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Treatment

The treatment for an enlarged prostate gland will depend on how badly the symptoms are affecting your qualify of life.

The main treatments are:

  • lifestyle changes
  • medicine
  • catheters
  • surgery and other procedures

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 (such as tea, coffee or cola) and artificial sweeteners can irritate the bladder and make urinary symptoms worse. 

Drinking less fluid in the evening

Try to reduce the amount of fluids 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 will not be able to reach a toilet easily.

Double voiding

Double voiding involves waiting a few moments after you have finished peeing 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, might be making your urinary symptoms worse.

Eating more fibre

Eating more fibre (which is found in fruit, vegetables and wholegrain cereals) can help you avoid constipation, which can put pressure on your bladder and make the symptoms of an enlarged prostate worse.

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 last 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 to record each time you pass urine and the volume of urine passed. You can download a bladder training chart (PDF, 115KB) from Bladder Matters. You'll need a plastic jug to measure this. Your doctor should also give you a chart to take home.

You'll also be taught several 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 last longer without peeing.

Ask your doctor or specialist nurse for more information about any of these lifestyle changes.

If lifestyle changes do not help, or are not suitable for you, you may be offered medicine.

Alpha-blockers

Alpha blockers relax the muscle in your prostate gland and at the base of your bladder, making it easier to pee. 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

Diuretics speed up urine production. If taken during the day, they reduce the amount of urine you produce during the night.

Desmopressins

Desmopressins slow down urine production so less urine is produced at night.

Alternative treatments

Your doctor should not offer you homeopathy, herbal treatments or acupuncture to treat urinary symptoms.

This is because there is not 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 continue to have trouble peeing, a condition called chronic urine retention, you may need a catheter to drain your bladder.

A urinary 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 your pubic bone.

You may be recommended a removable catheter, or a catheter that stays in your bladder for a longer period of time.

Most men with urinary symptoms do not need to have surgery, but it may be an option if other treatments have not 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 is not blocked. This helps to relieve symptoms such as 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.

The potential benefits of prostate artery embolisation compared with surgery are fewer complications and you can have this procedure under local anaesthetic as an outpatient.

Botulinum toxin

This procedure involves injections of botulinum toxin into the walls of your bladder. It may help men whose bladder muscle contracts before the bladder is full.

Implanted sacral nerve root stimulation

A small electrical device is implanted under your skin and sends bursts of electrical signals to your bladder and urine system for better control. This is suitable for men whose bladder muscle contracts before their bladder is full.

Urinary diversion

Urinary diversion involves linking the tubes that connect your kidneys to your bladder directly to the outside of the body, so urine can be collected without flowing into your bladder.

This is suitable for men whose symptoms cannot be managed by self-management and medicine, and who cannot have – or do not want – cystoplasty or sacral nerve root stimulation.

Water ablation

Water ablation is a new treatment for prostate enlargement. There are 2 types of water ablation procedure. In the first, water is injected into the prostate using a probe passed up the urethra. The pressure of the water is then used to destroy some of the prostate tissue, making it smaller.

The second type is very similar except steam, rather than water, is used to destroy prostate tissue.

Water ablation is probably less likely to cause side effects than a transurethral resection of the prostate (TURP).

However, not all NHS surgeons are currently trained to do these procedures, so access to these procedures may be limited and waiting lists for them may be longer than for other surgical options.