Older men tend to have larger prostates than younger men because the prostate continues to grow as a man ages. Enlargement of the prostate that is not the result of cancer is called benign prostatic hyperplasia (BPH).

BPH can cause problems with urination, and some treatments can lead to sexual problems and other side effects.

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An enlarged prostate directly affects a man’s ability to urinate. These effects include:

  • a frequent need to urinate
  • a feeling of not emptying the bladder
  • intense urges to urinate
  • a weak urine stream
  • problems starting or stopping urination

Prostate issues can also cause sexual problems. The extent of any sexual problem varies according to the condition of the prostate. Some common sexual side effects include:

  • erectile dysfunction (ED)
  • reduced sexual satisfaction
  • problems maintaining an erection
  • decreased libido

These conditions may also vary according to:

BPH and ED are separate conditions that are connected. ED usually means that a man is not able to achieve or maintain an erection.

Although ED may be caused by a variety of health problems, such as heart disease, diabetes, low testosterone levels, or psychological issues, it can also be made worse by BPH.

Some medications used to treat an enlarged prostate can cause ED. However, some medications used to treat ED can help improve symptoms of BPH.

Although no medication prescribed for ED has been approved to treat an enlarged prostate, early studies suggest that men who take ED medications may experience some relief from their prostate symptoms.

Several ED medications have shown some success in treating enlarged prostates. These include:

  • vardenafil (Levitra)
  • sildenafil (Viagra)
  • tadalafil (Cialis)

For example, one study showed that men who took 10 milligrams (mg) of vardenafil twice a day for 8 weeks experienced marked improvements in their prostate symptoms, compared to a similar group who took a placebo.

Another study found that men who took up to 5 mg of tadalafil daily saw significant improvements in both their prostate and ED symptoms.

However, before taking ED medication to treat symptoms of an enlarged prostate, speak to a doctor. ED medications have potential side effects that can make them unsafe for some men, particularly those with a history of the following conditions:

The American Cancer Society recommend that the following men get their prostates screened regularly, after discussing the risks and benefits with their doctors:

  • those over 50 with an average risk of developing prostate cancer
  • those over 45 with a moderate risk
  • those over 40 with a high risk

A prostate screening can help rule out cancer as the cause of a person’s symptoms.

In general, a man should seek medical attention if he experiences any symptom of an enlarged prostate.

Several treatment options may help reduce the severity of enlarged prostate symptoms. A man experiencing symptoms should explore the choices available with his doctor. Treatments may include medications, surgical options, and home remedies or lifestyle changes.

Some medications available to treat an enlarged prostate include:

  • doxazosin
  • terazosin finasteride
  • dutasteride
  • dutasteride-tamsulosin

However, these medications can lead to sexual side effects, including:

  • reduced sex drive
  • problems maintaining an erection
  • problems achieving an erection

If medication does not alleviate the symptoms, a doctor may recommend surgery. Surgical options include:

  • TURP (transurethral resection of the prostate), where some prostate tissue is removed
  • TUIP (transurethral incision of the prostate), where grooves are made in the prostate
  • TUMT (transurethral microwave thermotherapy), where microwaves destroy excess prostate tissue
  • prostatic urethral lift, where prostate tissue is moved away from the urethra

The TURP procedure is a well-established treatment for an enlarged prostate, but it is the most invasive option. Compared with the other procedures, TURP also results in more sexual side effects, such as ED and ejaculation problems.

Men who have undergone TURP have also reported dry ejaculation, which means that the semen enters the bladder rather than coming out of the penis during an orgasm.

Below are some commonly asked questions about an enlarged prostate:

Why do you pee more at night with an enlarged prostate?

When the prostate is very enlarged, it pushes against the bladder and urethra (the tube that urine leaves your body through). As a result of this pressure, the urge to urinate occurs more frequently – which is more noticeable to a person at night time when they are trying to rest.

Does prostatitis get worse at night?

Yes, symptoms of prostatitis include the need to urinate more frequently – especially at night time.

What should a person do before bed for an enlarged prostate?

According to Prostate Cancer UK, certain lifestyle changes, some of which can be done before bedtime, can alleviate symptoms of an enlarged prostate. These include:

  • reducing the intake of alcohol, sweeteners, and fizzy soda
  • avoiding drinking in the evening and before bed
  • checking whether medicines are contributing to symptoms
  • maintaining a healthy weight
  • exercising regularly, specifically Kegel exercises which can improve symptoms associated with an enlarged prostate

Many men will develop an enlarged prostate as they age, because the gland does not stop growing throughout their lifetime. As men age they should get regular prostate screenings to check for prostate cancer.

Several medications, lifestyle changes, and surgical options are available to help reduce the effects of living with an enlarged prostate. With proper treatment, men can usually maintain a regular sex life.