Benign prostatic hyperplasia, or BPH, is an enlarged prostate gland. Its symptoms can look like prostate cancer, but it’s not. BPH symptoms can also be hard to tell apart from urinary tract infections and bladder or kidney problems.
Your doctor can do tests like a digital rectal exam and a biopsy to know for sure whether you have BPH.
Once you have a diagnosis, treatments can help you avoid complications such as urinary tract infections or damage to the bladder or kidneys.
7 BPH Questions
The American Urological Association has a ratings system to rate how severe your symptoms are. It’s called the “BPH Symptom Score Index.”
It includes 7 questions about what’s been happening with you over the past month. They are:
- How often have you felt like you weren’t able to fully empty your bladder when you finished peeing?
- How often have you had to go again less than 2 hours after you last finished?
- How often have you stopped and started while peeing?
- How often have you found it hard to wait to go?
- How often have you had a weak stream?
- How often have you had to push or strain to start urinating?
- How many times do you have to get up and use the bathroom during the night?
Each question is assigned points from 0 (none at all) to 5 (almost always). Your score will show whether your BPH is mild or severe and guide your treatment.
You can see your usual doctor for a diagnosis, or you can visit a urologist, who is a specialist in diseases of the urinary tract and male reproductive system. This will likely involve the following:
Medical history: They will first ask you questions about your health and any medicines you take.
General physical: Then you’ll have a physical exam. The doctor will feel your belly and groin areas to check for any lumps.
Digital rectal exam: This is a way for your doctor to feel if your prostate is enlarged. The prostate is right next to your rectum.
First, you’ll bend over the exam table or you might lie on your side with your knees pulled up to your chest. Your doctor will gently slide a gloved, lubricated finger into your rectum to feel your prostate. They will feel for any growths or lumps.
You might feel the need to pee or a little discomfort, but the exam should be quick.
These tests can look for other causes of BPH symptoms, such as a urinary tract infection, a bladder problem, or prostate cancer.
Urine test. For this, you’ll pee into a cup. A treated piece of paper placed into your urine can show whether you have an infection. It might also be checked for small traces of blood that could signal bladder cancer or other conditions.
Blood test. This can check your levels of two chemical waste products: creatinine and blood urea nitrogen. High levels of these might mean your kidneys aren’t working as well as they should.
- PSA test. This checks for levels of what’s called prostate specific antigen, or PSA, in your blood. PSA is a protein your prostate makes. Both BPH and prostate cancer can raise your PSA level. This test alone can’t confirm that you have BPH. You will need other tests, too. If your level is high and your doctor suspects cancer, you’ll likely have a prostate biopsy.
Urodynamic tests. This group of tests checks how well you hold and release urine in your bladder and your urethra, which is the narrow tube in your penis through which pee and semen flow. You might get these tests at your doctor’s office or at a hospital.
- A post-void residual measurement checks how much urine is left in your bladder after you go to the bathroom. First you will be asked to pee. Then the doctor will place a thin tube called a catheter into your urethra. The tube will be threaded into your bladder to remove any urine that’s left inside. That leftover liquid is measured. It can also be checked with an office ultrasound or bladder scanner. Cold jelly is placed over the bladder and the ultrasound measures the left over urine.
- Uroflowmetry measures how fast you release urine. This is called your flow rate. During the test, you’ll pee into a special toilet or container. A slow flow might mean you have weak bladder muscles or a blockage in your urinary tract.
- Urodynamic pressure uses a meter to find out how much pressure needs to be on your bladder for you to pee. It also tests your flow rate. This test can show whether an enlarged prostate is blocking the flow out of your bladder.
Cystoscopy. This test lets the doctor see inside your urethra and bladder. You will first get medicine so you don’t feel pain. You are usually awake for this quick procedure. There may be mild discomfort, which the local anesthesia helps with.
The doctor will insert a tube called a cystoscope through your urethra into your bladder. The tube has a lens on one end that lets them look for problems inside your urinary tract.
Transrectal ultrasound. An ultrasound uses sound waves to make a picture of your prostate gland. It can show whether it is enlarged or you have a tumor. You can have this test at your doctor’s office or a hospital.
A technician will insert a thin device called a transducer into your rectum. As the device moves around, it will show different parts of your prostate.
Biopsy. For this test, you will first get medicine so you don’t feel any pain. The doctor will use an ultrasound, CT, or MRI scan to see your prostate gland. They will then use a needle to take a piece of tissue. The sample will be sent to a lab where a technician will look at it under a microscope to see whether it is cancerous.
Talk to your doctor about your test results. Make sure you understand what they mean and how they will affect your treatment.
- American Urological Association: “American Urological Association Guideline:
- Management of Benign Prostatic Hyperplasia (BPH)."
- Cedars-Sinai: “Digital Rectal Exam (DRE)."
- Johns Hopkins Medicine: “Benign Prostatic Hyperplasia (BPH)."
- National Cancer Institute: “Prostate-Specific Antigen (PSA) Test."
- National Institute of Diabetes and Digestive and Kidney Diseases: “Cystoscopy and Ureteroscopy," “Prostate Enlargement," “Urodynamic Testing."
- Urology Care Foundation: “How is BPH Diagnosed?" “What is Urethral Stricture Disease?”