Up all night to use the bathroom? Don't ignore the early signs of an enlarged prostate
Maybe it starts with waking up once or twice a night to use the bathroom. Then the urine stream becomes weaker. It takes longer to empty the bladder. Over time, those symptoms become so routine that many men simply learn to live with them.
According to David Dalton, M.D., a urologist at UT Health Austin and assistant professor in the Dell Medical School Department of Surgery and Perioperative Care, that mindset can prevent men from getting treatment for a condition that is both common and highly treatable.
What is BPH?
Benign prostatic hyperplasia, commonly known as BPH, affects millions of men as they age.
The condition occurs when the prostate continues to grow over time, eventually pressing against the urethra and making it more difficult to urinate.
"The biggest thing I would encourage people to understand is that there are a lot of solutions that can help you urinate better and improve your quality of life," Dalton said.
Common signs and symptoms
Because BPH develops gradually, many men don't recognize how much the condition is affecting them until symptoms become more severe.
Common symptoms include:
A weak urine stream
Difficulty starting urination
Feeling unable to completely empty the bladder
Frequent urination
Sudden urgency to urinate
Waking up multiple times during the night to urinate
In severe cases, men may be unable to urinate at all and require catheterization.
Why early evaluation matters
One of the biggest misconceptions about BPH is that it will improve on its own.
"I think a lot of guys get used to their symptoms," Dalton said. "Because the process is slow, they often don't realize how much things have changed."
While symptoms may initially seem manageable, untreated BPH can become a progressive problem. Over time, prolonged obstruction can affect bladder function and increase the risk of complications such as urinary retention or the need for more extensive treatment.
"The myth is that BPH gets better with time," Dalton said. "Typically it doesn't."
Treatment options for BPH
The good news is that treatment options exist at nearly every stage of the condition.
For some men, symptom management may begin with lifestyle changes, including:
Reducing caffeine and other bladder irritants
Limiting fluids before bedtime
Practicing timed voiding
Taking extra time to fully empty the bladder
Others benefit from medications that relax the prostate, shrink prostate tissue or improve urinary flow.
When symptoms become more severe or medications are no longer effective, procedural treatments may be recommended.
How HoLEP works
One of the most effective long-term treatment options is holmium laser enucleation of the prostate, commonly known as HoLEP.
While other less invasive procedures are available, they typically have less durable outcomes, whereas HoLEP removes as much of the portion of the prostate responsible for continued growth as possible, leading to long-lasting results. The procedure is performed through the urethra, requires no external incisions and can be used for prostates of nearly any size.
"HoLEP tends to be a one-and-done type procedure," Dalton said. "Patients do very well in the long term and tend to be very happy with the outcome."
Recovery and long-term outcomes
Recovery requires patience. Some men experience temporary urinary urgency, leakage or blood in the urine as the body heals.
However, most patients see significant improvement within a few months, and the vast majority regain normal urinary control as recovery progresses.
For Dalton, seeing those long-term results is one of the most rewarding aspects of his work.
"It can be a life-changing procedure," he said. "After they heal, these patients tend to be some of my happiest patients."
Don't wait to seek treatment
Whether treatment involves lifestyle changes, medication or a procedure such as HoLEP, seeking care early can help preserve bladder health, improve quality of life and provide more options for treatment.
If urinary symptoms are affecting your daily life, or if something simply doesn't feel right, Dalton encourages men to bring it up with a physician. The earlier BPH is identified, the more opportunities there are to manage it before it becomes a bigger problem.
