What are the symptoms of BPH and what causes them?

The symptoms of BPH are called 'lower urinary tract symptoms' (LUTS) because they affect the lower urinary tract (the bladder and urethra).

Symptoms of BPH happen because the prostate presses on the urethra (the tube that carries urine), causing it to narrow. This means that urine can't pass down it as easily as before - it's obstructed. This is why some symptoms are called 'obstructive symptoms'.

The following are typical obstructive symptoms:

• Poor stream - The flow of urine is weaker, and it takes longer to empty your bladder
• Hesitancy - You may have to wait at the toilet for a while before urine starts to flow
• Dribbling - Towards the end of passing urine, the flow becomes a slow dribble
• Poor emptying - You may have a feeling of not quite emptying your bladder

When you have obstructive symptoms, the bladder has to work to push the pee out. After a while, the muscle of the bladder wall starts to thicken because of the extra work it's been doing. This means it becomes less stretchy, so the bladder can't hold as much pee. That's why you have to go more often, including at night, and why you often can't hold on when you need to go. These are called 'irritative symptoms'.

The following are typical irritative symptom:

• Frequency (passing urine more often than normal). This can be most irritating if it happens at night. Getting up several times a night is a common symptom and is called 'nocturia'.
• Urgency. This means you have to get to the toilet quickly when you 'need to go'. It's often these symptoms that are most bothersome and cause the most disruption to daily life.