Patience and lifestyle changes relieve BPH
DEAR DOCTOR K:
I have BPH. I have some urinary symptoms, but because I work from home they're not difficult to manage. Is there any danger in not actively treating my condition?
Benign prostatic hyperplasia, or BPH, is the most common cause of prostate enlargement. As the name suggests, BPH is harmless; it does not lead to prostate cancer.
Up to two-thirds of men with BPH never develop any symptoms. Others find that BPH can make life miserable. You seem to be somewhere in between.
The most common symptoms of BPH involve changes or problems with urination. They include:
-- a hesitant, interrupted or weak urine stream;
-- a strong urge to urinate repeatedly throughout the day and night, even if there's not a lot of urine in the bladder;
-- leaking or dribbling urine;
-- a sense of incomplete emptying;
-- more frequent urination, especially at night.
Even if you find your symptoms to be manageable, it doesn't hurt to reassess every now and then. One way to get a sense of the severity of your symptoms is by calculating your urinary symptom score. I've put a copy of this questionnaire on my website, AskDoctorK.com.
If your symptoms don't bother you too much, you and your doctor may choose to do nothing other than watchful waiting. This involves regular monitoring but no treatment. Most physicians advise against active treatment for men with mild symptoms because the side effects of the treatment can outweigh the potential benefits.
Even if you choose to forgo treatment, your doctor should regularly monitor you for complications. BPH can increase your risk of urinary tract infections and, possibly, bladder stones. The increased risk of infection comes from difficulty in fully emptying the bladder. If all the urine is not emptied out of the body, bacteria in the urine that remains inside the bladder can multiply rapidly.
If your symptoms become more burdensome, talk to your doctor about treatment options. Usually a combination of lifestyle changes and medication can relieve the worst symptoms.
Lifestyle changes may include taking time to empty your bladder completely. Many of my patients with BPH say that if their urine stream stops, as if they have emptied their bladders, it will often start again if they just wait and continue to try to urinate. It also may help to avoid caffeinated or alcoholic beverages in the evenings. Your doctor may be able to substitute or adjust dosages of other medications you are taking that may affect urination.
Several medications exist to treat BPH. While medicines can cause side effects, they don't in most patients, and many of my patients swear by the medicines I've prescribed. Also, surgical treatments are more effective and have fewer side effects than ever before.
Usually, though, patience and lifestyle changes can give sufficient relief, and that's what I recommend first.
(Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.)
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