Urinary symptoms from an enlarged prostate tend to creep up slowly. Many men adapt without noticing, planning journeys around toilets or avoiding drinks before meetings. Putting a name to each symptom, and measuring how much it affects you, is the first step towards the right treatment.
Weak or slow flow
As the prostate grows, it can narrow the urethra, the tube that carries urine out of the body. The result is a stream that is weaker than it used to be, or that takes longer to empty the bladder. Some men find they need to stand for some time or strain to finish.
Hesitancy and a stop-start stream
Hesitancy means a delay between wanting to pass urine and the flow starting. An intermittent stream stops and starts several times. Both happen because the bladder has to push harder against the narrowed outlet.
Dribbling
Dribbling at the end of passing urine, known as terminal dribbling, is very common. Post-micturition dribble is slightly different: a small leak a few moments after you have finished and dressed. It happens when a little urine is left in the urethra. Gently pressing behind the scrotum after passing urine can help. Dribbling is rarely a sign of anything serious on its own, but it can be embarrassing and is worth mentioning, as it often improves with treatment of the underlying blockage.
Urgency and frequency
Urgency is a sudden, strong need to pass urine that is hard to put off. Frequency means going more often than usual, typically more than eight times a day. These are storage symptoms. They can happen because the bladder muscle becomes more sensitive after working hard against the prostate for a long time.
Getting up at night is another storage symptom. Our article on night-time toilet trips looks at this in detail.
Incomplete emptying
Some men feel that the bladder is never quite empty. A bladder scan after passing urine can show how much is left behind. A large amount of retained urine can increase the risk of infection and, over time, strain the bladder.
The IPSS questionnaire
Doctors use a short questionnaire called the International Prostate Symptom Score, or IPSS, to measure how severe symptoms are. It asks how often, over the past month, you have experienced seven symptoms:
- incomplete emptying
- frequency
- intermittent stream
- urgency
- weak stream
- straining
- waking at night to pass urine
Each question is scored from 0 to 5, giving a total from 0 to 35:
- 0 to 7: mild symptoms
- 8 to 19: moderate symptoms
- 20 to 35: severe symptoms
A final question asks how you would feel if your symptoms stayed as they are for the rest of your life. This quality of life score often matters as much as the total.
Why the score matters
The IPSS helps in several ways:
- it gives a clear starting point before treatment
- it shows whether symptoms are getting better or worse over time
- it helps match treatment to severity
- it allows the effect of treatment to be measured
NICE guidance on urinary symptoms in men recommends using a validated symptom score as part of assessment.
When symptoms need urgent attention
Most BPH symptoms develop slowly. Seek medical advice quickly if you have:
- sudden inability to pass urine
- blood in the urine
- fever with urinary symptoms
- pain in the lower back or sides
The NHS guide to an enlarged prostate explains when to seek help.
The next step
If your symptoms are bothering you, a GP or urologist can confirm the cause and discuss treatment. Our page on benign prostatic enlargement explains the condition, and our specialist areas page lists the treatments available, including Aquablation therapy.
Professor Prokar Dasgupta assesses urinary symptoms at The London Clinic, 145 Harley Street. Please contact the clinic to arrange a consultation.