KUALA LUMPUR, July 9 — Although benign prostate hyperplasia (BPH) is not life-threatening for most men, urination problems associated with an enlarged prostate can significantly affect their daily life. 

According to the National Health and Morbidity Survey (NHMS) 20191, three in five men with probable BPH in Malaysia had poor quality of life and were dissatisfied with their urination experience.

The United States’ National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)2 says health care providers may recommend lifestyle changes for men with mild BPH symptoms. 

Lifestyle changes include reducing the intake of liquids, especially before going out or before going to sleep; avoiding or reducing consumption of caffeinated beverages like coffee, tea, or cola, and alcoholic drinks; and avoiding or monitoring use of medications like decongestants, antihistamines, antidepressants, and diuretics, in consultation with your doctor.

Men with BPH are also advised to engage in pelvic floor muscle exercise, train their bladder to hold more urine for longer periods, and to prevent or treat constipation.

Other lifestyle changes recommended by the United Kingdom’s NHS3 to relieve BPH symptoms include drinking fewer fizzy drinks and artificial sweeteners that can irritate the bladder and worsen urinary symptoms.

NHS UK also recommends avoiding drinking anything for two hours before going to bed, while ensuring that one drinks enough fluid earlier in the day. Men with BPH should also double void – waiting a few moments after peeing before trying to urinate again, so as to empty your bladder properly.

Men with BPH should remember to go to the toilet before long journeys or when they know that they won’t be able to easily reach a toilet. 

Eating more fibre – found in fruit, vegetables, and wholegrain cereals – can help men with BPH avoid constipation, a condition that can put pressure on their bladder and worsen symptoms of an enlarged prostate.

Men can consider wearing absorbent pads or pants inside their underwear or to replace their underwear altogether to soak up any leaks. Urinary sheaths – which look like condoms with a tube that connect to a bag strapped to your leg under your clothing – can also help with dribbling problems.

On bladder training recommended by the NHS, this exercise programme sets targets like waiting at least two hours between each pee. Men can use a bladder training chart4 to record every time they urinate and the volume of urine passed. A plastic jug is needed to measure this.

Bladder training also involves exercises like breathing, relaxation, and muscle exercises to take your mind off the need to pee. Over time, men should be able to increase their target time to last longer without peeing.

According to the United States’ Urology Care Foundation,5 BPH often only requires active surveillance, where one’s condition is monitored through regular visits to their urologist, who will also recommend lifestyle changes to better manage symptoms.

However, active monitoring is best for men with mild to moderate BPH symptoms or for those who aren’t bothered by their condition. 

The IPSS – which measures the severity of lower urinary tract symptoms and response to therapy – is a test comprising seven questions related to one’s urination. A score of 0 to 7 indicates mild symptoms, 8 to 19 indicates moderate symptoms, while 20 to 35 shows severe symptoms.

If symptoms worsen or if new symptoms pop up, doctors may recommend starting treatment. 

The treatments available for BPH are intended to improve BPH symptoms, urinary flow, and quality of life, NIDDK said, quoting its Medical Therapy of Prostatic Symptoms (MTOPS) 2001 study6

BPH may place some patients at higher risk of progression to complications in future. Treatments may be initiated by your doctor to reduce the risk of these complications, which include acute urinary retention or the need for surgery.  

Patients need to be well informed about the potential side effects of treatments prescribed for BPH. It is recommended to report these side effects to your doctor. 

According to NIDDK2, side effects from medications used to treat BPH could include, but are not limited to: hives; rash; itching; shortness of breath; and rapid, pounding, or irregular heartbeat.

Other side effects from BPH medications include painful erection of the penis that lasts for hours; decreased sexual drive; and problems with ejaculation. Please consult your doctor if you are on medications for BPH and are facing side effects.

BPH medicines can also result in side effects like swelling of the eyes, face, tongue, lips, throat, arms, hands, feet, ankles, or lower legs; difficulty breathing or swallowing; chest pain; and dizziness or fainting when standing up suddenly; sudden decrease or loss of vision; blurred vision; sudden decrease or loss of hearing; and chest pain, dizziness, or nausea during sexual activity. The NIDDK advises men to get emergency medical care if they experience the above side effects.

Surgical options are available and may be offered to the patient based on the doctor’s opinion for the stage and severity of the condition.

If you have symptoms of BPH, please take the first step in diagnosing your condition with your healthcare provider so that a health care professional can advise you on how to manage your symptoms or recommend suitable treatment.

References:

  1. National Health and Morbidity Survey 2019: Technical Report – Volume I. National Institutes of Health (NIH), Ministry of Health Malaysia. iku.moh.gov.my/images/IKU/Document/REPORT/NHMS2019/Report_NHMS2019-NCD_v2.pdf. Accessed June 14, 2022.
  2. Prostate Enlargement (Benign Prostatic Hyperplasia). National Institute of Diabetes and Digestive and Kidney Diseases. www.niddk.nih.gov/health-information/urologic-diseases/prostate-problems/prostate-enlargement-benign-prostatic-hyperplasia. Accessed June 14, 2022.
  3. Benign prostate enlargement. NHS UK. www.nhs.uk/conditions/prostate-enlargement/. Accessed June 14, 2022.
  4. Frequency and volume chart. Bladder Matters. bladdermatters.co.uk/downloads/85923fchart.pdf. Accessed June 14, 2022. 
  5. Benign Prostatic Hyperplasia (BPH). Urology Care Foundation. www.urologyhealth.org/urology-a-z/b/benign-prostatic-hyperplasia-(bph). Accessed June 14, 2022.
  6. Medical Therapy of Prostatic Symptoms (MTOPS). National Institute of Diabetes and Digestive and Kidney Diseases. repository.niddk.nih.gov/studies/mtops/. Accessed June 14, 2022.

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