Getting up at night, rushing to the bathroom, a weaker stream: it is easy to shrug these off as getting older. Yet they are classic signs of an enlarged prostate, which most men will deal with at some point. Some symptoms look the same as those of prostate cancer, which is why knowing the signs and the red flags matters. (Based on the insights of Doctor Khalid)
Key Takeaways
- About 90% of men will have prostate enlargement in their lifetime. It is usually benign, is not cancer, and does not raise cancer risk.
- Eight signs: going more often, urgency, waking at night, hesitancy, a poor stream, leaking afterwards, not fully emptying, and retention.
- Passing no urine or only drops, with lower abdominal pain or bloating, is a medical emergency.
- Symptoms alone cannot separate an enlarged prostate from prostate cancer, even for doctors.
- Red flags: blood in semen or urine, unintentional weight loss, drenching night sweats, and unexplained bone, back, rib or chest pain. Only a check with a healthcare professional can tell them apart.
What the Prostate Is and Why It Enlarges
About 90% of men will have some prostate enlargement in their lifetime. The prostate is a small internal gland that sits between the penis and the bladder and surrounds the urethra, the tube that carries urine out of the body. Its job is to produce the thick white fluid that mixes with sperm to form semen. It is about the size and shape of a walnut, but it tends to get bigger as men get older.
This natural enlargement is called benign prostatic enlargement (BPE), also known as BPH in some countries. It is very common, usually appears in men over 50, is not prostate cancer, and does not usually cause serious health problems. Having an enlarged prostate does not raise the risk of prostate cancer, but the symptoms of the two can look very similar.
8 Signs of an Enlarged Prostate
1. Going More Often
If you keep having to stop what you are doing every couple of hours to head to the toilet, that is called increased frequency. An enlarged prostate can press on the tube that carries urine out of the bladder. This narrows the flow and can make the bladder more irritable, so it contracts more often, even when it is not full.
2. Rushing to the Toilet
Sudden urgency is the second sign. As well as going more often, many men find they have to rush and cannot hold their urine as long as they used to. The same irritable bladder mechanism is behind it.
3. Waking at Night to Pass Urine
Needing the toilet at night is called nocturia, and it is one of the most bothersome symptoms. It is not dangerous, but broken sleep leaves men tired and short-tempered the next day.
4. Hesitancy
If you stand waiting for the flow to start, or the first step of urinating takes longer than it used to, that is hesitancy. The urethra is being pressed and narrowed, so urine takes more time and straining to get through.
5. A Poor Urinary Stream
The strong, steady stream you used to have may feel diminished. You might notice more trickling, or a stream that stops and starts.
6. Leaking Afterwards
Terminal dribbling means leaking after you have finished, sometimes into your underwear later on. It is an embarrassing topic for many men, but the cause is simple: urine left in the urethra leaks out. There is a technique to help clear it.
7. Not Completely Emptying Your Bladder
You may make multiple trips and still feel there is a little left. For some men it affects confidence about shopping or traveling when they are unsure toilets will be nearby.
8. Urinary Retention (An Emergency)
If you pass no urine at all, or only a few drops, and you have lower abdominal pain, bloating or a fuller tummy, it could be acute urinary retention. The bladder fills up like a balloon because something is blocking the exit, often the prostate pressing on the tube. This is a medical emergency. Doctors normally pass a catheter, a plastic tube that sits in the bladder and drains the urine. Seek medical help as soon as you can. Men with an enlarged prostate are more prone to retention, and certain medications can raise the risk further, so it is worth asking your doctor or pharmacist about the medicines you take.
Enlarged Prostate or Prostate Cancer?
It is almost impossible, even for a doctor, to tell the two apart from symptoms alone. Most of the symptoms of benign enlargement come from two things: the narrowing of the urethra, and the bladder acting up as it pushes through that narrowing. Prostate cancer can cause the same narrowing, depending on its size and location, so the symptoms can mirror each other exactly.
Red Flags That Call for a Check Sooner
- Blood in the semen: many conditions can cause it, including infection and inflammation, but it is more worrying in a man over 40 and prostate cancer needs to be ruled out.
- Blood in the urine: other things can cause it too. Doctors check the urine for infection first, and if there is none, the picture becomes more suspicious.
- Unintentional weight loss: anyone losing weight without trying needs to find out why.
- New, drenching night sweats.
- Bone, back, rib or chest pains of unknown cause: in late-stage prostate cancer, the disease can spread to the bones.
Erectile dysfunction can also occur in later stages of prostate cancer, though it is not a common way for it to show up.
When to Get Checked
The only way to know whether it is an enlarged prostate or something else is to speak with a healthcare professional, who will need to run some tests. Booking that first visit can feel daunting, but it is the step that settles the question. If you have any of the red flags above, or cannot pass urine, get checked as soon as possible.
Frequently Asked Questions
What are the signs of an enlarged prostate?
Going to the toilet more often, urgency, waking at night, hesitancy, a poor stream, leaking afterwards, a feeling of not emptying completely, and in serious cases urinary retention.
Does an enlarged prostate mean I have prostate cancer?
No. An enlarged prostate is common, usually benign, and does not raise the risk of prostate cancer. The symptoms can look very similar, though, so a check is the only way to know.
What symptoms point to something more serious?
Blood in the semen or urine, unintentional weight loss, drenching night sweats, and bone, back, rib or chest pains of unknown cause. Erectile dysfunction can also occur in later stages.
When is it an emergency?
If you pass no urine or only a few drops and have lower abdominal pain or bloating. This is acute urinary retention, and you should seek medical help as soon as you can.
Prostate Checklist
- ☐ Note how often you urinate, including at night
- ☐ Notice hesitancy, a weak stream, dribbling or incomplete emptying
- ☐ Ask your doctor or pharmacist whether any of your medicines can raise retention risk
- ☐ Watch for blood in urine or semen
- ☐ Watch for unintentional weight loss, night sweats or unexplained bone pain
- ☐ Book a visit with a healthcare professional rather than waiting
- ☐ Seek urgent care if you cannot pass urine
This article is for general educational purposes and is not a substitute for personalized medical advice. Urinary symptoms can have several causes, so speak with a qualified healthcare provider for an evaluation. If you cannot pass urine, seek medical help immediately.