Written by Dr. Hiruni Pooja Welagedara, MBBS
Graduate of the Faculty of Medicine, University of Colombo
If you are a man over 40 and you urinate frequently, don't think it's normal. This is the first alarm bell of a dangerous disease that destroys both your kidneys.
Many men think urinating 3-4 times at night is normal with aging. It is 100% wrong. The reason is an enlarged prostate. In medicine, this is called BPH (Benign Prostatic Hyperplasia).
What is the Prostate? How Does it Get Blocked ?
.png "Normal Prostate vs Enlarged Prostate (BPH)")
The prostate is a small gland located just below the bladder. The tube that carries urine out (urethra) goes right through the middle of this gland.
Think of it like a donut. The donut is the prostate, and the hole in the middle is the urinary tube. When you are young, the donut is small, and the hole is wide open, so urine flows well.
After age 40, due to changes in male hormones, this donut swells and becomes Large. Then the hole in the middle gets tight, squeezed, and blocked. Look at the BEFORE side in the first picture, how the enlarged prostate has squeezed and blocked the urinary tube.
The normal diameter of the tube is 6-8mm, but in BPH it becomes less than 2mm. You can't urinate.
What Are The Main Risk Factors? Who Gets BPH Faster ?
BPH happens to every man if he lives long enough, but some men get it faster:
Age: After 40 years, risk doubles every 10 years. At 60, 50% of men have it.
Family History: If your father or brother had BPH, your risk is 4 times higher.
Obesity and Diabetes: Fat increases estrogen which swells the prostate. Diabetic patients have 3 times more risk.
Lack of Exercise and Heart Disease: People who sit all day and have high blood pressure get BPH faster.
Wrong Drinks: Drinking too much cola, soda, bottled drinks, and tea, coffee, alcohol in the evening increases irritation.
5 Dangerous Symptoms You Should Never Ignore
Feeling like you need to go again right after you went:
You need to go again 2 minutes after coming back. 8-10 times a day, 3-4 times at night. Can't sleep. This happens because the bladder never empties completely.
Blood in urine:
If your urine is pink, red, or cola-colored, this is never normal. The blood vessels in the enlarged prostate burst and bleed.
Swelling of legs, ankles and face:
This is the most dangerous symptom. Many people think it's swelling from walking. No. This is a symptom of kidney failure. Urine gets blocked, pressure goes back and kidneys swell (Hydronephrosis). When kidneys can't filter water, that water collects in the legs. If your legs are swollen, it means your kidneys are already in trouble.
Urine leakage while sitting:
The bladder is always full and swollen like a balloon. When pressure increases, it leaks automatically.
Weak urine stream, straining, burning:
The urine stream goes like a dripping tap. You have to strain your stomach to start. Burning comes because bacteria grow in the stagnant urine.
Why Do You Get Weakness, Loss of Appetite, Fainting, Fever ?
Loss of appetite: When kidneys fail and creatinine increases, toxins collect in the blood. Then you lose appetite and feel like vomiting.
Fainting / Tiredness: Kidneys stop making the hormone that makes red blood cells, blood decreases (anemia). You feel tired and sleepy all the time.
Fever: Pus forms in the blocked urine, and when those germs go to the kidneys, you get high fever and shivering. This is a life-threatening condition called Sepsis.
The Most Important Forgotten Test - Uroflowmetry Test (Qmax Test)
Why is this test the ONLY test that proves the blockage?
Ultrasound only shows the size of the prostate, but it does NOT show how much it has blocked the urine path. A man can have a small prostate but a very tight block. Another man can have a very large prostate but urine still flows. So size is not the final answer.
The final answer is Uroflowmetry.
How is it done step-by-step:
You must come with a comfortably full bladder. Not too full, not empty. You should have a strong urge to urinate.
The nurse takes you to a private, locked room. There is no one inside, no camera, only a special machine that looks like a toilet or a funnel.
This funnel (called a flow transducer) is connected to a computer outside. When you urinate into it, it measures three things every second: How fast the urine is coming (ml/sec), how much you urinated (total volume), and how long it took.
The computer then draws a graph. It looks like a hill.
How to read the graph like a doctor:
Normal Graph: It goes up fast like a mountain, peak is sharp and high. Qmax > 15 ml/sec. Total time is less than 30 seconds. This means NO block.
Blocked Graph (BPH Graph): It is flat, long, and low like a plateau. Qmax < 10 ml/sec. It takes more than 60-80 seconds, drop by drop, with breaks in between. Total volume is low. This proves 100% that the prostate is blocking.
If Qmax is 10-15: It is the borderline. Doctor will keep you under observation.
This is a 2-minute, painless test. Cost is very low (Rs. 1500-2500). But from this graph, the doctor decides: Does this patient need medicine for life or a permanent laser surgery? This test saves you from unnecessary surgery and also proves when surgery is mandatory to save your kidneys.
Don't Be Afraid of Surgery! They Don't Open Your Stomach! - Full Explanation of HoLEP Laser Surgery
The Old Fear: In the past (TURP surgery), they used an electric wire loop to scrape the prostate. It caused a lot of bleeding, needed 4-5 days in hospital, and had a high chance of growing again.
The New Gold Standard in 2026 - HoLEP (Holmium Laser Enucleation of Prostate):
This is what is shown in the second picture. No cut on your stomach at all. Everything is done through the natural hole you already have.
Step-by-step what happens inside:
Step 1 - Going in: You are given spinal anesthesia (numb from waist down, you are awake but no pain). The doctor takes a 26 Fr Resectoscope. It's a thin metal tube, only 8mm diameter, with a high-definition camera and light. He gently inserts it through your penis into the urinary tube.
Step 2 - Finding the plane: Inside on the big screen, the doctor can see the swollen prostate blocking the tube like two big hills from both sides. With the laser fiber (550 micron - thinner than a pen refill), he makes a small cut and finds the natural capsule plane between the swollen part and the normal prostate. It's like peeling an orange from the inside - the peel (capsule) stays, only the juicy flesh inside (adenoma) is separated.
Step 3 - Laser Enucleation: The Holmium laser (100W) has a special power - it cuts and stops bleeding at the same time. It does not go deep, only 0.4mm deep, so it is very safe for surrounding organs. The doctor uses this laser to peel off the entire large lobes (2 or 3 lobes) and pushes them into the bladder. So now, the blocked tube is completely wide open (See the AFTER picture).
Step 4 - Morcellation - Taking it out: The large pieces are now floating inside the bladder. They cannot come out through the small tube. So the doctor inserts another device called a Morcellator. It is like a small blender/shaver inside the bladder that cuts the large pieces into tiny 2-3mm pieces and sucks them out. All pieces are sent to the lab to confirm there is no cancer.
Step 5 - Finish: A small catheter (urine tube) is kept for 1 day to wash out with saline water. Next morning, the catheter is removed, you urinate like a 20-year-old boy with a strong stream, and you go home.
Advantages for you:
No cut on body, no scar.
Almost zero bleeding, so safe even for heart patients taking blood thinners.
Catheter only for 24 hours (old surgery needed 3-4 days).
Go home in 1-2 days, back to work in 3-4 days.
Prostate can be of any size - even 200g can be removed by laser, old method could only remove up to 60-80g.
Recurrence less than 1%, because it is removed from the root.
What equipment is used for this?
Holmium Laser Generator (Ho:YAG): A machine that generates 100W-120W laser light.
Laser Fiber 550µm: A very thin thread that carries the laser beam inside.
26 Fr Resectoscope: The tube with a camera.
Morcellator: A machine that crushes the removed large flesh pieces and takes them out.
Irrigation System & Catheter: Saline water and urine bag.
How to Control and Prevent BPH From Getting Worse? (Lifestyle Tips)
Medicine and surgery are not the only way. You can control it with lifestyle.
Water habit: Drink 2.5 liters during the day, but stop drinking water 2 hours before sleeping. This will reduce night-time urination.
Reduce irritants: Reduce tea, coffee, alcohol, and spicy foods after 6 PM. They irritate the bladder.
Double Voiding Technique: After you urinate, wait 30 seconds, relax, and try again. This empties the bladder fully.
Kegel Exercises: Tighten the muscle you use to stop urine for 5 seconds, then relax. Do 10 times, 3 times a day. It strengthens bladder control.
Foods Good for Prostate: Eat cooked tomatoes (lycopene), pumpkin seeds, broccoli, green tea, and pomegranate. They shrink the prostate.
Foods Bad for Prostate: Reduce red meat, fried foods, cheese, and too much salt. They increase swelling.
The Other Test You Must Do
Don't take medicine from the pharmacy. Meet a Urologist.
In addition to Uroflowmetry, he will tell you to do an Ultrasound KUB with Prostate Volume scan. It shows how large the prostate is, how much urine is left in the bladder, and whether the kidneys are swollen.
Frequently Asked Questions (FAQ)
Is BPH prostate cancer?
No. BPH is 100% benign (non-cancerous). But BPH and cancer can be there together. So you must do a PSA blood test too.
Can it be cured with medicine only?
In the beginning stage, yes. Medicine can relax the tube. But if Qmax is less than 10, kidneys are swollen, or there is blood, medicine will not work. Surgery is mandatory.
Will surgery affect manhood / sexual life?
This is the biggest myth. No. Modern laser surgery (HoLEP) does NOT affect manhood. In fact, urine flow becomes better, so life becomes better.
Will it grow again after surgery?
In the old TURP method, there was a 15% chance to grow again. But in the new HoLEP laser method, the whole swollen part is removed from the root, so recurrence is less than 1%.
Final Message
Swelling of legs, bleeding, frequent urination is not aging. It is your kidneys crying for help. See a doctor today. Tomorrow is too late.