BPH Treatment: Watchful waiting

Over time, most men develop an enlarged prostate gland due to benign prostatic hyperplasia (BPH). In general, symptoms tend to correlate with the size of the gland. But even with mild enlargement men can have BPH symptoms, such as a weak urine stream, difficulty with completely emptying the bladder, and frequent trips to the bathroom.

If your symptoms are mild and not particularly bothersome, your doctor will usually first recommend a conservative approach called watchful waiting. But it's also an option for men with more bothersome symptoms if they have not yet developed complications of BPH, such as kidney problems, urinary retention, or repeated urinary tract infections.

Lifestyle changes

Watchful waiting doesn't mean "wait and do nothing," however. During follow-up visits, your doctor will ask if your symptoms are becoming more troublesome. He or she may have you fill out a form with specific questions like how often you get up at night to urinate and urgency to use bathroom. Your doctor will do a rectal exam to estimate your prostate size and feel for any worrisome hard spots that might indicate prostate cancer. You might also need imaging such as an ultrasound of the bladder and kidneys and a blood test to measure kidney function.

Between visits to the doctor, you'll be encouraged to make simple changes in behavior that can help to ease urinary symptoms, including:

• Urinate when you first get the urge.
• Go to the bathroom on a timed schedule, even if you don't feel a need to go.
• When you go to the bathroom, take the time to empty your bladder completely.
• Avoid drinking fluids in the evening after dinner.
• Minimize consumption of caffeinated drinks.
• Avoid drinking a lot of fluids before going out in public or starting a trip.

Some prescription and over-the-counter drugs, such as antihistamines and decongestants, may make it harder for you to urinate. In consultation with your doctor, you may be able to reduce the effects by changing the dosages, changing when you take them, or switching to medications that cause fewer urinary problems.

To learn more about BPH, its causes, symptoms, and treatments, read Living Better with Benign Prostatic Hyperplasia, an online guide from Harvard Medical School.

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