Benign Prostatic Hyperplasia Symptoms

BPH symptoms arise only when the expanding nodules of prostate tissue (and the tightening of smooth muscle) place enough pressure on the urethra to interfere with urine flow. Some men with a very enlarged prostate may have no urethral obstruction; others with a modest enlargement may experience significant symptoms of BPH.

Constriction of the urethra leads to changes in the bladder. To compensate for the obstruction, the muscular wall of the bladder contracts more strongly to expel urine. These stronger contractions cause the bladder wall to thicken, making the bladder cavity smaller and decreasing its capacity to store urine.

Over time, the bladder holds smaller and smaller amounts of urine, resulting in the need to urinate more frequently. As the urethral obstruction worsens, the contractions can no longer empty the bladder completely, causing urinary retention. Urine retained in the bladder (residual urine) can become infected or can lead to the formation of bladder stones (calculi).

Less often, the kidneys become damaged from increased pressure on them from the overworked bladder or from an infection that has spread from the bladder to the kidneys.

Symptoms of bladder problems include

  • difficulty in starting to urinate
  • a weak urinary stream
  • a sudden, strong desire to urinate (urinary urgency)
  • an increased frequency of urination
  • frequent nighttime urination (nocturia)
  • a sensation that the bladder is not empty after urinating

When urinary retention occurs, and as the bladder becomes more sensitive to retained urine, a man may become incontinent because he is unable to respond quickly enough to urinary urgency.

A bladder infection or stone can cause burning or pain during urination. Blood in the urine (hematuria) may also be a sign of BPH, but most men with BPH do not experience it.

Sometimes a man with BPH suddenly becomes unable to urinate at all, even though his condition is responding to treatment. This problem, called acute urinary retention, requires immediate medical attention in a hospital emergency room. It is easily treated with catheterization—the passing of a tube into the bladder through the urethra to allow the urine to drain.

Acute urinary retention may be triggered by

  • an extended delay in urination
  • a urinary tract infection
  • alcohol intake
  • use of certain drugs such as antidepressants, decongestants, and tranquilizers

Acute urinary retention often occurs unexpectedly, and it is impossible to predict whether a man with only modest urinary tract symptoms will develop the condition. Some men who experience acute urinary retention will need to undergo surgery to remove excess prostate tissue.

Publication Review By: H. Ballentine Carter, M.D.

Published: 07 Apr 2011

Last Modified: 31 Aug 2015