Benign Prostatic Hyperplasia BPH
1/15/2026 by Anne Nguyen, DO
Waking Up at Night? It Might Be Your Prostate, Not Your Bladder.
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 (BPH).
What is BPH?
Benign prostatic hyperplasia is a non-cancerous 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 years of age and 80% of men 70-79 years of age. Risk factors include age >50, family history, obesity, and diabetes or metabolic syndrome.
What are the symptoms?
The symptoms can range from mild to severe and includes hesitancy (difficulty starting urination), weak stream, straining, incomplete emptying, urinary frequency, nocturia (waking up at night to urinate), and urinary urgency.
How do you diagnose it?
- Symptom scoring at the doctor’s office
- Physical exam including a digital rectal exam
- Urinalysis - PSA (to rule out prostate cancer, not to diagnose BPH)Post-void residual (bladder ultrasound) to evaluate for incomplete bladder emptying
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 (urinating, waiting a moment, and trying again)
More than one 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.
Bottom line:
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 doctor.
Anne Nguyen, DO, is a Family Medicine Physician and current Geriatric Medicine Fellow at Mayo Clinic in Rochester. She completed her medical degree at the University of the Incarnate Word School of Osteopathic Medicine. Dr. Nguyen completed 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.