Many men notice changes in urinary function as they age and assume it's simply part of getting older — something to be endured. But urinary symptoms caused by an enlarged prostate are not something you simply have to put up with — effective treatments are available. And for men who need catheterization as part of managing BPH, it's worth understanding the options.
This article covers what BPH is, how it's diagnosed and treated, when catheterization becomes part of the picture, and what to know about catheterizing with an enlarged prostate.
What Is the Prostate, and What Is BPH?
The prostate gland sits directly below the bladder and surrounds the urethra — the tube that carries urine from the bladder out of the body. Its primary function is reproductive: it produces fluid that forms part of semen. But its anatomical location means that when it enlarges, it compresses the urethra and interferes with urinary function.
Benign prostatic hyperplasia (BPH) — also called benign prostate enlargement (BPE) — is a non-cancerous growth of prostate tissue. It is very common, and becomes more common with age. BPH is not cancer and does not turn into prostate cancer, although the two conditions can occur at the same time — which is one reason your doctor may check your PSA.
The cause of BPH is not fully understood, but age-related hormonal changes — particularly involving dihydrotestosterone (DHT), a hormone derived from testosterone — are thought to play a role. It becomes increasingly common after 50, and by their 80s, most men have some degree of prostate enlargement.
Symptoms of BPH
Because the enlarged prostate compresses the urethra, the bladder has to work harder to push urine through a narrowed passage. Over time, the bladder may not be able to empty fully. The resulting symptoms are called lower urinary tract symptoms (LUTS) and are one of the most common reasons men see a urologist.
Many men normalize these symptoms for years before seeking help. This is worth addressing directly: these symptoms are not inevitable, and effective treatments are available. Having to plan every outing around access to a bathroom is not a normal part of aging — it's a sign that the prostate needs attention.
How BPH Is Diagnosed
A GP or urologist will typically perform a combination of assessments:
- Digital rectal examination (DRE) — the physician inserts a finger into the rectum to feel the size and shape of the prostate. This is brief and, while potentially uncomfortable, is important for initial assessment.
- Urine sample — to rule out infection as a contributing factor to symptoms.
- Blood tests — kidney function and, depending on the clinical picture, PSA (prostate-specific antigen) levels.
- Uroflowmetry and bladder scan — a flow rate test measures the speed and volume of urination; a post-void bladder scan checks how much urine remains after voiding. These together paint a clear picture of how well the bladder is emptying.
- MRI — if the prostate is very large, imaging may be used to measure it accurately before treatment planning.
Treatment Options for BPH
BPH treatment is tiered — from lifestyle adjustments to medication to surgery — and the right approach depends on symptom severity and individual circumstances.
Lifestyle Changes
For mild symptoms, lifestyle adjustments can provide meaningful relief. Avoiding constipation is particularly important: the rectum sits directly behind the prostate, and constipation increases pressure on both the prostate and bladder. Reducing caffeine, alcohol, and carbonated drinks — all bladder irritants — can also help. Your GP should review any current medications, as some (including certain antihistamines and decongestants) can worsen urinary symptoms.
Medications
Alpha Blockers
Relax the muscles around the prostate and bladder neck to improve urine flow. Common examples include tamsulosin and alfuzosin. They usually work within days to weeks.
5-Alpha Reductase Inhibitors
Can shrink the prostate over time. Finasteride and dutasteride are commonly used. They take months to reach full effect and are most useful for larger prostates.
Bladder and Night-Time Medications
Some medications (such as mirabegron) relax the bladder muscle to reduce urgency and frequency; others (such as desmopressin) reduce night-time urine production. They're used for specific symptoms and aren't suitable for everyone.
Combination Therapy
Alpha blockers and 5-alpha reductase inhibitors are often used together for moderate-to-severe BPH, particularly for men with larger prostates.
Surgical Options
Several minimally invasive and surgical procedures are available when medication isn't enough. Availability varies across Canada, and your urologist will advise which suits your prostate and health:
- TURP (Transurethral Resection of the Prostate) — a long-established surgical treatment. An instrument is passed through the urethra to remove obstructing prostate tissue, under general or spinal anaesthetic.
- HoLEP (Holmium Laser) — laser removal of obstructing tissue through the urethra; increasingly common, particularly for larger prostates.
- Rezum — steam (water vapour) treatment that causes prostate tissue to shrink. Performed through the urethra; improvement usually develops over several weeks to a few months.
- Prostate Artery Embolisation — a thin tube threaded through an artery (usually in the groin or wrist) releases tiny particles into the prostate's blood supply, causing it to shrink. Long-term durability is still being studied.
- Urolift — small implants hold the enlarged prostate lobes apart to open the urethra. Suitable only for certain prostate sizes and shapes.
When Catheterization Becomes Necessary
For men whose bladder is not emptying adequately — whether because BPH has caused significant obstruction or because they are waiting for surgery — a catheter may be required. There are two scenarios where catheterization is typically recommended:
Acute urinary retention — complete inability to urinate — is a medical emergency requiring immediate catheterization to drain the bladder. This is often managed initially with an indwelling catheter, but intermittent catheterization (CIC) is frequently the preferred long-term approach once the acute episode is resolved.
Chronic incomplete bladder emptying — if the post-void residual is consistently elevated, CIC allows the bladder to be drained at regular intervals. This helps reduce the risk of complications linked to urine left in the bladder, including UTIs, bladder stones and, over time, kidney problems.
Guidelines generally favour intermittent catheterization over a long-term indwelling (Foley) catheter when a person is able to do it, because it is associated with fewer catheter-related infections and leaves no catheter in place between uses.[2] See Indwelling vs. Intermittent Catheterization for a fuller comparison.
Catheterizing with an Enlarged Prostate
The prostate sits at the junction between the bladder and the urethra. When it is enlarged, it can narrow or angle the passage, which can make catheter insertion more difficult. This is one situation where catheter tip design is worth discussing with your care team.
A standard straight-tip catheter may advance easily in uncomplicated anatomy but can meet resistance at the prostatic urethra in men with significant BPH — particularly if the prostate has created an upward angle in the urethral path.
Coudé (Tiemann) tip catheters have a firmer, angled tip that is inserted pointing upward to follow the curve of the urethra near the prostate. Canadian best practice recommendations describe them as useful for prostatic obstruction.[1]
Flexible rounded-tip catheters have a soft, rounded bead on a flexible front section. Canadian recommendations describe this design as helping guide the catheter through curves and bends, including with prostate enlargement.[1] The IQ Catheter is one example.
No single design is right for every man.[1] If you've had prostate surgery such as TURP, follow your surgeon's instructions about when and how to catheterize. For a closer look at the options, see Straight, Coudé or Flexible Tip? Understanding Catheter Tip Designs.
Go slowly and never force a catheter past significant resistance. If you regularly meet resistance, see bleeding, or can't pass the catheter, contact your healthcare provider — a different catheter size or tip design, or a check for other causes such as a stricture, may help. If you can't pass urine at all and can't drain your bladder, seek urgent care: acute urinary retention is a medical emergency.
Talk to Your Doctor
Effective treatment options exist at every stage of BPH. If you are experiencing urinary symptoms — hesitancy, frequency, nocturia, weak stream, or a sense of incomplete emptying — speak with your GP. These symptoms are not a normal part of aging that must simply be accepted.
If you or your patients are managing BPH with intermittent catheterization and want to evaluate a flexible-tip catheter, healthcare professionals can request complimentary IQ Catheter samples.
Healthcare professionals can request complimentary IQ Catheter samples for BPH patients requiring intermittent catheterization. Submit a sample request →
This article was written by IQ Catheter Canada, which distributes the IQ Catheter in Canada. It is general information, not medical advice. Talk to your healthcare provider about your own situation.
References
- Nurses Specialized in Wound, Ostomy and Continence Canada, Canadian Nurse Continence Advisors, Urology Nurses of Canada, and Infection Prevention and Control Canada. Clean Intermittent Urethral Catheterization in Adults – Canadian Best Practice Recommendations for Nurses. 1st ed. 2020. PDF
- Hooton TM, et al. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 international clinical practice guidelines from the Infectious Diseases Society of America. Clin Infect Dis. 2010;50(5):625–663.