Prostate and urinary symptoms:
symptoms, IPSS score,
treatments.
A weak stream, waking at night, frequent urges: these urinary symptoms are most often linked to benign prostatic hyperplasia (an enlarged prostate, also called prostate adenoma or BPH), which affects around 1 in 2 men over 50. A specialised medical team assesses your symptoms and recommends the best course of action, screening advice included.
Complete assessment
IPSS score and screening for warning signs, online, in under 10 minutes.
Registered doctor
Registered with the Medical Council (France or EU), specialised in men’s health.
Report and recommendations
Diagnosis, screening recommendations (PSA, ultrasound) and a prescription if indicated.
Erection assessed too
Optional IIEF-5 in the same questionnaire: one treatment can relieve both.
Doctors online
What is
benign prostatic
hyperplasia?
Also called an enlarged prostate, prostate adenoma or BPH, benign prostatic hyperplasia is a gradual, non-cancerous increase in the size of the prostate gland. As it grows, the prostate compresses the urethra it surrounds and disrupts bladder emptying. Here is the essential, in under a minute, before going further.
- 01A non-cancerous enlargement of the prostate, which compresses the urethra and hinders bladder emptying.
- 02Around 1 in 2 men over 50 has BPH, and it becomes more frequent with age.
- 03Symptoms are assessed with the IPSS score (0–35), the international reference questionnaire in 7 questions.
- 04BPH is not cancer and does not turn into cancer, but a PSA test is always checked before treatment.
- 05Effective treatments exist at every stage: lifestyle, phytotherapy, alpha-blockers, 5-ARIs, tadalafil 5 mg.
- 06An online consultation allows a complete assessment and a prescription if indicated, with no waiting room.
Larger prostate or clinical impact?
Prostate volume naturally increases with age, without always causing problems. We speak of clinically significant BPH when lower urinary tract symptoms settle in durably: weak stream, frequent urges, waking at night, a feeling of incomplete emptying. Severity does not depend on volume alone: a small prostate can be very bothersome, and vice versa.
It is the impact on your daily life, measured by the IPSS score and its quality-of-life question, that guides the decision to treat — not only the size of the gland.
How the urinary bother arises
The prostate wraps around the urethra like a sleeve, just below the bladder. As it grows, it compresses the channel and forces the bladder to strain to empty. Over time the bladder muscle thickens, becomes overactive (urgent urges, waking at night) and may then tire (incomplete emptying, post-void residual).
Treating early relieves symptoms and prevents complications: recurrent urinary tract infections, bladder stones, acute urinary retention.
How
common
is BPH?
Benign prostatic hyperplasia is the most common urological condition in men. Present in around 1 in 2 men over 50, it becomes almost universal with age, but only some men develop symptoms bothersome enough to warrant treatment.
What are the
symptoms
of an enlarged prostate?
Doctors distinguish two families of lower urinary tract symptoms (LUTS): voiding symptoms, linked to the mechanical obstruction, and storage symptoms, linked to the bladder’s reaction. The IPSS score explores the 7 key symptoms and rates their severity from 0 to 35. Most men combine both families of symptoms, to varying degrees.
Voiding symptoms
- Weak or hesitant stream
The most telling sign of a prostatic obstruction: the stream loses force, takes time to start, and urination lasts longer.
- Abdominal straining
Needing to push or strain to start or keep urinating: the bladder is fighting the resistance of the compressed channel.
- Intermittent stream
The stream stops and starts again during urination, a sign of laborious emptying.
- Feeling of incomplete emptying
The impression that the bladder does not empty completely. A post-void residual measured by ultrasound can confirm it.
- Terminal dribbling
Leaks at the end of urination, common and often overlooked, due to incomplete emptying of the urethra.
Storage symptoms
- Frequent urges (frequency)
Needing to urinate again less than two hours after finishing, by day as by night.
- Waking at night (nocturia)
Getting up once or more per night to urinate. Often the most burdensome symptom day to day: fragmented sleep, fatigue.
- Urgency
Sudden, hard-to-hold urges, sometimes with leaks. A sign that the bladder has become overactive in reaction to the obstruction.
- Urinary leaks
Leaks on urgency or on arriving home (“key in the door”). Worth reporting to the doctor: they guide the treatment strategy.
- Burning or repeated infections
Stagnant urine favours urinary tract infections and bladder stone formation — complications to screen for.
BPH, PSA and
prostate cancer:
what you need to know.
Benign prostatic hyperplasia is not cancer and does not turn into it. But the two conditions can coexist. That is why every assessment of urinary symptoms includes a check of your screening status.
PSA (prostate-specific antigen) is a blood marker always checked before starting a prostate treatment: from 50 for all men, and from 45 in case of a family history of prostate cancer. A raised PSA does not mean cancer (BPH itself, an infection or a recent rectal examination can raise it), but it does require a specialist opinion.
Likewise, certain signs require a urological work-up before any treatment: visible blood in the urine, unexplained weight loss, bone pain, or a prostate MRI result classified PI-RADS 3, 4 or 5. The Kano questionnaire systematically screens for these signals: if they are present, the doctor refers you as a priority rather than prescribing.
Symptoms and
warning signs:
when to see a doctor?
Many men regard urinary symptoms as an inevitable part of ageing and delay seeking advice, at the cost of broken nights and outings planned around the nearest toilet. Yet the assessment is simple (IPSS questionnaire, medical history, screening for warning signs) and effective treatments exist at every stage. An online consultation lets you take stock in a few minutes and obtain an online prescription if a treatment is indicated. In case of acute retention (complete inability to urinate), go to the emergency department without delay.
- Urinary symptoms that have persisted for more than 3 months
- Repeated night-time waking that fragments your sleep
- IPSS score above 7 (moderate to severe symptoms)
- Blood in the urine, fever or inability to urinate: seek care quickly
- Impact on quality of life, outings and travel
What are the
treatments
for an enlarged prostate?
The choice of treatment depends on symptom severity (IPSS score), the impact on quality of life, prostate volume and the treatments already tried. Four main medical options exist, from the gentlest to the most powerful, and surgery remains reserved for advanced or complicated forms.
The reference treatment for moderate symptoms. They relax the muscle fibres of the prostate and bladder neck, improving the stream and reducing urges within a few days, without changing prostate volume. Possible side effects: orthostatic hypotension (dizziness on standing), ejaculation disorders.
They block the conversion of testosterone into dihydrotestosterone and gradually shrink the prostate (−20 to −30% in 6 to 12 months). Indicated when the prostate exceeds 40 mL, alone or combined with an alpha-blocker. They slow progression and reduce the risk of acute retention and surgery.
Extracts of saw palmetto (Serenoa repens) or African plum (Pygeum africanum). A first-line option in mild forms, recommended by the French Urology Association (AFU), with an excellent tolerance profile (no sexual side effects). Combined with lifestyle measures, it is often enough to control early symptoms.
A PDE5 inhibitor taken daily at a low dose, with an approved dual indication: it improves both urinary symptoms and erectile function. The option of choice for men affected by both conditions, which are frequently associated. Absolute contraindication: nitrates (nitroglycerin, isosorbide).
Watchful waiting, combination therapy and surgical options
When symptoms are mild, simple monitoring may be enough. Conversely, when medical treatment fails or complications arise, several interventional options are available, to be discussed with a urologist.
- Watchful waiting
For mild symptoms with no impact on daily life: lifestyle measures and an annual reassessment (IPSS, PSA). No medication is essential as long as the bother remains low.
- Combination alpha-blocker + 5-ARI
Combines both mechanisms (relaxation + volume reduction) in severe forms or those at risk of progression, generally with a urologist’s opinion.
- Transurethral resection (TURP)
The reference surgical procedure: removal of the adenoma through the natural passages. Indicated when medical treatment fails or in case of complications (retention, stones, repeated infections).
- Laser surgery (HoLEP, GreenLight)
Laser enucleation or vaporisation of the adenoma. Alternatives to TURP, with less bleeding and a shorter hospital stay, suited to large prostates or patients on anticoagulants.
- Minimally invasive techniques
Prostatic artery embolisation, UroLift implants, Rezum water vapour therapy, temporary iTIND implant: emerging options that better preserve sexual function, discussed case by case with the urologist.
- Treating aggravating factors
Reviewing medicines that favour retention (decongestants, anticholinergics), managing constipation, controlling diabetes, cutting down on evening drinks.
Prescription-only medicines. The molecule and dosage are determined by your doctor after a complete assessment (IPSS score, PSA, medical history, contraindications).
A care
pathway
tailored to you.
Four steps that build on each other: assessment, medical report, prescription and support. A complete medical assessment of your urinary symptoms, with systematic screening for the signs that call for a specialist.
Assessment by a specialised doctor
A detailed medical questionnaire with IPSS score, screening for warning signs (PSA, blood in the urine, imaging), and review of your file by a doctor registered with the Medical Council (France or EU). Not an algorithm.
- IPSS score + quality of life
- Screening for warning signs
- Optional erection assessment (IIEF-5)
Written diagnosis and recommendations
You receive a personalised medical report: interpretation of your score, recommendations for tests if needed (PSA, ultrasound), and referral to a urologist if a warning sign calls for it.
- Written medical report
- Screening recommendations
- Referral to a urologist if needed
Valid in every pharmacy
If a treatment is indicated, the secure digital prescription is valid for 3 months in every pharmacy in France. Alpha-blocker, 5-ARI, phytotherapy or tadalafil 5 mg depending on your profile.
- Secure digital prescription
- Valid for 3 months in pharmacies
- Treatment matched to your score
A care coordinator at your side
Ask your questions by secure messaging. Lifestyle, PSA follow-up, how your symptoms evolve: our team supports you beyond the prescription.
- Secure messaging
- Lifestyle advice
- Follow-up of your symptoms
What changes: a serious assessment, with no waiting room.
Not a questionnaire rushed through. A complete medical file, reviewed by a doctor, with systematic screening for the situations that belong to a specialist.
€35 all inclusive.
The consultation fee covers the complete medical assessment, the written report and the prescription if a treatment is indicated. The cost of the treatment, when prescribed, depends on the molecule: most BPH treatments are available as affordable generics in pharmacies.
- Consultation with a specialised doctor
- Written medical report with your IPSS score
- Secure digital prescription if indicated, valid for 3 months
- Personalised screening recommendations (PSA, ultrasound)
- Secure messaging with a care coordinator
Going further than
medication.
Lifestyle measures are recommended at every stage of BPH. They are often enough to control mild symptoms and they reinforce the effect of treatments. Our doctors detail them in every medical report.
Limiting fluids in the 2 hours before bed directly reduces night-time waking.
Caffeine and alcohol irritate the bladder and increase urine production. Cutting down eases urgency and frequency.
A sedentary lifestyle worsens urinary symptoms. 150 minutes of activity a week improve the IPSS score.
Metabolic syndrome (overweight, diabetes) accelerates prostate growth. Losing weight slows progression.
Urinating at regular times and practising double voiding (emptying again after a few seconds) improves emptying.
Chronic constipation compresses the bladder and worsens the bother. Fibre and daytime hydration are often enough.
A medical team
expert in urology,
always at your side.
Medical directionDr Sam Ward
“Urinary symptoms are not an inevitable part of ageing. A serious assessment relieves the bother, and above all makes sure nothing that should be screened for is missed.”
Your questions about
an enlarged prostate.
No. Benign prostatic hyperplasia (BPH), also called prostate adenoma or an enlarged prostate, is a non-cancerous increase in the size of the prostate. It does not turn into cancer and does not increase the risk of developing one. However, the two conditions can coexist in the same man: that is why a PSA (prostate-specific antigen) test is always checked before starting a treatment, in particular from the age of 50, or from 45 in case of a family history of prostate cancer.
The first signs are lower urinary tract symptoms: a weaker or hesitant urinary stream, needing to push to urinate, more frequent urges (by day as by night), getting up at night to urinate (nocturia), a feeling that the bladder has not emptied properly, urgent urges that are hard to control, or a stream that stops and starts again. These symptoms usually set in gradually. Their intensity does not depend only on the size of the prostate: a small prostate can be very bothersome, and vice versa.
The IPSS (International Prostate Symptom Score) is the international reference questionnaire for assessing the severity of prostate-related urinary symptoms. It comprises 7 questions scored from 0 to 5 (total score from 0 to 35) covering the past month: incomplete emptying, frequency, intermittent stream, urgency, weak stream, straining and night-time waking. From 0 to 7, symptoms are mild; from 8 to 19, moderate; from 20 to 35, severe. An additional question assesses the impact on quality of life, which weighs heavily in the decision to treat.
Four main medical options exist. Alpha-blockers (tamsulosin, alfuzosin, silodosin) relax the muscles of the prostate and bladder neck and relieve symptoms quickly: they are the reference treatment for moderate forms. 5-alpha-reductase inhibitors (finasteride, dutasteride) shrink the prostate and slow progression, especially above 40 mL. Phytotherapy (Serenoa repens, Pygeum) is a first-line option in mild forms. Tadalafil 5 mg taken daily treats both urinary symptoms and erectile dysfunction. In advanced or resistant forms, surgery (TURP, laser) is discussed with a urologist.
Yes. Tadalafil 5 mg taken daily has an approved dual indication: it improves both the urinary symptoms linked to benign prostatic hyperplasia and erectile dysfunction. It is a particularly interesting option for men affected by both conditions, which are frequently associated. Caution: tadalafil is strictly contraindicated with nitrates (nitroglycerin, isosorbide), as the combination can cause a dangerous drop in blood pressure.
Some signs call for prompt medical advice, or even a urological work-up before any treatment: visible blood in the urine (macroscopic haematuria), a complete inability to urinate (acute retention, an emergency), fever with a urinary tract infection (possible acute prostatitis), severe pelvic pain, unexplained weight loss or bone pain. An MRI result of PI-RADS 3, 4 or 5 also warrants a priority urological opinion if one has not already been obtained.
Urinary symptoms and erection problems are frequently associated: the more severe the urinary symptoms, the higher the risk of erectile dysfunction, independently of age. The shared mechanisms include vascular changes and overactivation of the sympathetic nervous system. In addition, some BPH treatments have sexual side effects: 5-alpha-reductase inhibitors can lower libido, and some alpha-blockers cause ejaculation disorders. That is why the Kano assessment also offers to evaluate erectile function (IIEF-5 score) in the same questionnaire.
Lifestyle has a measurable impact on symptoms: cutting down on coffee, tea and alcohol (especially in the evening), limiting fluids in the 2 hours before bed, taking regular physical exercise, losing weight if overweight, treating chronic constipation and avoiding certain medicines (decongestants, diuretics taken in the evening). Phytotherapy (Serenoa repens) may be enough to control mild symptoms. These measures do not shrink the prostate but they ease the day-to-day bother and can delay the need for medication.
Disclaimer: the information on this page is provided for information purposes and does not replace professional medical advice. The treatments mentioned (alpha-blockers, 5-alpha-reductase inhibitors, tadalafil) are prescription-only medicines. In case of acute urinary retention or any emergency, call 112 (or 15 in France).
