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As you get older, your prostate can get bigger. When this happens, doctors call it benign prostatic hyperplasia, or BPH. This condition is not cancer, and it isn't usually a serious health problem. But it can cause troublesome symptoms, such as having to get up at night to urinate.

If you can cope with the symptoms of an enlarged prostate, you may not need any treatment. But even if your symptoms are mild, it's important to get them checked out by your doctor to make sure that you don't have a more serious condition. And if you do need help for BPH, your doctor can provide treatments to help your symptoms.

Most men find it difficult to talk to their doctors about prostate problems. But don't be embarrassed. Your doctor will have helped lots of men with your symptoms.

• Having an enlarged prostate is common, especially among older men.
• BPH isn't serious, but the symptoms can be similar to those of more serious conditions. So it's important to get checked out by a doctor.
• BPH is often slow to develop, and it doesn't always get worse. Your doctor may try different treatments to work out which one is best for you.
• A wait-and-see approach (called watchful waiting) is becoming more widely used, and traditional surgery for BPH is becoming less common. (This operation is called transurethral resection of the prostate, or TURP.)
• Drugs, herbal treatments and surgery can help your symptoms.
• If you do opt for surgery, there are several new operations that are simpler to perform than a transurethral resection of the prostate (TURP). For many of these new procedures, you don't need a general anesthetic to make you sleep during the operation.
• It's important to discuss the benefits and possible harms of each treatment with your doctor.

To understand BPH and its treatments, you first need to know where the prostate is and how it works. The symptoms of the disease will also make more sense if you know how your prostate is linked to other parts of your body.

Only men have a prostate gland. It's a small, solid gland about the size of a chestnut. It helps make the milky fluid that comes out of your penis when you have an orgasm. Glands make substances that are used somewhere else in your body. The fluid from your prostate helps keep your sperm healthy and also helps them swim freely.

• Your prostate lies at the base of your bladder, the sac that is made of muscle and holds your urine. You can think of the prostate as a small fist resting against a bag of water.
• The front of your prostate is wrapped around your urethra, the tube that runs down from your bladder and through your penis. The urethra carries urine and semen out of your body. (Semen is the name given to your sperm and the fluid they are carried in.) Any change in the size or shape of your prostate can pinch this tube, making it difficult for you to urinate.
• The back of your prostate presses against your rectum. This is why your doctor examines your rectum if there's a problem with your prostate. He or she can feel the gland through your rectum wall.
• The two bundles of nerves that control your erections run on either side of your prostate. Because these nerves are so close to your prostate, they can be damaged by surgery on the gland.
• Your prostate is also linked to your testicles. These are the two organs that make your sperm. They lie in a pouch of skin on either side of your penis. Your sperm are carried by tubes that run from your testicles and through your prostate into your urethra. Your prostate adds its fluid to the sperm when they reach your urethra.¹

If you want to find out more about how your prostate works, see More about what the prostate does.

It's normal for the prostate to grow as boys approach puberty (the time when their sex organs mature). At this time, their bodies start to produce more male sex hormones, and it's these hormones that cause the prostate to grow.

Hormones are chemicals produced by one part of the body that travel through the bloodstream and have an effect on another part. In men, the sex hormones are known as androgens, and the main one is testosterone. Testosterone has two effects on your prostate: it makes your prostate grow at puberty, and it also helps your prostate make fluid to carry your sperm.

Your prostate reaches its adult size by around the time you're 20. Then, at around age 50, it starts growing again in some men.² Doctors aren't sure why this is, but it's probably linked to hormone changes. One theory is that, as you get older, the cells in your prostate respond more to the androgens in your blood and this causes the cells to grow.³

When your prostate starts growing again as you get older, this condition is called benign prostatic hyperplasia, or BPH. Benign means that the condition isn't cancer. Hyperplasia means normal cells are multiplying more quickly than usual. Even though this condition isn't cancer, it may lead to troublesome symptoms in the way your body gets rid of urine. For example, you may have to urinate often and urgently, or you may have to strain to urinate. To read more, see What are the symptoms of an enlarged prostate?

A large prostate is about the size of an apple, and a very large one could be as big as a grapefruit.

Doctors used to think that the symptoms of BPH were caused simply by an enlarged prostate pinching or pressing on the urethra and restricting the flow of urine from the body. Although you're more likely to have trouble urinating if your prostate is large, BPH is not that simple.

Some men with a large prostate have no problems urinating, and some men with a relatively small prostate do.³

Doctors now know that some symptoms can be caused by changes in your bladder that are triggered by changes in your prostate.³ For example, the wall of your bladder may become thick and irritable. This can make your bladder contract (get smaller) when it contains only small amounts of urine. (Normally your bladder contracts when it is full of urine.) This makes you feel like you need to urinate more often. Eventually your bladder may become so weak that it can't empty itself. If urine remains in your bladder, it can cause infections such as cystitis.⁴ To read more, see Complications of an enlarged prostate.

The good news is that lots of treatments are available for BPH, so don't put off seeing your doctor. Also, by getting treatment for BPH as soon as possible, you may prevent future problems with your bladder. Remember that doctors see men with these symptoms every day, so you shouldn't feel embarrassed talking with your doctor about your condition.

There are some things that make it more likely that you will get an enlarged prostate. These things are called risk factors.

• Your age: Your chances of getting an enlarged prostate increase as you get older.⁴
• Your family history: Enlarged prostates seem to run in some families. If your father or brother has had BPH, then you are at greater risk of getting it.
• Your race: Black men seem to have enlarged prostates that need surgery more often than white men do. And Asian men seem to be less likely than white men to need surgery. These trends need more study, and may be due to things such as diet.^{5 6 7}

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment. ©BMJ Publishing Group Limited 2008. All rights reserved.