BPH Treatment: Watchful waiting

Over time, most men develop an enlarged prostate gland from benign prostatic hyperplasia (BPH). Symptoms generally track the size of the gland, but even mild enlargement can bring BPH symptoms: a weak urine stream, trouble emptying the bladder completely, 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. It is also an option for men with more bothersome symptoms who have not yet developed BPH complications such as kidney problems, urinary retention, or repeated urinary tract infections.

Lifestyle changes

Watchful waiting does not mean "wait and do nothing." At follow-up visits, your doctor will ask whether symptoms are becoming more troublesome and may have you fill out a form with specific questions, such as how often you get up at night to urinate and how urgent the need feels. Your doctor will do a rectal exam to estimate prostate size and check for any worrisome hard spots that could point to 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, you will be encouraged to make simple behavior changes that ease urinary symptoms:

Urinate when you first feel the urge.

Go to the bathroom on a timed schedule, even when you do not feel the need.

Take the time to empty your bladder completely when you go.

Avoid drinking fluids in the evening after dinner.

Cut back on 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, can make urinating harder. With your doctor's guidance, you may be able to blunt those effects by adjusting doses, changing when you take them, or switching to medications that cause fewer urinary problems.