Often a man’s lifestyle will determine how burdensome he finds benign prostatic hyperplasia (BPH). Often medical treatment will be enough to relieve the worst symptoms, so the patient won’t need surgery.
The symptoms that disrupt the daily activities of a man who is conducting business or traveling may not bother another man who spends much of his day at home within easy reach of a bathroom. When symptoms are not particularly bothersome, the urologist may elect to hold off on treatment and instead monitor Benign Prostatic Hyperplasia.
To determine if this is the right choice , the doctor may ask if the symptoms prevent the patient from engaging in enjoyable activities, if they appear to be worsening, or if the patient is ready to accept a small degree of risk in exchange for the benefits of treatment. For more troubling symptoms, most doctors begin by recommending a combination of lifestyle changes and medication. Often these changes will be enough to relieve the worst symptoms, so the patient won’t need surgery.
Should surgery become necessary, keep in mind that there are several surgical techniques available and that just because a technique is new doesn’t mean it is better.
Tips for relieving benign prostatic hyperplasia symptoms
These simple steps can help alleviate some of the symptoms of BPH:
- Reducing stress by exercising regularly and practicing relaxation techniques such as meditation. Some men who are nervous and tense urinate more frequently.
- When going to the bathroom, taking the time to empty the bladder completely. This will reduce the need for subsequent trips to the toilet.
- Talking with the doctor about all the prescription and over-the-counter medications; some, such as antihistamines and decongestants, may affect urination. The doctor may be able to adjust dosages, change the schedule for taking these drugs, or prescribe different medications that cause fewer urinary problems.
- Avoiding drinking fluids in the evening, particularly caffeinated and alcoholic beverages. Both can affect the muscle tone of the bladder and stimulate the kidneys to produce urine, leading to nighttime urination.
Medications that treat benign prostatic hyperplasia
Before suggesting surgery, the doctor is likely to recommend medication for BPH. The FDA has approved three types of drugs for BPH:
- Alpha blockers, including alfuzosin (Uroxatral), doxazosin (Cardura, generic), prazosin (Minipress, generic), silodosin (Rapaflo), tamsulosin (Flomax, generic), and terazosin (Hytrin, generic)
- 5-alpha-reductase inhibitors, including dutasteride (Avodart) and finasteride (Proscar, generic)
- a PDE 5 inhibitor, tadalafil (Cialis).
The FDA has also approved Jalyn, a combination of the 5-alpha-reductase inhibitor dutasteride and an alpha blocker, tamsulosin. These drugs work in different ways to alleviate urinary symptoms, and they often work well together.
A good way to think about the difference between alpha blockers and 5-alpha- reductase inhibitors is that alpha blockers help the “going” problem while 5-alpha- reductase inhibitors help with the “growing” problem. Alpha blockers help with the act of urination (the “going” problem) by relaxing certain muscles in the prostate and bladder. The 5-alpha-reductase inhibitors reduce the encroachment of the prostate on the urethra and the lower part of the bladder (the “growing” problem) by reducing the size of the prostate.
In general, alpha blockers are better at relieving the lower urinary tract symptoms such as difficult or frequent urination. They also work quickly: men often notice a difference in their symptoms within a week. By contrast, 5-alpha-reductase inhibitors tend to take longer to have an effect. Men may not see the maximum benefit until they have been taking one of the 5-alpha-reductase inhibitors for six months to a year. These drugs work best for men with large prostates. 5-alpha-reductase inhibitors have a stronger track record than alpha blockers for reducing the chances of needing surgery or experiencing complications from BPH, such as urinary retention. With this in mind, some doctors prescribe both types of drugs for men with large prostates.
In 2011, the FDA approved the PDE5 inhibitor tadalafil (Cialis) for use in treating BPH and the combination of erectile dysfunction and BPH. PDE 5 inhibitors are a class of drugs normally used to treat erectile dysfunction. But after several studies suggested that men taking these drugs also experienced an improvement in urinary symptoms, investigators conducted separate studies on men with BPH. Two studies concluded that tadalafil improved BPH symptoms, and one concluded that it improved both BPH symptoms and erectile function. When used to treat BPH (with or without erectile dysfunction), the medication is taken at a 2,5 or 5 milligram (mg) dose once daily.
No matter which BPH drug is prescribed, the treatment needs to keep taking it to maintain the benefits. If it is stopped, symptoms usually return to their previous levels. But compared with surgery, medications for BPH are less likely to have serious adverse effects, so most men try medications first. However, medications can lose their effectiveness over time, so that BPH symptoms increase, along with adverse effects from the increased doses of drugs. Therefore, many patients will eventually resort to surgery.
Other medical treatments for BPH
Some men with BPH also have overactive bladders. Symptoms include frequent urination (over eight times a day) and strong urges to urinate right away. Antimuscarinics block receptors in the smooth muscle tissue in the wall of the bladder so that this muscle is less likely to contract. Antimuscarinics include oxybutynin (Ditropan) and tolterodine (Detrol). Several trials have shown that adding an antimuscarinic medication to an alpha blocker can alleviate lower urinary tract symptoms.
A variety of herbal remedies are marketed as BPH remedies, including saw palmetto, extract from the Pygeum africanum tree, and beta sitosterols. So far evidence for their effectiveness remains limited, and standardized doses and preparations have not been determined. There is little reason to believe any of the herbal remedies are effective and they are probably not worth the money.