Treatment – Benign prostate enlargement.
The treatment for an enlarged prostate gland will depend on the severity of your symptoms.
The main treatments are:
lifestyle changes medication catheters surgery and other procedures.
Lifestyle changes.
You might be able to relieve the symptoms by making some simple changes to your lifestyle.
Drink 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 2 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.
Remember 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.
Double voiding involves waiting a few moments after you have finished passing urine before trying to go again. It can help you 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.
Eating more fruit and fibre 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 2 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 pee.
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.
If lifestyle changes don’t help or aren’t suitable for you, you may be offered medicine.
Alpha-blockers.
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.
Anticholinergics relax the bladder muscle if it’s overactive.
5-alpha reductase inhibitors.
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, they reduce the amount of urine produced overnight.
Desmopressins.
Desmopressins slow down urine production so less urine is produced at night.
Alternative treatments.
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.
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 out of the body from the bladder. It can be passed through your penis, or through a small hole made in your tummy above the pubic bone.
You may be recommended a removable catheter or a catheter that stays in your bladder for a longer period of time.
Surgery and other procedures.
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 using a device called a resectoscope that’s passed through the urethra (the tube through which urine passes out of the body). It’s suitable for men who have an enlarged prostate.
Open prostatectomy.
During an open prostatectomy, the prostate gland is removed through a cut in your body. It’s suitable for men who have an enlarged prostate over a certain size.
Prostatic urethral lift (PUL) implants.
A surgeon inserts implants that hold the enlarged prostate away from the urethra so it isn’t blocked. This helps to relieve symptoms like pain or difficulty when peeing.
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 may help men whose bladder muscle contracts before it’s full.
Prostate artery embolisation.
A catheter is inserted into an artery in your groin or wrist. Using X‑ray guidance, it’s passed into the blood vessels that supply the prostate gland.
Tiny plastic particles are injected into these vessels to reduce the prostate gland’s blood supply, which shrinks it.
Potential benefits of prostate artery embolisation compared with surgery are fewer complications and you can have the procedure under local anaesthetic as an outpatient.
Botulinum toxin.
This procedure involves injections of botulinum toxin into the walls of the bladder. It 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.
Water vapour ablation.
Water vapour ablation is a new treatment for prostate enlargement. Steam is injected into the prostate using a probe passed up the urethra. The heat from the steam destroys some of the prostate tissue, making it smaller.
Water vapour ablation is probably less likely than a TURP to cause side effects.
But not all NHS surgeons are currently trained to carry out the procedure. So access to this treatment may be limited and waiting lists for it may be longer than for other surgical options.
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