate symptom relief. Potential side effects include decreased libido, erectile dysfunction, and reduced ejaculatory volume. Notably, 5-ARIs can lower PSA levels by approximately 50%, which must be accounted for during prostate cancer screening.
Combination Therapy
For men with moderate-to-severe symptoms and an enlarged prostate, combining an alpha-blocker with a 5-ARI has been shown to be more effective than either medication alone. The landmark MTOPS and CombAT trials demonstrated that combination therapy reduced the risk of BPH progression, acute urinary retention, and the need for surgical intervention.
PDE5 Inhibitors
Tadalafil (Cialis) at a daily dose of 5 mg is FDA-approved for the treatment of BPH symptoms. It works by relaxing smooth muscle in the prostate and bladder. Tadalafil can be especially convenient for men who also have erectile dysfunction, as it addresses both conditions with a single medication. It should not be used in combination with alpha-blockers without careful medical guidance due to the risk of blood pressure changes.
Minimally Invasive Procedures
For men who do not respond adequately to medication, experience intolerable side effects, or prefer to avoid long-term drug use, several minimally invasive procedures are available.
UroLift (Prostatic Urethral Lift)
The UroLift system uses small implants to hold the enlarged prostate tissue out of the way, opening the urethra without cutting or removing tissue. It is typically performed as an outpatient procedure under local anesthesia. UroLift has the advantage of preserving sexual function, including ejaculatory function, which is often affected by other surgical approaches. It is best suited for men with prostates between 30 and 80 grams without a significant median lobe.
Rezum (Water Vapor Thermal Therapy)
Rezum uses convective radiofrequency-generated water vapor (steam) delivered directly into the obstructing prostate tissue. The thermal energy causes the targeted cells to die, and the body gradually reabsorbs the treated tissue over the following weeks. Rezum is an outpatient procedure that can treat prostates with a median lobe component. Most men experience symptom improvement within two to four weeks, with full results by three months.
Surgical Treatment: TURP and Beyond
Transurethral resection of the prostate (TURP) remains the gold standard surgical treatment for BPH. During TURP, a urologist inserts a specialized instrument through the urethra and removes excess prostate tissue that is blocking urine flow. TURP provides significant and durable symptom improvement but requires anesthesia, a brief hospital stay, and a recovery period of several weeks.
Other surgical options include laser enucleation procedures such as HoLEP (holmium laser enucleation of the prostate) and simple prostatectomy for very large glands. Your urologist will recommend the most appropriate procedure based on prostate size, symptom severity, and your overall health.
Red Flags: When to Seek Immediate Care
While BPH itself is not dangerous, certain complications require prompt medical attention. Contact your healthcare provider or seek emergency care if you experience:
- Acute urinary retention — a sudden, complete inability to urinate. This is a medical emergency.
- Hematuria — visible blood in the urine
- Recurrent urinary tract infections
- Bladder stones — indicated by pain during urination or intermittent flow
- Signs of kidney damage — such as flank pain, swelling, or changes in urine output
When to See a Provider About BPH
Many men delay seeking care for urinary symptoms because they assume it is simply a normal part of aging. While BPH is indeed common, effective treatments exist that can dramatically improve your quality of life. You should consider scheduling an evaluation if:
- You wake up two or more times per night to urinate
- You experience urinary urgency that interferes with daily activities
- Your urine stream has become noticeably weaker
- You feel like your bladder never fully empties
- You have started limiting activities, travel, or social events because of bathroom access concerns
A telehealth visit is a convenient and effective way to begin the evaluation process. Your provider can review your symptom history, discuss your AUA Symptom Score, order any necessary lab work, and initiate treatment or refer you to a specialist if needed.
Frequently Asked Questions
What is BPH and what causes it?
Benign prostatic hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland that commonly occurs as men age. The exact cause is not fully understood, but it is linked to changes in hormone levels, particularly dihydrotestosterone (DHT), that occur with aging. By age 60, roughly 50% of men have some degree of BPH, and by age 85, about 90% are affected.
How do I know if my frequent urination is caused by BPH?
Common signs that frequent urination may be caused by BPH include urinary urgency, getting up multiple times at night to urinate (nocturia), a weak or intermittent urine stream, difficulty starting urination, and a feeling of incomplete bladder emptying. A healthcare provider can evaluate your symptoms using the AUA Symptom Index, perform a physical exam, and order tests such as a PSA level or urinalysis to determine whether BPH is the underlying cause.
What medications are used to treat BPH?
The most commonly prescribed medications for BPH include alpha-blockers such as tamsulosin (Flomax) and alfuzosin (Uroxatral), which relax the muscles around the prostate and bladder neck to improve urine flow. 5-alpha reductase inhibitors like finasteride (Proscar) and dutasteride (Avodart) work by shrinking the prostate over several months. For some patients, combination therapy or PDE5 inhibitors like tadalafil (Cialis) may also be recommended.
Can BPH be treated through telehealth?
Yes, many aspects of BPH evaluation and management can be handled through telehealth. A provider can review your symptoms, discuss your AUA Symptom Score, prescribe or adjust medications like alpha-blockers, and monitor your response to treatment remotely. If a physical examination, lab work, or surgical referral is needed, your telehealth provider will coordinate appropriate in-person follow-up.
When should I see a doctor about BPH symptoms?
You should see a healthcare provider if you experience urinary symptoms that interfere with your daily life or sleep, such as frequent urination, urgency, or nocturia. Seek prompt medical attention if you experience an inability to urinate (acute urinary retention), blood in your urine (hematuria), recurrent urinary tract infections, bladder stones, or signs of kidney problems. Early evaluation allows for more treatment options and better outcomes.
Does BPH increase the risk of prostate cancer?
BPH itself is not a precursor to prostate cancer and does not increase your risk of developing it. However, both conditions are common in older men and can occur at the same time, and they can produce similar urinary symptoms. Your provider may recommend a PSA blood test and digital rectal exam to help distinguish between the two when appropriate.
How long does it take for tamsulosin to start working?
Tamsulosin (Flomax) often improves urinary flow within a few days to two weeks of starting therapy. The full benefit is usually seen by four to six weeks. If you do not notice meaningful improvement after a month at a therapeutic dose, talk with your provider about adjusting the dose or trying a different medication.
Can saw palmetto or other supplements treat BPH?
Saw palmetto is one of the most popular supplements used for BPH, but rigorous clinical trials, including large NIH-funded studies, have not consistently shown it works better than placebo. Other supplements like beta-sitosterol and pygeum have limited evidence. If you want to try a supplement, tell your provider so it can be checked for interactions and so progress can be tracked objectively.
Will BPH medications affect sexual function?
Some BPH medications can affect sexual function. Alpha-blockers like tamsulosin and silodosin commonly cause retrograde or reduced ejaculation. 5-alpha reductase inhibitors like finasteride and dutasteride can lower libido, cause erectile dysfunction, or reduce ejaculate volume in a minority of men. Most of these effects are reversible when the medication is stopped, and tadalafil (Cialis) is an option that may help both BPH and erectile dysfunction.
Can BPH be managed by telehealth in Maryland, Washington, or Delaware?
Yes. InnoCre can evaluate BPH symptoms, calculate your AUA Symptom Score, prescribe non-controlled medications such as tamsulosin, alfuzosin, finasteride, dutasteride, or daily tadalafil, and monitor your response by telehealth for adults living in Maryland, Washington, or Delaware. If a digital rectal exam, imaging, urodynamic testing, or surgical evaluation is needed, your provider will refer you to a local urologist.
Ready to see a provider?
Book a same-day telehealth visit with a board-certified provider from home.
Book a Visit →Same-day visits · HSA/FSA accepted · Licensed in MD, WA & DE
Atul S. Vellappally, DNP, CRNP, FNP-BC
Founder, Innocre Telehealth. Board-certified Family Nurse Practitioner with doctoral-level training in evidence-based and precision medicine. Licensed in Maryland, Washington, and Delaware.
This article is for informational purposes only and does not constitute medical advice. If you are experiencing a medical emergency, call 911.
Sources
- American Urological Association. Management of Benign Prostatic Hyperplasia (BPH). AUA Clinical Guidelines, 2021 (Amended 2023). auanet.org
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Prostate Enlargement (Benign Prostatic Hyperplasia). niddk.nih.gov
- Mayo Clinic. Benign Prostatic Hyperplasia (BPH) — Diagnosis and Treatment. mayoclinic.org
- McConnell JD, Roehrborn CG, Bautista OM, et al. The Long-Term Effect of Doxazosin, Finasteride, and Combination Therapy on the Clinical Progression of Benign Prostatic Hyperplasia. N Engl J Med. 2003;349(25):2387-2398.
- Roehrborn CG, Siami P, Barkin J, et al. The Effects of Combination Therapy with Dutasteride and Tamsulosin on Clinical Outcomes in Men with Symptomatic Benign Prostatic Hyperplasia: 4-Year Results from the CombAT Study. Eur Urol. 2010;57(1):123-131.
Related Services