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 inevitable or untreatable. And for men who need catheterization as part of managing their BPH, the right catheter can make a significant difference to comfort, safety, and long-term urethral health.
This article covers what BPH is, how it's diagnosed and treated, when catheterization becomes part of the picture, and specifically why catheter design matters for men 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 the most common condition affecting the male lower urinary tract, and its prevalence increases markedly with age. An important point worth repeating: having BPH does not increase the risk of prostate cancer.
The cause of BPH is not fully understood, but hormonal changes associated with aging — particularly shifts in the balance of testosterone and estrogen — are thought to play a role. It becomes increasingly common in men over 50, and by their 80s, the majority of 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 treatment is effective. 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. Effects are relatively rapid.
5-Alpha Reductase Inhibitors
Actively shrink the prostate over time. Finasteride and Dutasteride are commonly used. These take months to show full effect but can meaningfully reduce prostate volume.
Mirabegron / Desmopressin
Mirabegron relaxes bladder muscles to reduce frequency; Desmopressin reduces nighttime urine production. Used for specific symptom profiles.
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 is insufficient:
- TURP (Transurethral Resection of the Prostate) — the gold standard surgical treatment. A resectoscope is inserted via the urethra to remove obstructing prostate tissue under general anaesthetic.
- HoLEP (Holmium Laser) — laser removal of obstructive tissue via the urethra. Increasingly common with comparable results to TURP.
- Rezum — steam vapour treatment that causes prostate tissue to shrink. Performed via the urethra; improvement typically seen within two weeks.
- Prostate Artery Embolisation — a catheter threaded through the groin releases microscopic beads into prostate arteries, causing the prostate to shrink. Effects are typically shorter-term.
- Urolift — prostate lobes are mechanically clipped back to relieve obstruction. Suitable for prostates under 100cc.
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 fully drained at regular intervals. This prevents complications including UTIs, bladder stones, and, over time, kidney damage from back-pressure.
CIC is generally preferred over an indwelling (Foley) catheter for men managing BPH-related retention, because it carries significantly lower infection risk, preserves more normal bladder function, and allows men to maintain a more active lifestyle.
Why Catheter Design Matters for Men with BPH
The prostate sits at the junction between the bladder and the urethra. When it is enlarged, it can create a narrowed, angled, or compressed passage that makes catheter insertion significantly more challenging than in an unobstructed urethra. This is the clinical context in which catheter tip design becomes critically important.
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.
Traditional Coudé (angled) tip catheters were developed specifically for this anatomy, using a rigid curved tip to navigate past the prostatic obstruction. However, their rigid tip means they apply directional force — which works in straightforward BPH but creates risk of false passage creation in more complex cases.
The IQ Catheter's flexible, round tip offers an important middle ground: it deflects on contact with resistance, finding the path of least resistance through the prostatic urethra, rather than forcing passage. Combined with a firm catheter body that allows controlled advancement, this makes it suitable for the range of prostatic anatomies encountered in BPH — including post-surgical anatomy following TURP or other procedures where the urethra may have been altered.
The catheter tip must navigate an anatomically obstructed urethra — often multiple times per day. A catheter that deflects on contact with the prostatic obstruction rather than forcing past it reduces insertion trauma, decreases false passage risk, and makes the procedure more tolerable for daily use. This is particularly important for men who catheterize independently and cannot rely on real-time clinical guidance.
Talk to Your Doctor
BPH symptoms are treatable at every stage. 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, the IQ Catheter's flexible-tip design may be worth evaluating. Healthcare professionals can request complimentary samples.
Healthcare professionals can request complimentary IQ Catheter samples for BPH patients requiring intermittent catheterization. Submit a sample request →