Do all older men have BPH?

BPH is so common that it has been said all men will have an enlarged prostate if they live long enough. A small amount of prostate enlargement is present in many men over age 40. More than 90% of men over age 80 have the condition.

medlineplus.gov - Enlarged prostate: MedlinePlus Medical Encyclopedia

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The treatment you choose will be based on how bad your symptoms are and how much they bother you. Your provider will also take into account other medical problems you may have.

Treatment options include "watchful waiting," lifestyle changes, medicines, or surgery.

If you are over 60, you are more likely to have symptoms. But many men with an enlarged prostate have only minor symptoms. Self-care steps are often enough to make you feel better. If you have BPH, you should have a yearly exam to monitor your symptoms and see if you need changes in treatment.

SELF-CARE

For mild symptoms:

Urinate when you first get the urge. Also, go to the bathroom on a timed schedule, even if you don't feel a need to urinate.

Avoid alcohol and caffeine, especially after dinner.

DO NOT drink a lot of fluid all at once. Spread out fluids during the day. Avoid drinking fluids within 2 hours of bedtime. Try NOT to take over-the-counter cold and sinus medicines that contain decongestants or antihistamines. These drugs can increase BPH symptoms. Keep warm and exercise regularly. Cold weather and lack of physical activity may worsen symptoms.

Reduce stress. Nervousness and tension can lead to more frequent urination.

MEDICINES

Alpha-1 blockers are a class of drugs that are also used to treat high blood pressure. These medicines relax the muscles of the bladder neck and prostate. This allows easier urination. Most people who take alpha-1 blockers notice improvement in their symptoms, usually within 3 to 7 days after starting the medicine. Finasteride and dutasteride lower levels of hormones produced by the prostate. These drugs also reduce the size of the gland, increase urine flow rate, and decrease symptoms of BPH. You may need to take these medicines for 3 to 6 months before you notice symptoms getting better. Possible side effects include decreased sex drive and impotence. Antibiotics may be prescribed to treat chronic prostatitis (inflammation of the prostate), which may occur with BPH. BPH symptoms improve in some men after a course of antibiotics.

Watch out for drugs that may make your symptoms worse:

SAW PALMETTO

Many herbs have been tried for treating an enlarged prostate. Many men use saw palmetto to ease symptoms. Some studies have shown that it may help with symptoms, but results are mixed, and more research is needed. If you use saw palmetto and think it works, ask your doctor if you should still take it.

SURGERY

Prostate surgery may be recommended if you have:

The choice of which surgical procedure is recommended is most often based on the severity of your symptoms and the size and shape of your prostate gland. Most men who have prostate surgery have improvement in urine flow rates and symptoms. Transurethral resection of the prostate (TURP): This is the most common and most proven surgical treatment for BPH. TURP is performed by inserting a scope through the penis and removing the prostate piece by piece. Simple prostatectomy: It is a procedure to remove the inside part of the prostate gland. It is done through a surgical cut in your lower belly. This treatment is most often done on men who have very large prostate glands. Other less-invasive procedures use heat or a laser to destroy prostate tissue. Another less-invasive procedure works by "tacking" the prostate open without removing or destroying tissues. None have been proven to be better than TURP. People who receive these procedures are more likely to need surgery again after 5 or 10 years. However, these procedures may be a choice for:

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How much caffeine is too much bladder?

When taken together, these studies demonstrate that drinking more than 2 cups of coffee per day (>200mg caffeine) is associated with worsening symptoms of overactive bladder.

uturology.com - Does caffeine REALLY cause overactive bladder? - UT Urology

If you are a coffee drinker and you suffer from symptoms of overactive bladder (OAB) such as frequent urination or urgent urination, it is a very safe bet that someone (very often your health care provider) has told you to cut out the caffeine. Caffeine can serve as both a stimulant, an irritant, and a diuretic so it should follow that it must lead to overactive bladder, right? That has been the conventional wisdom for years, though we should always be careful to check that our wisdom is really based on facts. A recent review article by Palma and Staak provides an overview of the most recent studies about the effects of caffeine on the bladder. When taken together, these studies demonstrate that drinking more than 2 cups of coffee per day (>200mg caffeine) is associated with worsening symptoms of overactive bladder. The effect does depend on the dose and more than 4 cups of coffee per day may result in developing symptoms of OAB even in patients with no symptoms before. One bit of good news is that the small amount of caffeine found in decaffeinated coffee does not appear to have a negative effect on OAB symptoms. In this case, the conventional wisdom, dispensed for years by friends, family and even your health care provider appears to be spot on. You may want to skip that extra cup of coffee tomorrow if you have a long meeting in the morning.

Colin M. Goudelocke, M.D.

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