Do I need to take medication for BPH?

DEAR DOCTOR K:

I have BPH. The symptoms don’t interfere with my work or home life very much. My doctor says there are medicines that might reduce the symptoms, but I like to avoid taking medicines. What’s your advice?

DEAR READER:

Benign prostatic hyperplasia, or BPH, is the most common cause of prostate enlargement. As the name suggests, BPH is harmless; it does not lead to prostate cancer.

Up to two-thirds of men with BPH never develop any symptoms. However, other men find that BPH can make life very unpleasant. You seem to be somewhere in between.

The most common symptoms of BPH involve changes or problems with urination. They include:

  • a hesitant, interrupted or weak urine stream;
  • a strong urge to urinate repeatedly throughout the day and night, even if there’s not a lot of urine in the bladder;
  • leaking or dribbling urine;
  • a sense of incomplete emptying;
  • more frequent urination, especially at night.

Even if you find your symptoms to be manageable, it doesn’t hurt to reassess every now and then. One way to get a sense of the severity of your symptoms is by calculating your urinary symptom score. I’ve put a copy of this questionnaire, below.

Your urinary symptom score

To evaluate the severity of your benign prostatic hyperplasia (BPH), your doctor may ask you to complete a questionnaire like the one below. Choose one number to respond to questions 1 to 7, and then calculate your total urinary symptom score. Question 8 is separate and indicates how bothered you are by the condition.

Urinary symptom scores of 1–7 indicate mild symptoms. Scores of 8–19 are considered moderate. And scores of 20 or greater are severe. If you have moderate to severe symptoms, and if your answer to question 8 is a 3, 4, or 5, you may want to discuss treatment (either medical or surgical) with your physician.

1. Over the past month, how often have you had a sensation of not having emptied your bladder completely after you finished urinating?

  1. Not at all
  2. Less than 1 in 5 times
  3. Less than half the time
  4. About half the time
  5. More than half the time
  6. Almost always

2. Over the past month, how often have you had to urinate again less than two hours after you last finished urinating?

  1. Not at all
  2. Less than 1 in 5 times
  3. Less than half the time
  4. About half the time
  5. More than half the time
  6. Almost always

3. Over the past month, how often have you stopped and started again several times while urinating?

  1. Not at all
  2. Less than 1 in 5 times
  3. Less than half the time
  4. About half the time
  5. More than half the time
  6. Almost always

4. Over the past month, how often have you found it difficult to postpone urination?

  1. Not at all
  2. Less than 1 in 5 times
  3. Less than half the time
  4. About half the time
  5. More than half the time
  6. Almost always

5. Over the past month, how often have you had a weak urinary stream?

  1. Not at all
  2. Less than 1 in 5 times
  3. Less than half the time
  4. About half the time
  5. More than half the time
  6. Almost always

6. Over the past month, how often have you had to push or strain to begin urination?

  1. Not at all
  2. Less than 1 in 5 times
  3. Less than half the time
  4. About half the time
  5. More than half the time
  6. Almost always

7. Over the past month, how many times, typically, did you get up to urinate between the time you went to bed and the time you got up in the morning?

  1. None
  2. Once
  3. Twice
  4. Three times
  5. Four times
  6. Five times or more

Urinary symptom score: ______

8. How would you feel if you had to live with your urinary condition the way it is now, no better, no worse, for the rest of your life?

  1. Delighted
  2. Pleased
  3. Mostly satisfied
  4. Mixed
  5. Mostly not satisfied
  6. Unhappy

Quality of life score: ______

 

If your symptoms don’t bother you too much, you and your doctor may choose to do nothing other than keep an eye on them. Most physicians advise against active treatment for men with mild symptoms because the side effects of the treatment can outweigh the potential benefits.

Even if you choose to forgo treatment, your doctor should regularly monitor you for complications. BPH can increase your risk of urinary tract infections and, possibly, bladder stones. The increased risk of infection comes from difficulty in fully emptying the bladder. If all the urine is not emptied out of the body, bacteria in the urine that remains inside the bladder can multiply rapidly.

If your symptoms become burdensome, talk to your doctor about treatment options. Usually a combination of lifestyle changes and medication can relieve the worst symptoms.

Lifestyle changes may include taking time to empty your bladder completely. That can require a little patience. When your stream stops, try just sitting there on the pot or standing in front of it for a minute or two. Try to will your bladder to release more urine. It will often start again if you just wait and continue to try to urinate.

Another trick is to avoid caffeinated or alcoholic beverages in the evenings. A final tip is to ask your doctor if any medicines you are taking for other conditions might be making your bladder a bit sluggish. There are lots of medicines that have this effect. Your doctor may be able to make changes in your medicines that improve your BPH symptoms.

You ask about the value of medications that treat BPH. I would try the lifestyle changes I’ve mentioned first. If you’re not getting adequate relief, medicines may help.

(This column is an update of one that ran originally in February 2013.)