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Benign prostate enlargement

The three main treatments for benign prostate enlargement are lifestyle changes, medication and surgery.

The treatment for an enlarged prostate gland will depend on the severity of your symptoms.

The main treatments are:

Lifestyle changes

Medication

Catheters

Surgery

Read a summary of the pros and cons of the different treatment options for benign prostate enlargement.

Lifestyle changes

You might be able to relieve the symptoms by making some simple
changes to your lifestyle, such as:

Drinking fewer fizzy drinks and less alcohol, caffeine and artificial sweeteners
Fizzy drinks and drinks that contain alcohol, caffeine (like tea, coffee or cola) and artificial sweeteners can irritate the bladder and make urinary
symptoms worse. 

Drinking less in the evening
Try to reduce the amount you drink in the evening and avoid drinking anything for two hours before you go to bed. This might help you avoid getting up in the night. Make sure you're still drinking enough fluid earlier in the day.

Remembering to empty your bladder
Remember to go to the toilet before long journeys or when you know you won't be able to reach a toilet easily.

Double voiding
This involves waiting a few moments after you've finished passing urine before trying to go again. It can help you to empty your bladder properly. But take care not to strain or push.

Checking your medicines
Check with your doctor whether any medicines you take, such as antidepressants or decongestants, may be making your urinary symptoms worse.

Eating more fruit and fibre
This will help you avoid constipation, which can put pressure on the bladder and worsen symptoms of an enlarged prostate.

Using pads or a sheath
Absorbent pads and pants can be worn inside your underwear, or may replace your underwear altogether. These will soak up any leaks.

Urinary sheaths can also help with dribbling. They look like condoms with a tube coming out of the end. The tube connects to a bag that you can strap to your leg under your clothing. 

Bladder training
Bladder training is an exercise programme that aims to help you go for longer without peeing and hold more pee in your bladder. You'll be given a target, such as waiting at least two hours between each time you pee.

It's a good idea to use a bladder training chart (PDF, 115kb), which allows you to record each time you pass urine and the volume of urine passed – you'll need a plastic jug to measure this. Your doctor should give you a chart to take home.

You'll also be taught a number of exercises, such as breathing, relaxation and muscle exercises, to help take your mind off the need to urinate.

Over time your target time will be increased, and at the end of the programme you should find you're able to go for longer without peeing.

Ask your doctor or specialist nurse for more information about any of these lifestyle changes. 

Medicines

If lifestyle changes don't help or aren't suitable for you, you may be offered medicine.

Alpha blockers relax the muscle in the prostate gland and at the base of the bladder, making it easier to pass urine. Commonly used alpha blockers are tamsulosin and alfuzosin.

Anticholinergics relax the bladder muscle if it's overactive.

5-alpha reductase inhibitors shrink the prostate gland if it's enlarged. Finasteride and dutasteride are the two 5-alpha reductase inhibitors available.

Diuretics speed up urine production. If taken during the day, it reduces the amount of urine produced overnight.

Desmopressins slow down urine production so less urine is produced at night.

Your doctor shouldn't offer you homeopathy, herbal treatments or acupuncture to treat urinary symptoms.

This is because there isn't enough reliable evidence about how well they work or how safe they are.

Herbal treatments may also cause side effects or interact with other medicines.

Catheters

If you continually have trouble peeing, a condition called chronic urine retention, you may need a catheter to drain your bladder.

A catheter is a soft tube that carries urine to the outside of the body from the bladder. It can pass through your urethra, or through a small hole made in the abdomen above your pubic bone.

You may be recommended a removable catheter or a catheter that stays in your bladder for a longer period of time. 

Surgery

Most men with urinary symptoms don't need to have surgery, but it may be an option if other treatments haven't worked.

Transurethral resection of the prostate (TURP)
TURP involves removing part of the prostate gland, generally using a tube that passes through the urethra. It's suitable for men who have an enlarged prostate.

Open prostatectomy
An open prostatectomy involves removing the prostate gland through a cut in your body. This procedure is suitable for men who have an enlarged prostate over a certain size.

Cystoplasty
Cystoplasty is a procedure to increase the size of the bladder by sewing a piece of tissue from the intestine into the bladder wall. This intervention may help men whose bladder muscle contracts before it's full.

Botulinum toxin
This procedure involves injections of botulinum toxin into the walls of the bladder. This intervention may help men whose bladder muscle contracts before the bladder fills.

Implanted sacral nerve root stimulation
A small electrical device is implanted under the skin and sends bursts of electrical signals to the bladder and urine system for better control. This is suitable for men whose bladder muscle contracts before the bladder fills.

Urinary diversion
Urinary diversion involves linking the tubes connecting the kidneys to the bladder directly to the outside of the body, so the urine can be collected without flowing into the bladder.

This method is suitable for men whose symptoms can't be managed by self-management and medicine, and who can't have – or don't want – cystoplasty or sacral nerve root stimulation.

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