BPH Behavioral Therapy

Avoid Bladder Irritants

• Limit caffeine and alcohol. They can increase urine production and act as an irritant on the bladder causing you to urinate frequently or urgently and get up too many times at night.
• Although caffeine and alcohol are the most common irritants in men with BPH, there are other bladder irritants to limit or avoid.
• Limit medication such as decongestants or antihistamines. They can tighten the muscles around the urethra that control the flow of urine, making it harder to urinate. Be aware some medications can affect urination such as antidepressants and diuretics. Speak to your provider or pharmacist with questions regarding alternatives, timing of dosing or questions. It is a good idea to know all your medications, why you are taking it and the side effects.

Pelvic floor exercises or distraction to avoid urgency with leakage

When irritative symptoms such as urgency and frequency occur, pelvic floor tightening and “distractions” can help patients decrease the need to urinate urgently.

Urinary habits may be impacting your bladder symptoms

• If you postpone urination related to things like job restraints, wishing to avoid certain bathrooms or lack of convenient facilities, change your habits. Go when you have the urge. Waiting too long can overstretch the bladder muscle and cause damage.
• If you lack an urge to urinate “until it’s too late” and then experience pain or leakage, or take more time to get to the bathroom because of the location or mobility issues, try scheduled toilet breaks. Urinate before the bladder is too full or irritated.
• By urinating “on the clock” every few hours (timed voiding), many men notice an improvement in their urgency.
• Your bladder can change if you urinate too frequently. The bladder urge or threshold to fill with urine may be lower because you always go frequently and it doesn’t get a chance to fill. Try gradually postponing urination by 5 minute intervals until you are urinating with a more acceptable frequency such as every 2 to 3 hours. Use urge suppression, contracting and holding the pelvic floor muscles or mental distraction to help you postpone the urge.
• If your bladder does not empty, it will fill up more quickly and you will need to urinate frequently (this might have been checked in the office with an ultrasound or catheterization called a post void residual). Urinate as much as you can and then relax and urinate again a few moments later. This is called double voiding. By using a double voiding technique, the bladder can empty more completel. This decreases urinary retention, incomplete emptying and urinary frequency.
• Post void dribbling is one of the more bothersome complaints of men with BPH. In order to minimize the amount of dribbling, wait a few seconds after urination has stopped and then gently “milk” the urethra to push or remove any remaining urine from the urethra. Post void dribbling can also be due to pelvic floor muscle weakness, these muscles surrounds the urethra. Like other muscles, exercises can be done to improve the pelvic floor strength.

Recording and reviewing your voiding diary

• A voiding diary measures the type and amount of fluids you drink, how much you urinate, and when bothersome symptoms such as leakage and urgency occur over 24 hours. You may be asked to complete 2 or 3 days of information.
• After reviewing the diary, suggestions can then be made to improve your symptoms. Such as, if drinking too much or too little fluid, identification of your bladder irritants and those with nocturnal polyuria (making excess urine at night).

Many men with BPH and lower urinary tract symptoms are most bothered by getting up too many times at night to urinate. This is called nocturia, and can result in poor sleep and feeling tired the next day. Although an enlarged prostate can cause nocturia, there are other reasons. Nocturia is often multifactorial or from a combination of different causes. Anything that awakens the patient can increase the number of times they urinate. Including:

• Obstructive sleep apnea
• Primary nocturnal polyuria
• Peripheral or whole body edema
• Restless legs syndrome
• Diabetes with poor blood sugar control
• Chronic pain
• Excessive fluid intake or intake of bladder irritants

When these are identified and treated you may sleep better and urinate less at night. For example:

• Obstructive sleep apnea managed with the use of CPAP devices helps improve sleep quality. With properly treated sleep apnea you will likely wake up less often and this will result in less nocturia.
• Primary nocturnal polyuria may benefit from medication such as Noctiva or from fluid restriction
• Reducing edema with compression stockings and leg elevation before bed enables fluid to be reabsorbed in your system. This helps you urinate the extra fluid before bedtime. Otherwise your body reabsorbs the edema when you are lying flat at night. This causes more urine production while you are sleeping.
• Restless legs syndrome managed with medications results in less sleep disturbance.
• Poorly controlled blood sugars increases urine volume.
• Chronic pain results in poor sleep.
• Alcohol, caffeine, intake of excessive fluid and other bladder irritants increase the number of voids at night due to increased urine volume and poor sleep.

Healthy lifestyle tips can improve bladder symptoms associated with BPH.

• Eat a healthy diet and maintain a good weight. Obesity is associated with enlarged prostate.
• Stay physically active. A sedentary lifestyle contributes to urinary retention.
• Keep warm. Cold temperatures or rapid changes from inside to outside temperatures can increase urinary urgency and retention.
• Bowel and bladder symptoms are closely associated. The muscles and nerves that control bladder and bowel function are shared.
• Constipation, frequent loose stools, and irritable bowel symptoms can increase urinary symptoms. Improvement of bowel function can help decrease bladder irritability, frequency urgency and may improve bladder emptying.
• Alternative medications
  • If you take supplementations or herbal medication, tell your provider and pharmacist. Certain supplements interact with other medications you may be taking and can increase risk of bleeding.
  • The FDA has not approved any herbal medications for BPH treatment.