8 ways to manage an enlarged prostate while you decide what to do

Spread your fluids through the day

Many men respond to urinary symptoms by drinking less all day. That can backfire. Concentrated urine can irritate the bladder and make urgency worse. A better approach is to drink a sensible amount spread across the day, rather than very little and then catching up later.

Avoid very large drinks in one go. Smaller, steadier amounts are easier on the bladder. If some parts of the day are worse, plan around them. If you have a morning meeting, for example, drink a little more earlier and ease off before you leave the house.

Ease off drinks in the evening

If getting up at night is your main problem, evening habits are the first place to look. Cutting back on fluids for two to three hours before bed can reduce night-time trips, especially if most of your drinking happens after dinner.

This is about timing, not dehydration. Keep your daytime intake reasonable, then be more selective later on. Watch for hidden evening fluids too: soup, large mugs of tea and a pint with dinner all count. If you take tablets at night, take them with just enough water to swallow them safely, unless you've been advised otherwise.

Worth knowing: waking at night to pass urine isn't always caused by the prostate. Some men simply make more urine at night, and conditions such as sleep apnoea, heart problems or diabetes can play a part. A symptom diary (see tip 7) helps tell these apart.

Cut out caffeine, and give it time

Caffeine can irritate the bladder and make urgency, frequency and night-time waking worse. Coffee is the obvious source, but strong tea, cola, energy drinks and some supplements contribute too.

Be patient. Cutting out caffeine completely may take four to six weeks to show a clear difference, which is long enough that many men give up too early and decide it made no difference. For a fair test, give it proper time and keep the rest of your habits steady while you judge the effect.

Common sources that are easy to overlook:

• tea, including green tea
• cola and energy drinks
• strong coffee and espresso-based drinks
• caffeine tablets and pre-workout supplements

Be careful with alcohol, especially if you take tamsulosin

Alcohol can worsen symptoms in two ways. It increases urine production, which adds to evening and night-time trips. And if you take tamsulosin or another alpha blocker, alcohol can add to the blood-pressure-lowering effect and leave you dizzy or light-headed.

That doesn't mean you need to stop drinking altogether. But moderation is sensible, especially in the evening and when you first start treatment. If you have ever stood up quickly after a drink and felt faint, take that seriously.

Try double voiding to empty more fully

Double voiding is simple. When you have finished passing urine, wait a few moments, relax, and try again. For some men, that second attempt empties the bladder more fully and eases the feeling that urine is left behind.

It isn't dramatic, but it can be useful, and it may reduce dribbling afterwards. The key is not to strain, which only makes things more frustrating. Give it a calm second try rather than forcing it.

Dribbling after you've finished? Gently pressing upwards behind the scrotum, then stroking forwards along the underside of the penis, can clear the last drops from the urethra. This is called urethral milking, and it is a simple habit that makes a real difference to many men.

Retrain your bladder for urgency and frequency

When urgency and frequent trips become a habit, the bladder can start behaving as if it needs emptying more often than it really does. Bladder training aims to stretch the time between trips gradually and gently.

Start where you are. If you normally go every hour, try holding on for an extra ten or fifteen minutes for several days before pushing further. Distraction and calm breathing help when urgency strikes. This works best when symptoms are annoying rather than severe, and when your bladder is emptying properly. It is a management tool, not a rescue treatment.

Keep a symptom diary before choosing treatment

A symptom diary is more useful than most men expect. It turns a vague sense that things are "getting worse" into something you can measure, which helps you and your specialist judge whether self-care is working, whether a medicine is helping, and how quickly things are changing.

Keep it for three days to two weeks, and record what matters to your daily life:

• Daytime frequency: how often you pass urine
• Night-time waking: how many times you get up
• Urgency: whether you struggle to hold on
• Flow: whether the stream is slow, or starts and stops
• Drinks: what you drink, and when
• Leaks or dribbling: even if they are occasional

A diary often reveals patterns. Some men find the real trigger isn't "the prostate" at all, but two large coffees before 10am, a late pint, or a litre of water after work because the day was too busy to drink.

Keep your plan under review

If symptoms are mild or only moderately bothersome, watchful waiting is a sensible plan: lifestyle advice, reassurance and regular review, rather than going straight to tablets or surgery. It is a recognised approach, not a way of being ignored.

Review matters even more once you start a medicine. Alpha blockers such as tamsulosin relax the muscle in the prostate and often improve flow within days to weeks. Medicines that shrink the prostate, such as finasteride, can take up to six months to work. Both should be reviewed properly rather than continued on autopilot.

Be sceptical about "natural" fixes. Saw palmetto and other herbal remedies are widely marketed for prostate symptoms, but in good-quality trials they have not worked better than a placebo, and NICE does not recommend them.