Enlarged Prostate Symptoms and Signs

July 1, 2024

This page was reviewed under our medical and editorial policy by Wesley Yip, M.D., assistant professor, Division of Urology and Urologic Oncology, Department of Surgery, City of Hope^® Cancer Center Duarte

The prostate may enlarge in many directions. When it grows, it may squeeze the urethra (the tube that drains urine out of the body), making it difficult for urine to leave the bladder. The bladder may become irritated and weakened, and unable to empty fully (urinary retention).

These lower urinary tract symptoms in men may worsen over time. Worsening symptoms may lead to urinary tract infections, as well as bladder or kidney problems. Therefore, it’s essential to look for the signs of an enlarged prostate.

Symptoms of Enlarged Prostate

An enlarged prostate, also called benign prostatic hyperplasia (BPH), may cause several symptoms that may develop slowly and become bothersome over time.

Some symptoms are related to the narrowing of the urethra (obstruction), making it difficult to get urine out, while others indicate that the extra growth is pressing against the bladder, causing bladder irritability and more frequent urination.

Other health conditions may cause similar problems, so men experiencing these symptoms should contact their doctor.

Symptoms indicating an obstruction from a narrowed urethra may include:

• A weak urine stream
• An urge to strain or trouble starting to urinate
• A urine stream that stops and starts
• Dribbling at the end of urinating
• Urine that has an odd color or smell
• Pain when urinating or ejaculating
• Inability to empty the bladder completely

Signs of bladder irritability may include:

• Frequent urination
• The urgent need to urinate
• Leakage when needing to urinate (urinary incontinence)
• Sleep disturbances that lead to waking at night more than twice to urinate (nocturia)

Over time, an enlarged prostate may lead to rare, but more serious symptoms, such as:

• Acute urinary retention (suddenly cannot urinate at all)
• Urinary tract infection
• Bladder or kidney damage
• Bladder or kidney stones

Can an Enlarged Prostate Cause ED?

An enlarged prostate, or BPH, does not generally cause erectile dysfunction (ED), but some BPH treatments may affect a man’s ability to achieve and maintain an erection.

Some of these BPH treatments may include medications used alone, or combined, for relief of symptoms and improved quality of life. Two examples of medications that may impact erections or ejaculation include alpha-blockers and 5 alpha-reductase inhibitors.

Alpha-blockers: These medications relax the muscles around the prostate and bladder so that urine flows more freely. Side effects may include lower blood pressure, dizziness and retrograde ejaculation.

Examples of alpha-blockers include:

• Terazosin (Hytrin®)
• Doxazosin (Cardura®)
• Tamsulosin (Flomax®)
• Alfuzosin (Uroxatral®)
• Silodosin (Rapaflo®)

5 alpha-reductase inhibitors: This class of medications shrinks the prostate by lowering the levels of hormones responsible for prostate growth. Side effects may include decreased sex drive, impotence (inability to get or keep an erection) and a smaller amount of ejaculation fluid. Finasteride (Proscar®) and dutasteride (Avodart®) are examples of these drugs.

Surgical treatments to remove all or part of the prostate may have an impact on erections and ejaculation. Surgical treatments may include the following.

Simple prostatectomy: In this procedure, the prostate is removed using one of three techniques through an opening in the skin. It is used mainly in men with prostates that have grown very large. It may require open surgery, in which one cut (incision) is made; laparoscopic surgery, which entails several smaller cuts; or robotic surgery, which is laparoscopic surgery using robotic arm assistance. Prostate surgery comes with risks of bleeding, incontinence and impotence.

Transurethral resection of the prostate (TURP): During this common procedure to treat an enlarged prostate, a doctor inserts a special instrument through the urethra to laser any prostate tissue causing blockage. There is a risk of bleeding, incontinence and impotence. Some patients develop retrograde ejaculation in which the semen flows backward into the bladder instead of out through the penis. They may also have no ejaculate fluids.

Other minimally invasive prostate procedures: Like TURP, in these procedures, no incisions are made. Instead a special tool is inserted through the opening of the penis in order to reach the prostate area (transurethral). Many of these techniques use cutting tools, heat, laser or microwave pulses to remove excess prostate tissue. The benefits of these approaches typically include less bleeding and a lower risk of incontinence and impotence compared to more invasive surgery. However, some risk of erection problems and retrograde ejaculation remains.

Does an Enlarged Prostate Affect a Man Sexually?

Having an enlarged prostate, and having treatments for an enlarged prostate, may affect men sexually in several ways.

Erectile dysfunction: ED is the inability to get or keep an erection long enough to have sexual intercourse. An enlarged prostate itself does not cause ED, but some treatments may contribute to it.

• Patients may experience difficulties getting an erection temporarily after surgery. In many cases, men who were able to achieve erection before surgery are able to get one afterward. In some cases, however, sexual side effects from surgery may be permanent.
• Some medications for enlarged prostate may cause men to have trouble getting an erection.

Libido: Libido is another term for sex drive or interest in sexual activity. This may be affected in many ways. For example, urinary symptoms and worry that medications or surgical treatments for BPH may affect a man’s ability to have an erection and may dampen an interest in sex. Also, medications such as 5-alpha reductase inhibitors lower DHT (dihydrotestosterone) levels, which affect sex drive.

Retrograde ejaculation: Surgeries such as TURP or prostatectomy may cause retrograde ejaculation. This may make it impossible to naturally father children. However, semen may be removed from the bladder and stored for assisted fertility procedures. Medications such as pseudoephedrine or imipramine may help by tightening the muscles in the bladder neck, making it harder for the semen to enter the bladder.

Sexual satisfaction: Enjoyment of sexual activity may be affected by some BPH symptoms, such as pain with ejaculation or urinating. Even though it may be short lived, the anticipation of a painful climax may prevent any satisfaction. Severe urinary symptoms may also affect enjoyment.

Sexual issues may be physical, psychological or emotional, and all are important. There are many ways the care team may help patients cope with and manage changes in sexual function. Treatments are available.

Understanding the effects, especially of procedures, and discussing any concerns with a health care provider helps many men regain their sexual function more quickly. Partner involvement also plays a key role in understanding and navigating changes in sexual function, whether they are temporary or permanent changes.