The treatment for an enlarged prostate gland will depend on how severe your symptoms are.

The three main treatments are:

• lifestyle changes
• medication
• surgery

If your symptoms are mild to moderate, you may not receive any immediate medical treatment, but you'll have regular check-ups to carefully monitor your prostate gland. This is often referred to as "watchful waiting".

You may also be advised to make lifestyle changes, to see whether they improve your symptoms.

Lifestyle changes

If your prostate gland is enlarged, you may be advised to:

• avoid drinking any liquids for one to two hours before going to bed – this will reduce your chances of waking up during the night to pass urine (nocturia)
• experiment with the time you take prescribed medication – for example, taking it at 7pm may help to prevent nocturia
• stop drinking alcohol and caffeine, or limit your consumption of them – they can irritate your bladder and make your symptoms worse
• exercise regularly – research has shown that moderate exercise, such as walking for 30 to 60 minutes a day, can improve symptoms (although it's unclear exactly why this is)
• join a patient support group – your doctor should be able to recommend one; it may help you manage mild symptoms without the need for medication

Bladder training

Bladder training is an exercise programme that aims to increase the time between urination and increase the amount of urine your bladder can hold.

You'll be given a target, such as waiting for at least two hours between each time you urinate. It's a good idea to use a bladder training chart, which allows you to record each time you pass urine and record the volume of urine passed (you'll need a plastic jug to measure this). Your doctor should give you a chart to take home.

You'll also be taught a number of exercises, such as breathing, relaxation and muscle exercises, to help take your mind off the need to urinate.

Over time, your target time will be increased, and at the end of the programme you should find that you're able to go for longer without urinating.

Bladder training should only be carried out under medical supervision.

Medication

Medication, in combination with the lifestyle changes above, is usually recommended to treat moderate to severe symptoms of benign prostate enlargement.

Finasteride or dutasteride

Finasteride and dutasteride are widely used to treat benign prostate enlargement. They block the effects of a hormone called dihydrotestosterone (DHT) (see causes of prostate enlargement) on the prostate gland, which can reduce the size of the prostate and improve your associated symptoms.

If you're prescribed one of these medications, you may experience an immediate improvement in symptoms. However, you'll need to take it for at least six months to get the maximum benefit, and your doctor will need to monitor you every year.

Use condoms if you're sexually active, because both finasteride and dutasteride can have an adverse effect on your sperm. If you get a woman pregnant, there's a risk the baby could develop birth defects.

Other possible side effects can also include impotence and little or no sperm when you ejaculate.

In many cases, these side effects will improve as your body gets used to the medication. See your GP if the side effects are troubling you.

Alpha blockers

Alpha blockers help to relax the muscles of your bladder, making it easier to pass urine. You may be prescribed alpha blockers as your primary treatment or in combination with finasteride.

Tamsulosin and alfuzosin are two alpha blockers commonly used to treat benign prostate enlargement. Side effects of tamsulosin and alfuzosin are uncommon and usually mild. They include:

• dizziness 
• headaches 
• weakness
• little or no sperm when you ejaculate

You should only begin taking alpha blockers over a restful weekend, when you're not planning to drive, because there's a risk they could cause low blood pressure (hypotension) and fainting.

Generally, if you experience dizziness while taking this medication, avoid driving or operating heavy machinery until it's passed.

Surgery

Surgery is usually only recommended for moderate to severe symptoms of benign prostate enlargement that have failed to respond to medication.

Transurethral resection of the prostate (TURP)

Transurethral resection of the prostate (TURP) is a surgical procedure where excess prostate tissue is removed to reduce the pressure on your bladder.

The surgeon will insert a small instrument called a resectoscope into your urethra (the tube that carries urine from your bladder to your penis). A wire loop heated by an electric current is used to remove excess tissue from your prostate.

TURP is carried out using either a general anaesthetic (where you're asleep), or a spinal anaesthetic (where you're awake, but the lower half of your body is numbed).

The procedure can take up to an hour, depending on how much tissue needs to be removed. Most men are well enough to leave hospital two to three days after the operation.

Following surgery, you'll be unable to urinate normally at first, because of your swollen urethra. A thin tube called a catheter will be inserted into your urethra and up into your bladder, to allow urine to drain away. This will usually be removed 24-48 hours after surgery.

A common complication of TURP is that you'll no longer produce semen when you ejaculate. This is known as retrograde ejaculation. It causes sperm to go into your bladder rather than out of your penis during ejaculation. However, you'll still experience the physical pleasure associated with ejaculation (the climax).

Transurethral incision of the prostate (TUIP)

Transurethral incision of the prostate (TUIP) is a surgical procedure where the urethra is widened, making it easier to pass urine.

Like TURP, the surgeon will insert a resectoscope into your urethra that has a heated wire loop at the end. This will be used to make small incisions in the muscle where the prostate meets the bladder.

This type of surgery relaxes the opening to the bladder, helping urine to flow out of it. As with TURP, TUIP is carried out under a spinal or general anaesthetic.

After surgery, you may not be able to urinate, and a catheter may be needed to empty your bladder. Like TURP, you'll only need to use a catheter for a short time until you're able to urinate normally.

There's less of a risk of retrograde ejaculation with TUIP compared with TURP, although it can sometimes still occur.

Alternative techniques

There are also a number of newer surgical techniques that may lead to fewer side effects or a quicker recovery than TURP and TUIP.

However, as these treatments are still fairly new, they may not be available and their long-term effectiveness isn't always clear. These alternative techniques are explained below.

• Bipolar transurethral resection of the prostate – different instruments are used to perform the procedure, which allow saline water to be pumped into the urethra, rather than a fluid called glycine. This is thought to lead to a lower risk of TURP syndrome (see risks of a TURP).
• Holmium laser enucleation of the prostate – a laser is used to remove excess prostate tissue, using a similar route to a TURP. The procedure has shown good results in medium-term follow-up (five to seven years) and is emerging as a promising alternative. It doesn't use glycine, so there's no risk of TURP syndrome.
• KTP laser vaporisation – a small tube known as a cystoscope is inserted into your urethra. The cystoscope fires pulses of laser energy to burn away prostate tissue.

Open prostatectomy

An open prostatectomy is a procedure that may be more effective than TURP if you have severe benign prostate enlargement. However, it's now rarely used, even for larger prostates, because of the development of other techniques, such as holmium laser enucleation of the prostate (see above).

During an open prostatectomy, an incision will be made in your abdomen (tummy) and the outer portion of your prostate will be removed.

The procedure carries a higher risk of complications, such as erectile dysfunction and urinary incontinence. There's also a greater chance that these complications will become permanent than if they occur following TURP.