BPH surgery and Tips to urinate less often - day or night

Patient satisfaction after BPH surgery is highly variable. A very smart mentor of mine once told me that 15% of patients you treat for BPH will still be unhappy regardless of objective improvements in flow or how much the patient leaves behind. How could this be?

Its all about expectations of what surgery on the prostate can and cannot do. Remember women do not have prostates - do they have urinary complaints? Of course they do, with urgency, frequency, and leakage being the most common. The bladder is the culprit here most often because as we age, the bladder goes rogue and decides to squeeze without permission. Something like 40% of all humans above age 60 have overactive bladder symptoms. These sometimes do AND importantly sometimes DO NOT get better in men who get prostate surgery.

Before you get surgery for BPH make sure it is not the bladder causing the problems. Here is a list of behaviors you CAN control to reduce frequency, urgency and accidents. There are 12 Cs which I list here that if you address can help with these symptoms:

Consumption: The more you drink, the more you pee - full stop. You should drink enough to not get thirsty but beyond people with low blood pressure or kidney stone formers, you don't need to force yourself to drink more, especially at night.

Caffeine: the worlds most used psychoactive substance, directly irritates the bladder and makes you pee more often and in smaller amounts. For most of us, drinking caffeine after lunch will also lead to nocturia (night-time urination)

Constipation: the bladder and bowel share real estate - urinary problems and constipation go hand in hand. By comparison, think of women in their 3rd trimester, baby is compressing the bladder which leads to extreme urinary frequency. In little kids who have accidents, it's almost always constipation.

These above 3 are by far the biggest offenders for urinary symptoms. The next 9 are more individualized as humans we are all different and cause bladder irritation to different degrees:

Capsaicin - this is the active ingredient in spicy food
Coke Zero - or any beverage with artificial sweeteners
C the actual vitamin in high doses
Couch Potato - people who are physically active have 20-30% less urinary complaints
Cigarettes
Citrus - the acidity causes issues
Carbonation - anything with bubbles
Cocktails - Alcohol
Comatoes - yep tomatoes can cause issues and I'm not clever enough to come with a different way to remember this one

To specifically address Nocturia - night time urination consider these:

Night time fluid restiction - several hours prior to bed stop drinking any fluids
Double voiding within a short period before trying to sleep
Elevating your legs a few hours before you go to sleep to get all the leg swelling out of your system
Minimize alcohol and caffeine
Optimize timing of diuretics or jardiance or other pills that cause urination
Proper sleep habits (including addressing sleep apnea/snoring)

Hope these tips help some of you

Dr Kohler, MD, MPH
Professor of Urology
Mayo Clinic Men's Health