Quick Answer
Urinary urgency, frequency, burning and lower abdominal pain can occur in a man who also has BPH, but they should not automatically be blamed on the enlarged prostate.
Persistent urgency despite tamsulosin and finasteride may reflect bladder-storage symptoms such as overactive bladder, inadequate treatment duration, significant obstruction, high residual urine, infection or another urinary condition. Before choosing surgery, the useful next steps usually include a symptom score, urinalysis, post-void residual, uroflowmetry, prostate-size assessment and a bladder diary.
Burning during urination and lower abdominal pain deserve evaluation for urinary infection, prostatitis, bladder irritation, stones, retention and other causes. A normal or previously low PSA does not rule out prostatitis.
Herbs such as saw palmetto should not be relied on to shrink the prostate or replace established BPH treatment. High-quality reviews find little or no benefit from saw palmetto used alone for BPH symptoms.
Question 1: Severe Urgency and Frequency Despite BPH Medicines
I am 75 and have an enlarged prostate with urinary frequency and urgency. I feel a very strong urge to urinate about every hour.
Some urologists have advised surgery while others advise against it. I have used tamsulosin 0.4 mg and Proscar 5 mg without satisfactory improvement. Should I agree to surgery, continue medicines, or try a herbal treatment that can reduce the size of my prostate?
Personal phone number and email address from the original submission have been removed for privacy.
Hello Haroon,
Urgency every hour is a significant symptom, but it does not tell us by itself whether your main problem is prostate obstruction or the bladder’s storage function.
Male lower urinary tract symptoms are usually divided into:
- voiding symptoms such as weak stream, hesitancy and straining;
- storage symptoms such as urgency, frequent urination, nocturia and urge leakage; and
- post-void symptoms such as dribbling or a feeling of incomplete emptying.
Your description is dominated by storage symptoms.
Do Tamsulosin and Finasteride Treat the Same Problem?
No.
Tamsulosin 0.4 mg
Tamsulosin is an alpha blocker. It relaxes smooth muscle around the prostate and bladder neck and can improve urine flow relatively quickly.
It does not substantially shrink the prostate.
Proscar 5 mg
Proscar is the brand name for finasteride 5 mg, a 5-alpha-reductase inhibitor.
Finasteride is most useful when the prostate is demonstrably enlarged and the man has an increased risk of BPH progression. Unlike tamsulosin, it can gradually reduce prostate volume and reduce the long-term risk of urinary retention and BPH-related surgery.
Why Might Urgency Continue Even If the Prostate Treatment Is Appropriate?
Several possibilities should be considered:
- the bladder may be overactive;
- there may still be significant bladder-outlet obstruction;
- the bladder may not empty completely;
- a urinary infection may be present;
- the prostate may not be large enough for finasteride to provide much benefit;
- the medicines may not have been used long enough;
- large fluid intake, caffeine, alcohol or diuretic medicines may worsen frequency; or
- diabetes, sleep disorders or other medical conditions may contribute.
What Tests Would Help Decide Between More Medicine and Surgery?
Before deciding on an operation, I would want the following information:
- IPSS symptom score to quantify severity and bother;
- urinalysis to look for infection, blood or glucose;
- post-void residual (PVR) to determine how well the bladder empties;
- uroflowmetry to measure urinary flow;
- prostate volume and anatomy when these findings will influence treatment;
- PSA when appropriate for prostate-cancer risk assessment and/or BPH treatment decisions; and
- a 3-day bladder diary recording voiding times, urine volumes, urgency and fluid intake.
Current European guidance specifically recommends bladder diaries for predominant storage symptoms and follow-up assessment with symptom scores, uroflowmetry and PVR.
Can Another Medicine Be Added for Urgency?
Possibly.
If your post-void residual is acceptable and the main remaining problem is urgency/frequency, current BPH guidelines allow medicines directed at bladder-storage symptoms.
Antimuscarinic Medicines
Medicines such as solifenacin or tolterodine can reduce urgency and daytime frequency.
Because these drugs can increase residual urine, the EAU advises caution and recommends not using antimuscarinic overactive-bladder medicines when PVR is greater than 150 mL.
Beta-3 Agonists
A beta-3 agonist such as mirabegron may also be considered for storage symptoms in selected men. This can be particularly useful when anticholinergic side effects such as dry mouth or constipation are undesirable.
These medicines do not shrink the prostate; they target bladder symptoms.
What About Tadalafil?
Daily tadalafil 5 mg is another evidence-based option for men with moderate-to-severe lower urinary tract symptoms, with or without erectile dysfunction.
It can improve symptom scores and erectile function, although it does not substantially improve maximum urinary flow or reduce prostate size.
Tadalafil must not be used with nitrate medicines for angina, and cardiovascular status and other medicines need to be reviewed first.
When Does Surgery Make More Sense?
Surgery should not be decided simply because you are 75 or because urgency persists.
Current EAU guidance makes surgery more compelling when BPH causes:
- recurrent or refractory urinary retention;
- overflow incontinence from retention;
- recurrent urinary infections related to obstruction;
- bladder stones or diverticula associated with obstruction;
- persistent visible bleeding attributed to BPH;
- upper urinary tract dilation or kidney impairment caused by obstruction; or
- symptoms or high residual urine that remain unacceptable despite appropriate conservative and medical treatment.
If obstruction is objectively demonstrated and your quality of life remains poor despite appropriate medication, then a BPH procedure is reasonable to discuss.
Will Surgery Definitely Cure Urgency?
No.
Surgery can relieve prostate obstruction very effectively, but urgency may persist if the bladder has developed overactivity or if another condition contributes to the symptoms.
This is why measuring PVR, flow and prostate anatomy—and sometimes performing urodynamics in uncertain cases—can be important before surgery.
Can Herbs Shrink the Prostate?
I would not recommend relying on them.
The original answer recommended saw palmetto, pygeum, soy and pumpkin products rather broadly. The evidence is much less convincing.
Saw Palmetto
The U.S. National Center for Complementary and Integrative Health states that a 2023 review of 27 studies found that saw palmetto used alone provides little or no benefit for BPH symptoms.
Pygeum
There is limited short-term evidence that pygeum may improve some urinary symptoms, but the studies have generally been small and short and do not establish reliable prostate shrinkage or prevention of urinary retention.
Pumpkin Seed Products
Some studies suggest modest symptom improvement from certain pumpkin-seed preparations, but they have not been proven to prevent BPH progression or reliably shrink the prostate.
See our evidence-based natural remedies guide.
I would not choose between surgery and more medicine until your urologist documents your post-void residual, urinary flow, prostate size and symptom pattern.
If the bladder is emptying reasonably well and urgency/frequency are the dominant remaining symptoms, an antimuscarinic or beta-3 agonist may be worth discussing rather than assuming tamsulosin and finasteride have exhausted all medical options.
If obstruction is substantial, residual urine is high, complications are developing or your symptoms remain unacceptable despite appropriate treatment, surgery may be the more effective option.
I would not substitute saw palmetto or another supplement for this evaluation.
Question 2: Burning Urination, Lower Abdominal Pain and Erectile Problems
I was diagnosed with an enlarged prostate in 2008. My PSA was 1.6 ng/mL in 2008 and 1.9 ng/mL in 2011.
I now frequently experience burning during urination, lower abdominal pain when I press the lower part of my abdomen, and erectile problems. I have taken tamsulosin for two months without relief. What treatment should I consider for the painful urination and sexual problem?
Hello Ephraim,
Burning during urination and lower abdominal discomfort should not simply be attributed to BPH.
NIDDK lists urinary frequency, urgency, burning during urination, lower abdominal or pelvic pain and urinary retention among symptoms that can occur with prostatitis, while similar symptoms may also occur with urinary infection or bladder disorders.
What Can Cause Burning During Urination in a Man With BPH?
Possible causes include:
- urinary tract infection;
- acute or chronic bacterial prostatitis;
- chronic prostatitis/chronic pelvic pain syndrome;
- urethritis, including sexually transmitted infections when relevant;
- bladder or urinary stones;
- significant residual urine with secondary infection or irritation;
- urethral narrowing; and
- other bladder or urinary tract conditions.
A new evaluation is appropriate when these symptoms persist.
What Tests Make Sense First?
I would usually start with:
- urinalysis;
- urine culture when infection is suspected;
- post-void residual urine measurement;
- physical examination;
- review of medications and urinary symptoms; and
- testing for sexually transmitted infections if the history indicates risk.
Depending on the results, a urologist may consider ultrasound, cystoscopy, uroflowmetry or other testing.
Does a PSA of 1.6 or 1.9 Rule Out Prostatitis?
No.
This was an important error in the original answer.
PSA is not a diagnostic test for prostatitis. The European Association of Urology specifically notes that PSA may rise during active prostatitis but that PSA testing provides no practical diagnostic information for prostatitis.
Therefore, your old PSA values cannot be used to exclude prostatitis.
Does an Enlarged Prostate “Push” the Lower Abdominal Organs and Cause Pain?
That is not a good explanation.
The prostate lies below the bladder. BPH can obstruct urine flow, and severe retention can distend the bladder enough to produce lower abdominal pressure or pain. But a moderately enlarged prostate does not normally cause abdominal pain simply by pushing other abdominal organs.
Lower abdominal pain can come from the bladder, urinary infection, retention, pelvic pain syndromes, bowel conditions or many other causes.
If your lower abdomen feels full or painful and you are passing only small amounts of urine, post-void residual should be checked promptly.
Do You Automatically Need a Colonoscopy, Parasite Test or Candida Stool Test?
No.
The original answer recommended a broad set of gastrointestinal investigations without evidence that they were indicated.
If you have bowel symptoms, weight loss, rectal bleeding, anemia or other gastrointestinal warning signs, those should be evaluated appropriately. But burning urination and lower urinary pain should first receive a focused urinary assessment.
Why Has Tamsulosin Not Helped the Burning?
Tamsulosin treats part of the urinary obstruction caused by BPH. It is not an antibiotic, anti-inflammatory treatment or pain medicine.
If the burning is caused by infection, prostatitis, bladder irritation or urethritis, tamsulosin alone may not resolve it.
What About the Erectile Dysfunction?
Erectile dysfunction is common in men with lower urinary tract symptoms but should still be assessed independently.
Possible contributors include:
- vascular disease;
- diabetes;
- medication effects;
- low testosterone in selected men;
- neurologic disease;
- psychological factors;
- chronic pelvic pain; and
- age-related changes.
Tamsulosin is better known for causing ejaculatory changes than for directly causing erectile dysfunction.
Could One Medicine Help Both BPH Symptoms and Erections?
For some men, yes.
Current EAU and AUA guidance recognizes tadalafil 5 mg once daily as an option for lower urinary tract symptoms with or without erectile dysfunction.
It may be particularly relevant when urinary symptoms and erectile dysfunction coexist.
Tadalafil also does not treat urinary infection or bacterial prostatitis, so the cause of the burning should be established first.
Should You Use Uva Ursi or Saw Palmetto?
I would not recommend them for this problem.
Uva ursi is not a standard treatment for male BPH, prostatitis or recurrent painful urination. Saw palmetto has not shown meaningful benefit for BPH in high-quality reviews and has not shown significant benefit for chronic prostatitis/chronic pelvic pain syndrome either.
Neither should delay urine testing when burning and abdominal pain are present.
When Is This Urgent?
- complete inability to urinate;
- a painful and increasingly full lower abdomen;
- fever or chills with urinary urgency or burning;
- visible blood in the urine;
- severe pelvic, abdominal or flank pain;
- vomiting or marked weakness; or
- rapidly worsening symptoms.
Your burning urination and lower abdominal pain need a focused urinary evaluation rather than assuming they come from the enlarged prostate. I would begin with urinalysis, urine culture when indicated, post-void residual measurement and an examination.
Your historical PSA values do not exclude prostatitis. PSA is not a prostatitis diagnostic test.
Once infection, retention and other painful urinary causes have been addressed, your erectile dysfunction should be evaluated separately. If it is medically safe for you, tadalafil 5 mg daily is one treatment worth discussing because it can improve both lower urinary tract symptoms and erectile function in selected men.
What Both Patients Have in Common
These two questions illustrate an important point: having an enlarged prostate does not mean every urinary symptom is caused by the prostate.
| Symptom | Possible BPH relationship | Other causes that may need evaluation |
|---|---|---|
| Urgency / frequency | Can occur with BPH and bladder outlet obstruction. | Overactive bladder, UTI, diabetes, excessive fluid/caffeine, medications, bladder disease. |
| Burning urination | Can occur in men who also have BPH but is not specific. | UTI, prostatitis, urethritis, stones, bladder irritation. |
| Lower abdominal pain | May occur if severe retention distends the bladder. | UTI, prostatitis/pelvic pain, bladder disease, stones, gastrointestinal causes. |
| Erectile dysfunction | LUTS and ED often coexist. | Vascular disease, diabetes, medications, hormones, neurologic and psychological factors. |
Medical References
European Association of Urology. 2026 Guidelines on the Management of Non-neurogenic Male Lower Urinary Tract Symptoms: diagnostic evaluation, storage-symptom treatment, PDE5 inhibitors, follow-up and indications for surgery.
European Association of Urology. Guidelines on Urological Infections: bacterial prostatitis. PSA testing provides no practical diagnostic information for prostatitis.
American Urological Association. Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: guideline recommendations on anticholinergic therapy, beta-3 agonists and tadalafil.
National Institute of Diabetes and Digestive and Kidney Diseases. Enlarged Prostate (BPH), Prostatitis and Prostate Tests.
National Center for Complementary and Integrative Health. Saw Palmetto: Usefulness and Safety; BPH and Complementary Health Approaches.
Last evidence update: September 2026.