BPH Treatments and Medications

Urination issues can be an irritating obstacle to your daily life. They can have you getting up multiple times a night, frequently leaving meals, meetings, and family gatherings, or unable to go, even when you feel the urge. When you have benign prostatic hyperplasia (BPH), commonly called an enlarged prostate, it can seem like your life is a never-ending cycle of bathroom trips. But there's hope. Prostate enlargement is responsive to several medications and procedures.

What is BPH?

Benign prostatic hyperplasia (BPH), also known as enlarged prostate, is a condition that affects older men. When you have BPH, prostate growth pinches the urethra, which can make it difficult to urinate. BPH does not indicate prostate cancer, but it can cause uncomfortable lower urinary tract symptoms, including frequent urination, urinary retention, and incontinence.

BPH is not a rare occurrence. In fact, according to the American Urological Association (AUA), nearly 80% of men will develop BPH during their lifetimes–a total of 14 million men in the U.S., 50% of them before they reach age 60. “BPH is so common, in fact, it is the leading cause of visits by men to the urologist,” says John Pettit, MD, of the Bellingham Urology Group.

The prostate gland is an essential part of the male reproductive system. It secretes a protective fluid that mixes with sperm to form semen. Because it’s situated beneath the bladder and surrounds the urethra, when the prostate begins to grow after age 30, it threatens to restrict the flow of urine.

Common symptoms of BPH include difficulty starting urination, inability to completely empty the bladder, weak urine flow, and more severe cases, including urinary tract infections, kidney damage, and bladder stones.

How is BPH diagnosed?

The easiest way to identify BPH is by spotting some telltale symptoms like “frequent urination, difficulty starting urination, the urgency to urinate, a urinary stream that stops and starts, and the feeling that you cannot completely empty your bladder,” according to Dr. Pettit. Your doctor or urologist will ask you a series of questions about your urinary complications, including frequency, sensations, appearance, and more. Your doctor will probably also ask about your medical and family history, as this can provide some essential context for an accurate diagnosis.

From that point, physical tests are the most effective way to confirm a diagnosis. Your healthcare provider may use a PSA blood test and/or a digital rectal exam to evaluate your prostate condition. Prostates produce a protein called prostate-specific antigen (PSA). Low PSA levels in the blood indicate a healthy prostate, but increased amounts of PSA in the bloodstream could be a sign of prostate complications. A digital rectal exam can provide a more direct analysis, during which your physician will use a finger to feel the shape and size of the prostate, evaluating any irregularities.

Your doctor might also order a urine flow study to measure your urinary pressure, speed, and amount, or a cystoscopy, which involves a tiny urethral scope that gives a better look at your urinary system. MRIs and transabdominal ultrasound can also provide more detailed imaging. In certain cases, a biopsy of prostate tissue might also be necessary to rule out prostate cancer.

BPH treatment options

Treatments vary depending on your health, symptoms, and age. Your doctor’s recommendation may range from observation in minor cases to medications or minimally invasive surgery for moderate to severe symptoms. The good news is that BPH is often responsive to one or more of these treatments, and some patients can achieve results simply with natural remedies and lifestyle changes.

In the very early stages of prostate enlargement, when symptoms aren't severe or troublesome, physicians may recommend "watchful waiting” with routine check-ins to monitor your condition. But when BPH progresses, medication is often the best course of action. Common prescription medications for BPH include alpha-blockers (which relax your prostate and bladder neck muscles), 5-alpha reductase inhibitors (which help shrink your prostate), or combination therapy that includes both types.

When an enlarged prostate becomes more severe, a minor surgical treatment might be necessary. These are often outpatient, minimally-invasive procedures and commonly include:

• Transurethral resection of the prostate (TURP): This is the most common procedure and has long been considered the gold standard in BPH treatment. During TURP, the doctor inserts a resectoscope through the urethra to trim away prostate tissue that’s blocking urine flow.

• Transurethral needle ablation (TUNA): Like TURP, this procedure involves accessing the prostate through the urethra, this time with an instrument called a cystoscope. Using tiny needles that generate radio waves, the cystoscope creates scar tissue that decreases the prostate's size.

• Transurethral incision of the prostate (TUIP): This procedure is also similar to TURP, but instead of cutting pieces of the prostate away, the doctor uses a resectoscope to cut grooves, allowing urine to flow smoothly.

• Transurethral microwave thermotherapy (TUMT): Instead of a scope, the doctor inserts a urinary catheter that contains a microwave antenna. This antenna emits microwaves that destroy excess prostate tissue.

• Photoselective vaporization of the prostate (PVP): This procedure uses a cystoscope like TURP, but rather than needles, it employs a laser that vaporizes any prostate tissue that’s preventing the regular flow of urine.

• Holmium laser enucleation of the prostate (HoLEP): HoLEP is another minimally invasive procedure that uses a holmium laser to burn away excess prostate tissue.

• Open prostatectomy: This surgical procedure is often only necessary in severe cases where the prostate is excessively large or if other surgeries aren't possible. It involves complete prostate removal through an incision in the lower abdomen and may require a one or two-day hospital stay.

BPH medications

Alpha-blockers

Noradrenaline (norepinephrine) is a neurotransmitter that can induce constriction of smooth muscles, like those around the bladder. Alpha-blockers inhibit this chemical, thereby relaxing smooth muscle tension in your bladder neck, removing pressure from the urethra, and promoting regular urine flow. According to Havard Health, alpha-blockers provide relief for approximately 70% of men with BPH, although typically, it's most effective on prostates that aren't advanced in size or symptoms yet. You might be familiar with popular alpha-blocker brand names like Flomax, Cardura, Hytrin, and Uroxatral. While taking one of these medications, you may experience side effects like dizziness, headaches, low blood pressure (hypotension), lightheadedness, or fainting.

5-alpha reductase inhibitors

Rather than relaxing certain muscles around the prostate, these medications go right to the source, preventing your body from producing 5-alpha-reductase, an enzyme that converts testosterone to dihydrotestosterone. Dihydrotestosterone is the most prevalent male sex hormone found in prostate cells, so by decreasing its levels, 5-alpha reductase inhibitors can halt and even reverse prostate growth. This makes it effective in men with large prostates, unlike alpha-blockers, which work best on smaller prostates. After evaluating your prostate condition, your doctor might prescribe a 5-alpha reductase inhibitor like Proscar or Avodart. Because these medications lower male sex hormone levels (hypogonadism), side effects might include decreased sex drive and inhibited sexual function.

Phosphodiesterase inhibitors

Originally developed for erectile dysfunction, a phosphodiesterase inhibitor like Cialis can also be effective in treating the urinary symptoms of BPH. It works by slowing the production of phosphodiesterase-5, an enzyme that breaks down chemicals that increase blood flow to the penis. These chemicals also help relax muscles around the bladder and prostate, which makes urinating easier. It's not uncommon for older men to experience both BPH and ED, so Cialis can serve two separate functions. Common side effects include headache and indigestion. If you have a heart attack while taking Cialis, you must inform your physician to avoid severe drug-drug interaction with medications that treat cardiac arrest.

What is the best medication for BPH?

While enlarged prostate symptoms can be frustrating, several medications have proven effective in treating them. These are some of the most commonly prescribed treatments but keep in mind that there’s no overarching cure that works on 100% of BPH cases. Rather, different medications are more effective for different people. It all depends on your unique condition. Your healthcare provider will prescribe the one that is the best fit for your health, lifestyle, medical history, and other medications.

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Best medications for BPH