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Benign enlarged prostate: What can I do myself?

Many men over the age of 50 will know what it is like to have a frequent urge to urinate, and get up regularly at night to go to the toilet. These problems are usually caused by a benign enlarged prostate. Then it is often possible to manage them by simply changing a few everyday habits.You can find more information on this topic in our feature. The gradual growth of the prostate gland is a normal part of aging in men. This usually does not have any noticeable effects. But in some men the gland grows so big that they have problems urinating: they have to go more often and more urgently, it takes longer for the urine to start flowing, and their urine flow is weaker. Urine may drip and leak after urinating too, and they might feel like their bladder is never really empty. The medical term for this group of symptoms is "benign prostatic hyperplasia" (BPH) or lower urinary tract symptoms (LUTS).Various strategies can make it easier to cope with an enlarged prostate in everyday life. These include:Limiting the amount of fluids you drink in situations where needing to go to the toilet may be inconvenient, like before going to sleep or before going somewhere where you will not be in easy reach of a bathroom for some time. But it is important not to exaggerate. You still need to drink enough – especially whenever you are thirsty.Avoiding drinks that are diuretics. These can increase the amount of urine released by the body. Diuretics include alcohol and drinks with caffeine in them (like green and black tea, coffee and cola) in particular.Using what is called a double-voiding technique when you urinate: after urinating, you wait a moment and try again to see if more urine comes out. This increases the chances of emptying your bladder properly.Doing exercises to train your bladder to hold more urine. For instance, practising holding on longer before urinating, and not going to the toilet as soon as you feel the need.If a man who has prostate problems takes other medication too, it is a good idea to find out whether they perhaps make the body release more urine or affect the bladder muscles. Medications that do this include:Diuretics: Medications that make the body release more urine, such as medicines for the treatment of high blood pressure.Antispasmodic medications.Some medications that are used to treat allergies.Neurological medications, such as particular drugs for the treatment of Parkinson’s disease and depression.Your doctor or pharmacist can help determine whether you are taking this kind of medication, and whether there are alternatives that will not make your prostate problems worse.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: January 15, 2014

Extracts from the African prune tree (Pygeum africanum) may be able to help relieve urinary symptoms caused by enlarged prostate (benign prostatic hyperplasia)

Benign prostatic hyperplasia (BPH), enlargement of the prostate gland, is common in older men. An enlarged prostate can interfere with urination, increasing the frequency and urge, or causing problems emptying the bladder. Both surgery and drugs are used to try to treat BPH. However, using herbal medicines to try to relieve the symptoms of BPH is becoming common. Pygeum africanum is one of several popular herbal remedies for BPH. The review found that pygeum africanum is well tolerated, cheaper than many prescription medicines used for BPH, and provides moderate relief from the urinary problems caused by an enlarged prostate.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Benign enlarged prostate: Overview

Many middle-aged men will know what it is like to have to go to the bathroom a lot at night and still feel like your bladder is never really empty. This problem is usually caused by a benign enlarged prostate. Here we describe the various treatment options for this condition.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: January 15, 2014

Microwave thermotherapy is an effective treatment to relieve urinary symptoms and urinary flow problems caused by an enlarged prostate gland

Benign prostatic hyperplasia may lead to troublesome urinary symptoms, particularly in older men. Transurethral resection of the prostate (TURP) has been considered the definitive treatment for BPH. However, TURP is associated with complications. Therefore, less invasive techniques have been developed. These include microwave thermotherapy, which applies energy (heat) to shrink enlarged prostatic tissue. We found microwave thermotherapy to be a relatively safe and effective treatment option. Microwave thermotherapy can be performed as an outpatient procedure and has fewer and less severe side effects than TURP. However, TURP produced greater improvements in urinary symptoms and urine flow and fewer men required retreatment. Further studies are needed to determine the long‐term outcomes of microwave thermotherapy and to identify the most effective microwave thermotherapy devices and energy settings.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Benign enlarged prostate: Medication and herbal products

Most men who have prostate problems either wait a while to see how their symptoms develop, or take medication. Medication is often used when the symptoms are not bad enough for surgery to be needed, but have become too bothersome to be left untreated.This might be the case if you have to go to the bathroom several times a night, or constantly feel the need to urinate during the day too because your bladder no longer empties properly. These typical symptoms of an enlarged prostate can become a real burden.Several types of medications and combinations of medications are available for the relief of problems associated with an enlarged prostate. Like with any medication, it is important to carefully consider the advantages and disadvantages of these medications, and be aware of possible interactions between different medications. The majority of men with an enlarged prostate are over the age of 50, and often on other medications too, like drugs for high blood pressure (hypertension).For instance, if a man is taking alpha blockers for the treatment of prostate problems, he should not use impotence drugs as well. This is because both of these medications have a blood-pressure-lowering effect, so his blood pressure could become too low otherwise.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: January 15, 2014

Benign enlarged prostate: Surgery: Advantages and disadvantages

Surgery can very effectively reduce the problems associated with a benign enlarged prostate. But side effects are common. Surgery is considered if, for instance, other treatments do not provide enough relief, or if the enlarged prostate keeps causing medical problems such as urinary tract infections.There is usually no urgent need for men who have a benign enlarged prostate to have surgery. So they can generally take their time to consider whether they think a surgical procedure will have more pros or more cons for them. Men might decide to have surgery for various reasons:The prostate-related problems are very distressing, and other treatments have not lead to a big enough improvement.The enlarged prostate frequently causes other medical problems, such as recurring urinary tract infections or bladder stones.Treatment with medication is not possible for medical reasons.An enlarged prostate can occasionally lead to a fairly rare complication called acute urinary retention. This happens when the prostate pushes against the urethra so much that the man can hardly urinate any more, or can no longer urinate at all. Then the bladder has to be emptied using a catheter. Surgery is usually needed afterwards too. Sometimes surgical treatment is not an option, or not advisable, because of other medical conditions or particular risks. For example, general anesthetics may be too risky in some people.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: January 15, 2014

Prostate cancer: Overview

Prostate cancer is a malignant tumor in the prostate, a gland that is part of the male internal reproductive system. The prostate is a gland about the size of a chestnut, and is located between the bladder and the pelvic floor muscles.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: March 28, 2013

Prostate Cancer Screening (PDQ®): Patient Version

Expert-reviewed information summary about tests used to detect or screen for prostate cancer.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: July 31, 2015

PSA tests for prostate cancer screening

Men’s opinions on prostate cancer screening vary greatly: Some prefer not to think about it at all, while others want to take every opportunity to try to prevent prostate cancer. Either way, anyone looking into the topic of prostate cancer screening will come across conflicting information and advice, and that can make it harder to decide whether or not to be screened.The confusion starts with the various ways the examinations are talked about. Screening is sometimes referred to as prostate cancer prevention, which can give you the impression that screening can keep you from developing cancer. But none of the examinations currently offered can do that. The goal of screening is to detect prostate cancer as early as possible in the hope of increasing the chances of successful treatment.Prostate cancer is different in different men: Sometimes it grows so slowly that no treatment is needed. But it can also be aggressive, cause problems or even become life-threatening. Fortunately, most prostate cancer tumors are the slow-growing type.The only screening test for prostate cancer that has been investigated in larger studies is the PSA test. This test is designed to detect prostate cancer before it starts causing symptoms, and in turn give men better treatment options and increase their life expectancy. But PSA testing is a controversial issue. As with any screening test, the results of PSA tests are sometimes wrong, and there are some clear disadvantages too. So it is worth carefully weighing the pros and cons of the test before deciding on whether or not to have it.In Germany, PSA tests for prostate cancer screening are not covered by statutory health insurers. But many doctors offer the test as an individual health care service, which need to be paid out of pocket. The test costs about 15 to 20 euros. Because it involves a consultation and other related tests it often ends up costing around 50 euros.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: January 28, 2015

Prostate Cancer Prevention (PDQ®): Patient Version

Expert-reviewed information summary about factors that may influence the risk of developing prostate cancer and about research aimed at the prevention of this disease.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: July 31, 2015

Prostate Cancer Treatment (PDQ®): Patient Version

Expert-reviewed information summary about the treatment of prostate cancer.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: July 7, 2016

Prostate Cancer, Nutrition, and Dietary Supplements (PDQ®): Patient Version

Expert-reviewed information summary about the use of nutrition and dietary supplements for reducing the risk of developing prostate cancer or for treating prostate cancer.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: June 10, 2016

Laser prostatectomy for benign prostatic obstruction

Bothersome lower urinary tract symptoms (LUTS) associated with benign prostatic obstruction (BPO) is a common problem for older men.  LUTS can be both irritative (urgency, frequency, frequent nighttime urinations) and obstructive (weak stream, hesitancy, intermittency, and feeling the bladder is not emptied).  Transurethral resection of the prostate (TURP) is considered the gold standard treatment for symptomatic BPO.  TURP improves urinary symptoms and urinary flow by surgically removing prostatic tissue through the urethra.  However, side effects occurring in approximately 20% of all TURPs include blood loss requiring transfusion, infections, strictures, sexual dysfunction, urinary incontinence, and urinary retention.  Laser prostatectomy, which uses a laser to destroy the enlarged prostate tissue that leads to LUTS, is a minimally invasive procedure currently used as an alternative to TURP.  This review of 20 studies involving 1898 subjects found laser techniques to be useful and relatively safe alternatives to TURP.  The small number of enrolled subjects and differences in study design limit any definitive conclusions regarding which type of laser technique is the most effective.  Improvements in LUTS and urine flow slightly favored TURP, though laser procedures had fewer side effects and shorter hospitalization times.  The follow‐up durations of these studies ranged from 6 to 36 months and men with extremely large prostates were generally excluded from the trials. The risk of needing a reoperation for recurrent LUTS was higher following laser procedures. Study results were insufficient to adequately compare laser techniques with other minimally invasive procedures. More studies, using randomized treatment assignment, enrolling larger numbers of subjects, and comprehensive measures of treatment effectiveness and side events, are needed to better define the long‐term safety and durability of laser techniques for treating LUTS associated BPO.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Electrical stimulation with non‐implanted electrodes for urinary incontinence in men

Some men leak urine (urinary incontinence) when they cough or exercise (stress urinary incontinence) or when they have a sudden, compelling urge to pass urine (urgency urinary incontinence). Men may also need to pass urine more often than usual (frequency) or get up more than once at night to pass urine (nocturia). In men this may be due to an enlarged prostate gland or develop after surgery to removal the prostate. Men can contract their pelvic floor muscles to reduce or stop these symptoms. Electrical stimulation with non‐implanted devices involves stimulation of these muscles with a painless electric current using surface electrodes on the skin or a probe placed into the anus. The aim is to make the pelvic floor muscles contract so that they become stronger and so better able to prevent leakage, or to make the muscle at the base of the bladder (the sphincter) contract more strongly to stop urine escaping. Electrical stimulation might also lessen the contractions of the bladder muscle to ease the sense of urgency and allow the bladder to hold more urine.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

How does the urinary system work?

The urinary system includes the kidneys, two ureters, the bladder and the urethra. The kidneys are our body’s “sewage treatment plant”: they filter toxins and other substances that we no longer need out of the body.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: January 7, 2015

Childhood Rhabdomyosarcoma Treatment (PDQ®): Patient Version

Expert-reviewed information summary about the treatment of childhood rhabdomyosarcoma.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: May 25, 2016

Smart Health Choices: Making Sense of Health Advice

This book aims to help consumers and practitioners develop the skills to assess health advice – and hopefully to make decisions that will improve the quality of their care. For some people, making better-informed decisions could be life saving. We hope that it will be useful if you are struggling to come to terms with an illness or injury, and the best ways of managing it. Or you may simply want to lead a healthier life, and may be wondering how to make sense of the often conflicting flood of health information that deluges us every day, through the media, and from our friends and health practitioners.

Hammersmith Press.

Version: 2008

Treatments for female pattern hair loss

The most common type of hair loss in women is FPHL, also known as androgenic alopecia. Unlike men, women do not go bald, but have hair thinning predominantly over the top and front of the head. It can occur at any time, from puberty until later in life. However, it occurs more frequently in postmenopausal women.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Testing Treatments: Better Research for Better Healthcare. 2nd edition

How do we know whether a particular treatment really works? How reliable is the evidence? And how do we ensure that research into medical treatments best meets the needs of patients? These are just a few of the questions addressed in a lively and informative way in Testing Treatments. Brimming with vivid examples, Testing Treatments will inspire both patients and professionals.

Pinter & Martin.

Version: 2011

Late Effects of Treatment for Childhood Cancer (PDQ®): Patient Version

Expert-reviewed information summary about the health problems that continue or appear after cancer treatment has ended.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: May 26, 2016

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