BPH can be asymptomatic or symptomatic. Symptoms can be related to the obstructive effect of prostate enlargement itself, to secondary effects of the obstruction on the bladder, or to the complications of BPH.

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Obstruction of the bladder outlet can have variable effects on the bladder. It can lead to thickening of the bladder muscle and bladder muscle instability. Bladder instability is thought to account for irritative symptoms.

Obstruction can also lead to, or worsen, poor bladder contraction. This can lead to obstructive symptoms and poor bladder emptying. Both bladder instability and poor bladder contraction are associated with aging per se. Obstruction will accentuate both these effects of aging.

Obstructive symptoms

• Poor urine stream
• Feeling of incomplete bladder emptying
• Intermittent stream
• Hesitancy (delay in starting urination)
• Straining while passing urine

Irritative symptoms

• Frequency (frequent passage of urine)
• Urgency (a strong desire to urinate that is difficult to suppress)
• Nocturia (getting up during the night to pass urine)

Symptoms of complications

• Blood in urine (hematuria): BPH can cause blood in the urine, but bleeding cannot be assumed to be due to an enlarged prostate unless other more serious causes have been eliminated.
• Urinary Tract Infection which has symptoms such as: burning with passing urine, bladder pain, fever and frequent urination.
• Retention of urine: a complete inability to pass urine.
• Overflow incontinence: leaking of urine due to an overfull bladder which does not empty.
• Kidney failure: fatigue, weight loss, fluid overload etc.

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