Managing an Enlarged Prostate: Lifestyle & Medical Options

You've been diagnosed with Benign Prostatic Hyperplasia (BPH). The late-night trips to the bathroom vary from annoying to exhausting. But you aren't ready for surgery. What are your options?

Managing BPH is a ladder. You start at the bottom with simple lifestyle tweaks and climb up to medications and procedures only if necessary. This guide details every rung of that ladder.

Rung 1: Lifestyle modifications (Watchful Waiting)

For men with mild symptoms, doing "nothing" (medically) is often the best choice. But "nothing" doesn't mean ignoring it. It means smart adjustments:

• Fluid Restriction: Stop drinking fluids 2-3 hours before bed. This is the #1 cure for nocturia.
• Avoid Irritants: Caffeine and alcohol are diuretics and bladder irritants. Cutting back on coffee and spicy foods can calm the "urgency."
• Double Voiding: When you finish peeing, wait 30 seconds, and try again. This helps empty the bladder more completely.
• Review Meds: Antihistamines (Benadryl) and decongestants (Sudafed) tighten the prostate muscles, making it harder to pee. Avoid them if possible.

Rung 2: Medications

If lifestyle changes aren't enough, doctors turn to two main classes of drugs.

Alpha Blockers (The "Relaxers")

Examples: Tamsulosin (Flomax), Alfuzosin.
These drugs don't shrink the prostate. They relax the smooth muscle around the bladder neck and prostate, "opening the door" wider.

• Pros: Work quickly (within days).
• Cons: Dizziness, retrograde ejaculation (dry orgasm).

5-Alpha Reductase Inhibitors (The "Shrinkers")

Examples: Finasteride (Proscar), Dutasteride (Avodart).
These block the hormone (DHT) that causes prostate growth. Over 6-12 months, they can shrink the prostate by 20-25%.

• Pros: Actually treats the cause (size). Prevents progression.
• Cons: Takes months to work. Can cause sexual side effects (low libido, ED).

Note: Combination therapy (taking both) is often the most effective for large glands.

Rung 3: Minimally Invasive Surgical Therapies (MIST)

These are procedures done in an office or outpatient setting. They are not "major surgery."

UroLift

Implants tiny "staples" to pin the prostate lobes back, holding the channel open like tie-backs on a curtain.
Best for: Men concerned about sexual function (zero sexual side effects).

Rezum (Steam Therapy)

Shoots super-heated steam into the prostate tissue. The steam kills the cells, and the body reabsorbs them over time, shrinking the gland.
Best for: Reducing volume without cutting.

Rung 4: Surgical Gold Standards

When the prostate is too big for MISTs, we turn to the heavy hitters.

TURP (Transurethral Resection of the Prostate)

The "Roto-Rooter" job. A scope is inserted, and an electric loop scrapes away the inside of the prostate. It has been the gold standard for 50 years.

HoLEP (Holmium Laser Enucleation)

For massive prostates (>100cc), HoLEP is superior. It uses a laser to "scoop out" the entire inner pulp of the prostate like an orange, leaving just the rind. It provides the most lasting relief.

Conclusion

BPH is not a one-size-fits-all condition. A man with a 40cc prostate might do great on Flomax. A man with a 150cc prostate might need HoLEP. Knowing your prostate volume is the first step in choosing the right tool for the job.