Understanding BPH and treatment
Benign prostatic hyperplasia (BPH) is a condition that affects men. It’s caused by enlargement of the prostate. The prostate is a small gland located between the penis and the bladder. The urethra is a tube that runs through the center of the prostate from the bladder to the penis. Its job is to release urine from your body. If a man’s prostate grows too big, it can get in the way of his urethra’s ability to empty his bladder.
BPH can cause bothersome symptoms. These can include:
- not being able to fully empty your bladder
- trouble urinating
- urinating more often than normal
- an urgent need to urinate
- trouble starting a urine stream or a weak stream that starts and stops
- dribbling after urinating
Most of the time, BPH symptoms can be treated with medication. BPH drugs don’t cure the condition, but they may slow down the growth of your prostate. All BPH drugs are oral medications. This means you take them by mouth. You take these drugs every day to help relieve your symptoms.
Like all drugs, BPH medications can cause side effects. Each drug comes with benefits and risks. Talk about your options with your doctor. Your treatment will depend on your symptoms, the size of your prostate, and other health issues. Together, you and your doctor can find the BPH medication that’s right for you. Here’s a list to get you started.
Alpha-blockers can help treat BPH. These drugs also work by helping to relax certain muscles, including your bladder outlet muscles. This makes it easier for people with BPH to pass urine. With better urine flow, you’ll be able to empty your bladder more completely.
Most people take alpha-blockers for BPH long-term, often for life. These drugs can give you relief quickly. They work within a few days or couple of weeks of when you start taking them.
Alpha-blockers for BPH include:
- alfuzosin (Uroxatral)
- prazosin (Minipress)
- terazosin (Hytrin)
- doxazosin (Cardura)
- silodosin (Rapaflo)
- tamsulosin (Flomax)
Alpha-blockers are often also used to lower blood pressure. They help keep your arteries open to improve blood flow. Because these drugs lower blood pressure, they may cause lightheadedness or dizziness in people who take them for BPH. For this reason, you should stand up slowly from sitting or lying positions, especially during your first few days of treatment.
You may fall due to low blood pressure during treatment with these drugs. Other common side effects can include:
Alpha-blockers do not slow the growth of the prostate. If your prostate continues to grow, your symptoms may become more serious or harder to manage, even if you’re taking medications.
These drugs are often prescribed to men with especially large prostates. They interfere with the hormones that promote prostate growth. This helps slow the growth of the prostate and in turn eases BPH symptoms.
You’ll take these drugs for life to ease your BPH symptoms. These medications can take several months to work fully. Examples of 5-alpha reductase inhibitors include:
- finasteride (Proscar, Propecia)
- dutasteride (Avodart)
- dutasteride/tamsulosin (Jalyn)
These medications may not always relieve symptoms. This is because the size of your prostate doesn’t always match how severe your symptoms are. If your prostate isn’t very large, these drugs may not help you.
Most men tolerate these drugs well without many side effects. Common side effects can include:
- Retrograde ejaculation. This is when some semen moves backward to the bladder instead of coming out of the penis.
- Other sexual side effects. These can include decreased sex drive and trouble getting or keeping an erection.
These drugs are approved to treat erectile dysfunction (ED). Only one of these drugs, called tadalifil (Cialis), is also FDA-approved to help relieve BPH symptoms. The other drugs in this class, vardenafil (Levitra) and sildenafil (Viagra), are only approved to treat ED. The dosage for BPH is less than the dosage for ED. Most of the time, tadalifil is only given to men for BPH if they also have ED.
This drug often starts working to ease BPH symptoms within a few days or couple of weeks.
Common side effects of tadalifil can include:
- back, muscle, or limb pain
- flushing (reddening and warming of your skin)
Do not take heart drugs called nitrates (such as nitroglycerin) with PDE-5 inhibitors. Make sure you tell your doctor about all medications you’re taking before you start taking a PDE-5 inhibitor.
Some men see the best results by taking both an alpha-blocker and a 5-alpha reductase inhibitor. Taking both medications may work better to ease your symptoms, but you may also have a higher risk of side effects from one or both drugs.
You shouldn’t take tadalafil or any other PDE-5 inhibitor in combination with alpha-blockers.
While there’s no medication that can cure your BPH, there are several options that can ease bothersome symptoms of the condition. Not everyone responds to BPH drugs in the same way. If one medication doesn’t improve your symptoms or if it causes uncomfortable side effects, your doctor may recommend another drug. Always let your doctor know how you’re feeling. This can help them find the best treatment for your BPH and bring you needed relief.