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Benign prostatic hyperplasia - Lifestyle Changes

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of benign prostatic hyperplasia (BPH).

Alternative Names

Enlarged prostate; BPH

Lifestyle Changes:

General Lifestyle Recommendations

Certain lifestyle changes may help relieve symptoms and are particularly important for men who choose to avoid surgery or drug therapy. They include:

Limit daily fluid intake to less than 2,000 mL (about 2 quarts).
Limit or avoid alcohol and caffeine.
Limit beverages in the evening. Avoid drinking fluids after your evening meal.
Try to urinate at least once every 3 hours.
“Double-voiding” may be helpful -- after urinating, wait and try to urinate again.
Stay active. Cold weather and immobility may increase the risk for urine retention. Keeping warm and exercising may help.

Avoiding Medications that Aggravate Symptoms

Decongestants and Antihistamines. Men with BPH should avoid, if possible, the many medications for colds and allergies that contain decongestants, such as pseudoephedrine (Sudafed). Such drugs, known as adrenergics, can exacerbate urinary symptoms by preventing muscles in the prostate and bladder neck from relaxing to allow urine to flow freely. Antihistamines, such as diphenhydramine (Benadryl), can also slow urine flow in some men with BPH.

Diuretics. Men who are taking diuretics, which increase urination, may want to talk to their doctor about reducing the dosage or switching to another drug. These are important drugs for many people with high blood pressure, with a proven track record for saving lives. No one should go off these medications without medical supervision.

Other Drugs. Other drugs that may worsen symptoms are certain antidepressants and drugs used to treat spasticity.

Pelvic Floor Muscle Training

Pelvic floor muscle exercises, first developed to help women with childbirth, may also help men prevent urine leakage, particularly after surgical procedure. These exercises strengthen the pelvic floor muscles that both support the bladder and close the sphincter.

Performing the Exercises. Since the muscle is internal and sometimes hard to isolate, doctors often recommend practicing while urinating:

The patient is asked to contract the muscle until the flow of urine is slowed or stopped. He attempts to hold each contraction for 20 seconds.
He then releases the contraction.
In general, patients should perform 5 - 15 contractions, three to five times daily.

Dietary Factors

A heart-healthy diet rich in vegetables and fruit may help reduce BPH risk. Some evidence indicates that fruits and vegetables rich in beta-carotene and vitamin C may help protect against BPH. Dietary choices should also focus on increasing intake of healthy fats, such as omega-3 fatty acids, and limiting intake of saturated fats and trans-fatty acids.

[For more information, see In-Depth Report #43: Heart healthy diet.]

Herbs and Supplements

Generally, manufacturers of herbal remedies and dietary supplements do not need approval from the Food and Drug Administration to sell their products. Just like a drug, herbs and supplements can affect the body's chemistry, and therefore have the potential to produce side effects that may be harmful. There have been several reported cases of serious and even lethal side effects from herbal products. Patients should check with their doctor before using any herbal remedies or dietary supplements.

Popular herbal and dietary supplement treatments for BPH include:

Saw palmetto is one of the most popular herbal remedies for BPH. It comes from the berry of the plant Serenoa repens. Most clinical trials have shown a modest benefit at best. A large, high-quality study found that saw palmetto had no benefit for treating BPH for men with moderate-to-severe BPH when the herb was taken for 1 year.
Other popular herbs include include extracts from African plum tree (Pygeum africanum), rye grass pollen (Secale cerale), stinging nettle root (Urtica dioica), South African star grass (Hypoxis rooperi), and pumpkin seed oil (Cucurbita peponis). Beta-sitosterol is a plant sterol found in some of these herbs that is marketed as a dietary supplement for prostate health. There is no scientific evidence that any of these remedies help treat BPH.
Patients should be aware that high doses of zinc supplements may increase the risk and progression of BPH.

Resources

www.niddk.nih.gov -- National Institute of Diabetes and Digestive and Kidney Diseases
www.urologyhealth.org -- American Urological Association

References

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Bravi F, Bosetti C, Dal Maso L, Talamini R, Montella M, Negri E, et al. Food groups and risk of benign prostatic hyperplasia. Urology. 2006 Jan;67(1):73-9.

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Reviewed last on: 7/8/2009
Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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