If you’ve been getting up three times a night to use the bathroom or standing at the urinal waiting for something to happen, there’s a good chance your prostate is the problem. This is BPH Benign Prostatic Hyperplasia and it’s incredibly common in men over 50.

Here’s the simple version: your prostate sits just below your bladder and wraps around the tube that carries urine out of your body. When it grows, which it tends to do with age, it squeezes that tube and makes everything harder. Not dangerous in the way cancer is, but genuinely disruptive to daily life.

The good news? It’s very treatable.

So why does this happen?

Honestly, we don’t have a complete answer. What we do know is that hormone changes as men age play a big role. Testosterone levels shift, the prostate responds, and over time it grows. It doesn’t happen the same way or at the same pace for everyone.

Most men start noticing symptoms in their 50s or 60s, but the risk keeps climbing with age.

A few things make BPH more likely: obesity, diabetes, heart disease, a family history of it, and not getting much exercise. None of these are guarantees, but they do matter.

What about younger men?

Younger men don’t typically get true BPH, but urinary symptoms can still show up, usually from prostate inflammation, infection, or something else going on. If you’re in your 30s or 40s and having trouble urinating, don’t brush it off. Get it checked.

What does BPH actually feel like?

The symptoms sneak up on you. Most men don’t wake up one day with a problem; it builds gradually and they adapt to it without realising how much it’s affecting them.

Things to watch for:

• Needing to urinate more often, including through the night
• A weak or slow stream
• Starting and stopping mid-flow
• Straining to go
• That frustrating feeling that you haven’t fully emptied
• Sudden strong urges you can’t always control

Some men have mild symptoms they barely notice. Others find it’s quietly wrecking their sleep, their travel plans, and their confidence. In serious cases when BPH goes untreated for too long it can lead to urinary retention, infections, bladder stones, or kidney problems. That’s when things get complicated.

When should you actually see someone?

This is where a lot of men get it wrong. They assume it’s just ageing, put up with it, and come in years later when things are much harder to treat.

See a doctor if:

• Urinary symptoms have been going on for a while
• You’re struggling to empty your bladder
• There’s blood in your urine
• You keep getting urinary tract infections
• You suddenly can’t urinate at all

That last one acute urinary retention is a medical emergency. Don’t wait on that.

The earlier you come in, the more options you have.

How do we figure out what’s going on?

A proper diagnosis isn’t just a quick check. Your doctor will sit down with you, go through your symptoms in detail, and build a picture of how this is affecting your life.

From there, tests might include a physical exam, a digital rectal exam (DRE), a PSA blood test, urine analysis, an ultrasound, a uroflowmetry test to measure your stream, and a check on how much urine is left after you go. Together, these confirm whether BPH is the issue, how much it’s affecting the bladder, and whether something else might be going on.

Medication — the usual first step

For most men, medication is where we start. It works well and it buys time sometimes a lot of it.

• Alpha-blockers – Relax the muscles around the prostate and bladder neck. Most men feel the difference within a few weeks.
• 5-alpha reductase inhibitors – Work differently they actually shrink the prostate over time by targeting hormone activity. They take longer to kick in but work better for men with significantly enlarged prostates.

Sometimes both are used together, which tends to give better control than either one alone.

When medication isn’t enough

If symptoms aren’t responding to medication or complications have developed, a procedure makes sense.

• TURP – Has been the go-to surgical option for decades. Prostate tissue is removed through the urethra no external incision and it reliably improves urine flow.
• HoLEP – A laser procedure that’s become the preferred option for larger prostates. It’s technically more demanding but delivers strong, lasting results with less bleeding and a faster recovery.

Other laser procedures and minimally invasive options also exist, and in the right patient, they work very well. Recovery tends to be quicker and disruption to daily life is minimal.

There’s no single best procedure for everyone. Prostate size, symptom severity, your health, and your lifestyle all factor into the decision.

What about supplements?

Men ask about this a lot. The honest answer is that the evidence is mixed. Some supplements have been studied, a few show modest benefits in certain people, but none of them replace proper treatment or medical evaluation.

If you’re relying on a supplement to manage urinary symptoms, you’re probably delaying care you actually need.

What happens if you ignore it?

BPH doesn’t fix itself. Left alone, it tends to get worse and the complications that come with it are serious. Urinary retention, recurrent infections, bladder damage, kidney problems. These are all avoidable with timely treatment.

FAQs

• What’s the best treatment for BPH? – The one that fits your situation. Mild symptoms might respond to medication alone. More significant cases may need a procedure. There’s no universal answer.
• Which medication works best? – Alpha-blockers and 5-alpha reductase inhibitors are the main options. Which one or whether to use both depends on your prostate size and symptoms.
• Which surgery is best? – TURP and HoLEP are the most widely performed and best-evidenced. The right choice depends on your prostate size and overall health.
• Can younger men get BPH? – True BPH is uncommon in younger men, but urinary symptoms absolutely can and do occur. They need proper evaluation to find the actual cause.
• When is a catheter needed? – When the bladder can’t empty at all acute urinary retention. It’s a temporary measure while the underlying problem is addressed.
• Can BPH be prevented? – Not with certainty. But staying at a healthy weight, exercising regularly, and managing conditions like diabetes and high blood pressure all help.

About Dr. Sandeep Bafna

Dr. Bafna has treated a wide range of urological conditions in men, from early BPH managed with medication to complex cases requiring advanced laser surgery. Every patient gets a thorough assessment and a treatment plan built around their specific symptoms, lifestyle, and goals not a standard protocol applied to everyone.

If urinary symptoms are getting in the way of your daily life, the right time to do something about it is now.