BPH: When to Consider Watchful Waiting

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Because the course of benign prostatic hyperplasia (BPH) is unpredictable, watchful waiting is the best option for men with minimal symptoms that are not especially bothersome. With this management option, physician visits are needed about once a year (unless symptoms change) to review symptom status, conduct a physical examination, and perform a few simple laboratory tests.

During watchful waiting, men should adopt certain lifestyle measures to help relieve symptoms or prevent them from worsening. For example, they should not take over-the-counter antihistamines or decongestants, which can worsen symptoms, and they should avoid delaying urination, which can lead to urinary retention.

Men also need to limit the amount of fluid consumed at any one time, not drink anything a few hours before bedtime, and limit alcohol intake. Some men find that avoiding beverages that contain caffeine and cutting back on spicy or salty foods helps relieve symptoms.

Engaging in regular physical activity, doing Kegel exercises (contractions of the pelvic floor muscles), and keeping warm also can be helpful. The association between lower urinary tract symptoms and cold weather is probably related to increased sympathetic activity (the sympathetic nervous system is more active in cold weather), which causes increased smooth muscle tone within the prostate.

Also, preventing weight gain (especially around the middle), eating a diet rich in vegetables, and keeping blood sugar under control may help reduce symptoms.