Prostate symptoms and treatment problems are often first noticed as changes in urination: a weaker stream, difficulty getting started, waking several times at night, urgency, dribbling or feeling that the bladder did not empty properly.
These symptoms are common, particularly as men get older, but they do not automatically mean that the prostate is enlarged. Similar symptoms can come from the bladder, urinary infection, prostatitis, diabetes, medication, urethral narrowing, neurological conditions and other urological problems.
Common prostate-related symptoms include a weak or stop-start urine stream, difficulty starting urination, dribbling, frequent or urgent urination, waking at night to urinate and a feeling that the bladder has not emptied. Treatment depends on the cause and severity. Mild benign prostate enlargement may sometimes be monitored with conservative measures, while bothersome symptoms may require prescription medicine or urological procedures. Pain, fever, blood in the urine or inability to pass urine needs prompt conventional medical assessment.
What Is the Prostate?
The prostate is a gland below the bladder that surrounds part of the urethra, the tube that carries urine out through the penis. It also contributes fluid to semen.
The prostate commonly becomes larger with age. A non-cancerous increase in prostate size is called benign prostate enlargement (BPE) or benign prostatic hyperplasia (BPH).
An enlarged prostate can narrow or compress the urethra in some men, but prostate size and symptom severity do not always match. Some men have a relatively large prostate with few symptoms, while others have bothersome urinary problems with less enlargement.
Common Prostate and Urinary Symptoms in Men
These are often called lower urinary tract symptoms (LUTS). LUTS describe the symptoms; they do not identify the diagnosis.
Does Urinary Frequency Always Mean an Enlarged Prostate?
No. Frequent urination, urgency and waking at night can occur with benign prostate enlargement, but they may also be related to:
- overactive bladder
- urinary infection
- diabetes or high glucose
- diuretic medication
- large fluid intake, alcohol or caffeine
- sleep disturbance or sleep apnoea
- bladder dysfunction
- neurological disease
- prostatitis
- other urological conditions
That is why a man should not self-diagnose BPH simply because he gets up several times at night.
Benign Prostate Enlargement: BPH or BPE
Benign prostate enlargement is common in older men and is not cancer. When enlargement narrows the urethra or affects bladder function, urinary symptoms can develop.
Possible symptoms include:
- weak flow
- difficulty starting
- stop-start urination
- dribbling
- incomplete emptying
- urgency
- frequency
- night-time urination
Not every enlarged prostate requires treatment. Management depends more on symptom severity, complications, prostate characteristics and quality-of-life impact than on prostate size alone.
BPH Is Not Prostate Cancer
Benign prostate enlargement is non-cancerous and does not by itself mean that a man has a higher risk of developing prostate cancer. The conditions arise differently, although a man can have both at the same time.
It is also important to understand that early prostate cancer often causes no symptoms. Urinary symptoms are more commonly related to non-cancerous prostate or bladder conditions, but persistent changes should still be medically assessed.
A man with prostate-cancer concerns should discuss his individual risk, examination and PSA testing with an appropriately qualified medical practitioner.
What Is Prostatitis?
Prostatitis means inflammation of the prostate. It is different from ordinary benign enlargement.
Symptoms can include:
- pain or burning during urination
- difficulty urinating
- frequent urination
- pelvic or perineal discomfort
- penile, scrotal or testicular pain
- pain during or after ejaculation
- fever or chills in acute infection
Acute bacterial prostatitis can be serious. Fever, severe illness, painful urinary symptoms or inability to pass urine requires prompt conventional medical assessment. A herbal supplement or naturopathic programme should not delay antibiotic or emergency treatment where bacterial prostatitis is suspected.
Which Prostate Symptoms Need Prompt Medical Assessment?
Arrange conventional medical assessment if you have:
- persistent difficulty starting urination
- progressively weaker urine flow
- repeated night-time urination that is affecting sleep
- ongoing urgency or frequency
- a feeling that the bladder does not empty properly
- painful urination
- recurrent urinary infection
- pelvic or perineal pain
- blood in urine or semen
- unexplained weight loss
- new persistent back, hip or pelvic pain
- sexual-function changes alongside prostate or urinary symptoms
Seek urgent medical care if you cannot pass urine
Complete inability to urinate can represent acute urinary retention and requires urgent conventional medical care.
Also seek prompt or urgent care for urinary symptoms accompanied by high fever, chills, severe pain, vomiting, marked weakness or signs of serious illness.
How Are Prostate and Urinary Symptoms Assessed?
A GP or urologist may consider:
- the type, duration and severity of urinary symptoms
- medical and surgical history
- medication, supplement and herbal-product use
- fluid, caffeine and alcohol patterns
- diabetes and neurological history
- physical examination
- a digital rectal examination where appropriate
- urinalysis to look for blood, infection or other abnormalities
- a PSA discussion where clinically relevant
- a urinary symptom questionnaire or bladder diary
Specialist assessment may additionally involve urine-flow measurement, assessment of urine left in the bladder after voiding, imaging, cystoscopy or other tests when clinically indicated.
NICE recommends that uncomplicated lower urinary tract symptoms should not automatically trigger every urological test. Assessment should be guided by the symptom pattern and clinical findings.
What Is a PSA Test?
PSA stands for prostate-specific antigen. It is a blood test that may be discussed when urinary symptoms suggest benign prostate enlargement, when the prostate feels abnormal on examination or when a man is concerned about prostate cancer.
A PSA result is not a cancer diagnosis.
PSA may be raised for reasons other than cancer, and an abnormal result may lead to further medical assessment such as repeat testing, MRI or specialist review depending on the situation.
Men should discuss the potential benefits, limitations and next steps of PSA testing with a medical practitioner rather than ordering or interpreting the test in isolation.
How Is an Enlarged Prostate Treated?
Treatment depends on:
- how bothersome the symptoms are
- whether urinary retention is present
- risk of progression
- prostate size and examination findings
- other medical conditions
- current medication
- sexual side-effect priorities
- kidney/bladder complications
1. Conservative or watchful management
Men with mild uncomplicated symptoms may sometimes be managed initially with monitoring and practical measures such as:
- adjusting fluid timing without becoming dehydrated
- reducing evening caffeine or alcohol if they worsen symptoms
- reviewing medicines that may contribute to urinary difficulty
- using a bladder diary
- managing constipation
- avoiding rushing or excessive straining during urination
These strategies can reduce inconvenience but do not prove that the prostate has become smaller.
2. Alpha-blocker medicines
Qualified medical prescribers may use alpha blockers such as tamsulosin or related medicines in selected men with moderate to severe LUTS. These medicines primarily relax smooth muscle around the prostate and bladder outlet; they are not generally used to shrink the prostate.
Possible side effects can include dizziness, blood-pressure effects and ejaculation changes. Prescription decisions belong with a medical practitioner.
3. 5-alpha-reductase inhibitors
Medicines such as finasteride or dutasteride may be considered for selected men with prostate enlargement and higher risk of progression. Unlike alpha blockers, these medicines can reduce prostate volume over time.
They may affect libido, erection or ejaculation in some men and also change how PSA results are interpreted. Do not start, stop or change them without medical advice.
4. Other bladder-directed medicines
Some men have prominent urgency, frequency or overactive-bladder symptoms. Depending on the clinical assessment, a medical prescriber may consider other medication classes.
Urinary urgency should not be treated by guessing which organ is responsible.
5. Procedures and surgery
Men with significant obstruction, retention, recurrent complications or symptoms that have not responded adequately to other management may be referred to urology.
Depending on anatomy, prostate size, availability and individual priorities, specialist options may include:
- TURP
- HoLEP
- prostatic urethral lift in selected men
- water-vapour or other minimally invasive procedures in appropriate settings
- prostate artery embolisation in selected cases
- other endoscopic or surgical approaches
These are conventional urological procedures and are not provided by Sandton Men’s Clinic.
Can Herbs Shrink an Enlarged Prostate?
No commonly sold herb has been shown to reliably shrink an enlarged prostate in the way selected prescription medicines can.
Some botanical extracts have been studied for urinary symptoms, but symptom improvement is not the same as reducing prostate volume.
NICE guidance advises against offering phytotherapy as treatment for lower urinary tract symptoms in men. Evidence also varies between extracts and products, so results from one standardised preparation should not be assumed to apply to every supplement bearing the same herb name.
Read our detailed evidence review: Herbs That Shrink the Prostate: What Really Works?
Can Sex Affect an Enlarged Prostate?
Sexual activity, erections and ejaculation are closely associated with how men experience prostate and urinary health, but sex should not be promoted as a treatment that shrinks the prostate.
Prostate enlargement, prostate medication and prostate procedures can also affect ejaculation or erection confidence in some men.
Read our focused guide: Sex and Enlarged Prostate: Is It Safe?
Prostate Symptoms and Erectile Dysfunction
Urinary symptoms and erectile dysfunction can occur in the same man, particularly as age, cardiovascular risk, medication use and chronic health conditions change. One does not automatically prove that the other is caused by the prostate.
Men with persistent erection problems should also consider the broader ED pathway rather than assuming that treating the prostate will automatically restore erections.
Read erectile dysfunction treatment options for the wider context.
Private Prostate and Urinary Symptom Self Health Check
This self-check is educational and cannot diagnose BPH, prostatitis or prostate cancer.
- Is your urine stream weaker or more stop-start than before?
- Do you struggle to start urinating or need to strain?
- Do you feel that the bladder does not empty completely?
- How often are you waking at night to urinate?
- Are urgency or daytime frequency affecting work, travel or sleep?
- Is there pain or burning during urination?
- Is there pelvic, perineal, penile, testicular or ejaculation pain?
- Have you seen blood in your urine or semen?
- Have medication, diabetes, fluid intake, caffeine or alcohol patterns changed?
- Are you unable to pass urine, or do you have fever, severe pain, vomiting or marked illness?
How to interpret this:
- Mild urinary symptoms without red flags: arrange a routine medical assessment and track the pattern with a bladder diary.
- Bothersome weak stream, incomplete emptying or repeated nocturia: GP/urology assessment may be appropriate.
- Pain, burning, fever or pelvic pain: infection/prostatitis or another condition needs conventional medical review.
- Blood in urine or semen: medical assessment is needed.
- Unable to pass urine: seek urgent conventional medical care.
When to See a Urologist
Urological assessment may be appropriate when:
- urinary symptoms are significantly bothersome
- symptoms persist despite conservative or medical management
- urinary retention occurs
- urinary infection is recurrent
- kidney impairment related to urinary obstruction is suspected
- blood in the urine is present
- prostate cancer is suspected
- PSA or examination findings need specialist interpretation
- a prostate procedure or surgery is being considered
If you are unsure which practitioner to see, our guide to doctors for men’s problems explains the role of a GP, urologist and other specialists.
How Sandton Men’s Clinic Fits Into Prostate Wellness
Sandton Men’s Clinic is a premium men’s wellness clinic led by George Mulaudzi, Naturopath. The clinic provides natural, holistic, functional and non-surgical support around general men’s wellbeing.
Within a prostate-health discussion, a naturopathic consultation may explore:
- urinary-symptom patterns
- fluid, caffeine and alcohol habits
- sleep
- body composition
- physical activity
- nutrition
- constipation
- medication and supplement history
- sexual-health concerns
- whether conventional medical or urological referral is appropriate
Sandton Men’s Clinic does not:
- diagnose BPH, prostatitis or prostate cancer as a urology service
- prescribe alpha blockers
- prescribe finasteride or dutasteride
- prescribe antibiotics
- perform PSA-based cancer diagnosis
- perform cystoscopy
- perform prostate ultrasound or biopsy
- perform TURP, HoLEP or other prostate surgery
- provide emergency urinary-retention treatment
- guarantee prostate shrinkage
Naturopathic care may complement but does not replace GP, urology, oncology, radiology, pathology or emergency medical care.
Private Men’s Wellness Support in Sandton
If urinary or prostate-health concerns are affecting sleep, confidence or general wellbeing, a confidential naturopathic consultation can help you organise lifestyle and supplement factors while making sure medical or urological referral is not delayed.
Sandton Men’s Clinic
199 Vanessa Street, Buccleuch, Sandton
Phone: +27 10 205 9208
Frequently Asked Questions | Prostate Symptoms And Treatment
What are the most common symptoms of an enlarged prostate?
Common symptoms include difficulty starting urination, weak or stop-start flow, dribbling, incomplete emptying, urgency, frequency and waking at night to urinate. These symptoms can also have non-prostate causes, so assessment matters.
Does frequent urination mean my prostate is enlarged?
Not necessarily. Frequent urination can also be related to overactive bladder, diabetes, urinary infection, medication, fluid intake, sleep problems or other health conditions.
Is an enlarged prostate cancer?
No. Benign prostate enlargement is not prostate cancer and does not itself mean you have cancer. However, both conditions can occur in the same man.
Does prostate cancer always cause urinary symptoms?
No. Early prostate cancer often causes no symptoms. Urinary symptoms are more commonly related to benign prostate or bladder conditions, but persistent changes still deserve medical assessment.
Can a PSA test diagnose prostate cancer?
No. PSA is a useful medical test but cannot diagnose cancer on its own. A raised result may have several causes and may lead to further assessment.
Can herbs shrink the prostate?
No commonly sold herb has been shown to reliably shrink an enlarged prostate. Some extracts have been studied for urinary symptoms, but this is not the same as reducing prostate volume.
What medicines are used for BPH?
Qualified medical practitioners may use alpha blockers, 5-alpha-reductase inhibitors or other bladder-directed medicines depending on symptoms and clinical findings. Sandton Men’s Clinic does not prescribe these medicines.
When is prostate surgery needed?
Urological procedures may be considered for severe obstruction, retention, complications or persistent symptoms that do not respond adequately to conservative or medical treatment. The procedure depends on the man’s anatomy, prostate size, health and priorities.
When is difficulty urinating an emergency?
If you cannot pass urine at all, seek urgent conventional medical care. Fever, severe pain, vomiting or serious illness with urinary symptoms also requires prompt assessment.
Does Sandton Men’s Clinic treat prostate enlargement?
Sandton Men’s Clinic is a naturopath-led men’s wellness practice. It can provide complementary lifestyle and supplement education within scope, but BPH diagnosis, prescription treatment, PSA interpretation, prostatitis treatment and prostate procedures require appropriately qualified medical or urological care.
The Bottom Line
Weak urine flow, urgency, frequency, night-time urination and incomplete emptying can be associated with an enlarged prostate, but symptoms alone do not prove BPH.
The safest approach is to identify the cause before choosing treatment. Mild uncomplicated symptoms may sometimes be managed conservatively, while prescription medicine or urological procedures may be appropriate for other men. Pain, fever, blood in the urine or inability to pass urine should not be managed with supplements or delayed medical care.
Reviewed by George Mulaudzi, Naturopath, Sandton Men’s Clinic.
This article provides general information and does not replace personalised medical advice, physical examination, urine testing, PSA discussion, urology assessment, cancer screening or emergency care. Urinary frequency, weak stream, nocturia, incomplete emptying, pelvic pain, blood in the urine or semen, fever and difficulty urinating can have several causes and should not be self-diagnosed as benign prostate enlargement. Do not stop or change prescribed prostate, blood-pressure, bladder or other medication without speaking to the prescribing clinician. Sandton Men’s Clinic provides naturopathic wellness support and refers appropriately where medical or urological care is indicated.