BPH Benign prostatic hyperplasia Causes & Treatment

BPH is most common in men over the age of 50, but it can affect younger men too. 

Diagnosis of benign prostatic hyperplasia (BPH)

Diagnosing benign prostatic hyperplasia (BPH)—an enlargement of the prostate gland that commonly affects men as they age—relies on a combination of clinical evaluation, symptom assessment, and diagnostic testing. The goal is to confirm that symptoms are due to BPH and not another condition, such as prostate cancer or infection.

1. Medical history and symptom review

Diagnosis begins with a detailed discussion about symptoms and medical background. The doctor will ask about:

• Urinary symptoms such as difficulty starting urination, weak stream, dribbling, or frequent night-time urination.

• Duration and severity of symptoms, including how much they interfere with daily life.

• Medication use, as some drugs (like antihistamines or decongestants) can worsen urinary problems.

• Other health issues, including diabetes or neurological conditions that might affect bladder function.

Patients may also complete a symptom score questionnaire (such as the International Prostate Symptom Score, IPSS) to measure the severity of their urinary problems and track improvement over time.

2. Physical examination

A digital rectal examination (DRE) is an essential part of diagnosing BPH. During this exam, the doctor gently inserts a gloved, lubricated finger into the rectum to feel the prostate’s size, shape, and consistency.

• A smooth, firm, and enlarged prostate usually suggests BPH.

• A hard or irregular surface may prompt further testing to rule out prostate cancer.

3. Urine tests

A urinalysis helps detect signs of infection, blood, or sugar in the urine. This test rules out other causes of urinary symptoms such as urinary tract infections (UTIs), bladder stones, or diabetes-related changes.

4. Blood tests

A blood test may include:

• Prostate-specific antigen (PSA): Measures PSA levels in the blood. PSA can be slightly elevated in BPH, but a markedly high level may indicate prostate cancer, warranting further investigation.

• Kidney function tests (urea, creatinine): Assess whether long-term urinary obstruction has affected kidney performance.

5. Urinary flow test (uroflowmetry)

This simple test measures how quickly urine flows during urination. Patients urinate into a special device that records flow rate and pattern. A weak or interrupted flow may indicate obstruction caused by prostate enlargement.

6. Post-void residual volume test

Using an ultrasound scan or a catheter, doctors measure how much urine remains in the bladder after urination. A high post-void residual (PVR) volume suggests incomplete bladder emptying, often due to BPH.

7. Ultrasound imaging

An ultrasound of the prostate and bladder provides detailed images that help estimate prostate size and detect complications such as bladder thickening, stones, or residual urine. In some cases, a transrectal ultrasound (TRUS) gives a more precise measurement of prostate volume.

8. Cystoscopy (if needed)

If symptoms are severe or the diagnosis is uncertain, a cystoscopy may be performed. This involves inserting a thin, flexible tube with a camera into the urethra to view the bladder and prostate directly. It helps detect structural blockages, strictures, or bladder abnormalities.

Key takeaway

Diagnosing benign prostatic hyperplasia involves ruling out other conditions with similar symptoms and understanding how much the enlarged prostate is affecting bladder function. Once confirmed, the results guide treatment options—ranging from lifestyle adjustments and medication to minimally invasive procedures or surgery.