Benign prostatic hyperplasia
1/15/2026 by Anne Nguyen, D.O.
If you find yourself waking up multiple times a night to use the restroom or struggling to start a urinary stream, you are not alone. These are classic signs of benign prostatic hyperplasia or BPH.
What is BPH?
Benign prostatic hyperplasia is a noncancerous condition that commonly occurs in aging men when the prostate enlarges. It can cause lower urinary tract symptoms because the prostate grows and compresses the urethra, making it harder to pass urine.
What causes it?
BPH is mainly related to hormonal changes that occurs naturally with aging, especially shifts in testosterone and dihydrotestosterone, (DHT), as well as estrogen-to-androgen balance.
Who gets BPH?
BPH affects approximately 25% of men age 40–49 and 80% of men age 70–79. Risk factors include being over 50, family history, obesity and diabetes, or metabolic syndrome.
What are the symptoms?
The symptoms can range from mild to severe and include:
- Hesitancy or difficulty starting urination.
- Weak stream.
- Straining.
- Incomplete emptying.
- Urinary frequency.
- Nocturia or waking up at night to urinate.
- Urinary urgency.
How is it diagnosed?
BPH is diagnosed through these methods:
- Symptom scoring at the doctor’s office.
- Physical exam, including a digital rectal exam.
- Urinalysis
- Post-void residual, or bladder ultrasound, to evaluate for incomplete bladder emptying
A prostate-specific antigen, or PSA, test may be used to rule out prostate cancer. However it is not used to diagnose BPH.
What is the treatment and management?
Many men successfully manage BPH for years. The American Academy of Family Physicians recommends self-management strategies including
- limiting evening fluid intake.
- reducing caffeine and alcohol consumption.
- Practice double voiding, which is urinating, waiting a moment and trying again.
More than half of affected men have at least moderate symptoms, and approximately one-third receive medical treatment. Primary medical treatment can include medications for urinary symptom relief and slowing prostate growth. There are surgical intervention options for severe symptoms and signs of BPH-related complications.
How can you can prevent it?
While you can’t entirely prevent BPH, addressing modifiable lifestyle factors, such as maintaining physical activity, managing hypertension and controlling diabetes, may help reduce the risk of bothersome symptoms.
BPH is common and manageable. It is not cancer and does not increase prostate cancer risk, though both can coexist. If you are noticing changes in your urinary habits, talk to your healthcare professional.
Anne Nguyen, DO, is a Family Medicine physician and current Geriatric Medicine Fellow at Mayo Clinic in Rochester, Minnesota. She completed her medical degree at the University of the Incarnate Word School of Osteopathic Medicine and a Family Medicine residency at Baylor Scott & White Health in Texas. Her interests include preventive care, post-acute and long-term care, and home-based care settings.