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Try these techniques to relieve common urinary symptoms without medication

NOV 2013

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For nighttime urination, frequency, or urgency, these methods really work. And you can always switch to medication later.

If you are a man over age 50, chances are you know—or will soon—someone taking a medication for an overgrown prostate gland. Better known as benign prostatic hyperplasia (BPH), this condition can cause bothersome problems like frequent urination at night, difficulty completely emptying the bladder, and the urgent need to urinate at inconvenient times.

BPH triggers noticeable problems in a third of men in their 60s and nearly half of those in their 80s. Drug therapy relieves symptoms, and for severe problems surgery may be considered. But for men with milder symptoms that don't interfere much with their daily lives, there's another option: watchful waiting.

In watchful waiting, you and your
doctor monitor your symptoms closely and then take action only when you feel it is necessary. In the meantime, simple changes in behavior can help to take the edge off urinary symptoms. This approach also avoids the costs and risks associated with more aggressive treatment.

"Watchful waiting is broadly available to men who have lower urinary tract symptoms that have been attributed to BPH, but who are not bothered enough to take on the small but finite risks of treatment, such as drugs or surgery," says Dr. Michael J. Barry, a clinical professor of medicine at Harvard Medical School who helped to write national guidelines on how to treat BPH.

Do you have BPH?

IRRITATIVE SYMPTOMS
(Problems with bladder function)

  • Frequent urination during the day or night

  • Strong and sudden urge to urinate, sometimes with involuntary leaking of urine

OBSTRUCTIVE SYMPTOMS
(Problems with the flow of urine)

  • Difficulty starting urination

  • Straining to urinate

  • Incomplete bladder emptying

  • Weak or intermittent urine stream

  • Dribbling after urinating

What is BPH?

In many men, the prostate gland may begin to grow larger over time. The urethra—the tube that conveys urine from the bladder to outside the body—passes right through the prostate, so it doesn't take much prostate growth to make urination difficult. As the bladder works against the restriction, its muscular walls thicken. This can cause problems like the need for more frequent visits to the bathroom and difficulty fully emptying the bladder.

For some men, the symptoms of BPH don't demand immediate treatment. The question that should drive that decision is this: How much do your symptoms bother you? "Whether it is getting in the way of doing the things you want to do should be the primary driver of treatment," Dr. Barry says.

How bothersome is it?

Doctors use the International Prostate Symptom Score (IPSS) to measure how frequent a man's symptoms are. It's a seven-item questionnaire about typical BPH symptoms that provides a score from 0 to 35. You can see the questionnaire at health.harvard.edu/IPSS.

Typically, men who score 8 and above are more likely to think their condition needs treatment, but it varies from man to man. "Above a score of 8 there is actually a spectrum of bother," Dr. Barry says. "Two men can have the same symptom score, and one can tolerate it just fine but the other can't."

The IPSS test cuts through the subjectivity with this additional question: "If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that?" If the answer is, "I could live with it," then watchful waiting might be best for you.

But watchful waiting doesn't mean "do nothing." It should include strategies to lessen symptoms or make them easier to cope with. In one recent study, men who attended classes on such self-management techniques lowered their IPSS symptom scores by 6 points within three months. "Six points is a difference most men would perceive," Dr. Barry says.

Living with BPH: A toolbox for managing urinary symptoms

BPH progresses slowly, so most men can decide for themselves if and when they would like to consider medication or surgery. Men with mild to moderate symptoms often find that the changes in fluid intake, medication use, and bladder habits listed below can noticeably relieve BPH's bothersome effects.

MEDICATION USE: Alter use of medications that could worsen urinary symptoms.

  • Talk to your doctor or pharmacist about prescription or over-the-counter medications that may be contributing to your BPH symptoms. Antihistamines and decongestants can cause problems for some.

  • If you use medications that could make you urinate more, don't take them right before driving, traveling, attending an event, or going to bed.

  • Don't rely on ineffective dietary supplements. Saw palmetto and other herbal supplements have failed rigorous scientific testing so far.

FLUID RESTRICTION: Change how much fluid you drink and when to prevent bothersome bathroom visits.

  • Don't drink liquids before driving, traveling, or attending events where finding a bathroom quickly could be difficult.

  • Avoid drinking caffeinated or alcoholic beverages after dinner or within two hours of your bedtime.

BLADDER HABITS: Change the timing and manner in which you empty your bladder to reduce symptoms or make them less disruptive.

  • Don't hold it in; empty your bladder when you first get the urge.

  • When you are out in public, go to the bathroom and try to urinate when you get the chance, even if you don't feel a need right then.

  • Take your time when urinating so you empty your bladder as much as possible.

  • Double void: After each time you urinate, try again right away.

  • Try urethral milking: To prevent post-void dribbling, gently squeeze the base of the penis after urinating and work your way outward to force urine out of the urethra.

BLADDER TRAINING

If you experience urinary urgency, progressively delay the time to when you urinate.

(Ask your doctor for detailed instructions.)

Be watchful—and informed

As you discuss watchful waiting with your physician, make sure you understand how your symptoms could change over time. In other words, what can you expect? What should you watch out for? Lower urinary tract symptoms from BPH generally worsen slowly over time, but not always. In one study of men with moderate symptoms who chose watchful waiting, 13% had milder urinary problems after four years of follow up, in 46% things stayed the same, and in 41% the symptoms progressed to severe or the men opted for surgery.

Many men also need to be reassured that the changes in urinary function they are noticing are not signs of something like prostate cancer. It's a common fear, Dr. Barry says. "Many men will consult a doctor about the lower urinary symptoms less because they are bothered enough to do something about them, but more because they are concerned about what the symptoms could represent."

Finally, mark your calendar for the next appointment, because watchful waiting means you should come back to check in. "The watchful part is checking in periodically with a doctor to make sure the symptoms haven't changed and that there aren't other things to be concerned about," Dr. Barry says.