Medicine Cabinet

Q: During the last couple of months, I've had a frequent urge to urinate and need to get up a three times per night to empty my

bladder.

I just had a prostate checked and my doctor says prostate is getting larger.

My PSA is normal. Do I need to start treatment immediately?

A: Benign prostatic hyperplasia (BPH) is severe enough in some men to require immediate

treatment.

But in most men, BPH progresses slowly. They can decide for themselves when and if they should be treated.

Watchful waiting is a safe choice as well as the only choice for men with low Symptom Index scores.

It's also a reasonable choice for many others who find that simple adjustments in lifestyle reduce the

daily nuisance-factor of BPH.

Here are a few lifestyle changes to try:

n Reduce your intake of fluids, particularly after

dinner.

n Limit your intake of alcohol and caffeine, and avoid them after mid-afternoon; both are diuretics that increase urine flow.

n Avoid medications that stimulate muscles in the bladder neck and prostate, such as pseudoephedrine and other decongestants.

n Avoid medications with anticholinergic properties that weaken bladder contractions. Antihistamines such as diphenhydramine are the most common offenders. Various antidepressants and antispasmodics have similar properties.

n If you're taking diuretics for high blood pressure or heart problems, take it in the morning when you first wake up.

Also ask your doctor if you can reduce the diuretic dose.

n Never pass a chance to use the bathroom, even if your bladder does not feel full. Take your time, so you empty your bladder as much as possible.

n When you are in new surroundings, learn the location of the bathroom before you really need it.

n Make your nighttime trips to the bathroom easy and safe. Be sure there is enough light to see where you're going.

Avoid bright light that jolts you awake, making it hard for you to get back to sleep.

Be sure there are no electrical cords, telephone wires, loose rugs or stray objects that might trip you during the night.

Today's Medicine Cabinet column was written by Harvey B. Simon, M.D., an associate professor of medicine at Harvard Medical School and a member of the Health Sciences Technology Faculty at Massachusetts Institute of Technology. For additional consumer health information, visit health.harvard.edu.