Watchful Waiting for Benign Prostatic Enlargement
If you have benign prostatic enlargement (BPE) but you do not experience any bothersome lower urinary tractsymptoms (LUTS), you will generally not need drugs or surgery for your condition. Instead, the urologist will explain your condition to you, how it can develop, and how you can adjust your lifestyle to reduce your symptoms and cope with them. The urologist will closely observe your condition over the following months or years and will start treatment when needed. This is called watchful waiting.
Watchful waiting is a good option if your symptoms are mild and if you feel that your quality of life has not declined. Despite of how it may feel, this is not a passive approach because it includes regular check-ups to make sure your condition does not get worse.
Most men with BPE are offered a period of watchful waiting before starting any treatment. It is widely recommended because severe complications during this time are very rare. In fact, some symptoms can improve on their own while others may remain stable for years.
A watchful waiting programme includes:
- Evaluation of your symptoms
- A physical examination
- Blood and urine tests
- Education about your condition
- Support and reassurance
- Lifestyle and self-management advice
- Drink at least 1 litre every day and discuss with your doctor if you can drink more
- Drink more if you live in a hot climate or do a lot of physical exercise
- Drink less before and during long trips
- Drink less in the evening to avoid getting up at night to urinate
- Avoid alcohol and caffeine because they increase urine production and irritate the bladder
- Try to exercise 2 or 3 times a week. Lack of movement can make it more difficult to urinate and cause urinary retention
- Have a balanced and varied diet
- Always try to keep your lower abdomen dry and warm. If you go swimming, bring an extra set of dry clothes and change as soon as you are out of the water. Dampness and cold may increase the need to urinate and can cause a urinary infection
- Sometimes urine sprays and it can wet the toilet seat or the bathroom floor. Some men prefer to sit down when urinating to avoid this, while others prefer to urinate in a cup and empty it in the toilet
Apart from following general lifestyle advice you can actively manage the symptoms caused by BPE in your everyday life. Self-management can reduce symptoms and keep your condition stable.
- Completely empty your bladder each time you urinate. It may help if you sit down
- If you feel your bladder is not empty after urinating, try again after 5 minutes
- Use a small pad to catch involuntary urine loss
- After urinating, press under the scrotum with your fingers onto the urethra and then slide your fingers from the base to the tip of the penis to squeeze out the last drops of urine. This will help to avoid wetting your underwear
- Use breathing exercises to distract yourself from the feeling of urgency
- Apply pressure to your penis or perineum (Fig. 1) to divert your attention from urination
- Encourage yourself to “hold on” longer when you feel the urgency to urinate. This will train your bladder to keep more urine so that you will urinate less often
- Avoid constipation by adapting your diet
- Avoid sudden exposure to cold weather and always try to keep your lower abdomen warm
Next to these recommendations, you may keep a bladder diary to monitor your symptoms.
Write down how much you drink, how often you urinate, and how much urine you produce. The bladder diary is important because it helps your doctor to understand your symptoms better.
You can easily measure the volume of urine at home with the help of a measuring jug. You may use a stopwatch to record the time it took you to urinate. Note down the amount of urine (in millilitres) and the time it took to urinate (in seconds) (Fig. 2).
What measuring your urine flow rate at home can tell you:
- Normal urine flow is above 15 millilitres per second
- If your flow of urine is 10 millilitres per second or less and you experience symptoms, you should see your urologist
Measuring at home is never as accurate as at the hospital or clinic. Make sure to consult your doctor about your urine flow rate.