DEAR DOCTOR K:
Can you discuss medications to treat BPH?
Around the time of a man’s 50th birthday, his prostate begins to grow. This is called benign prostatic hyperplasia (BPH). BPH is not cancer, and it does not lead to cancer. However, BPH causes bothersome symptoms in about half of men with the condition.
As the prostate gets bigger, it starts to press against the urethra and the bladder, like fingers pinching a straw. This pressure eventually obstructs the flow of urine. It forces the bladder to squeeze harder to push urine through the urethra. Like any muscle, the bladder wall becomes thicker with work. That thickness reduces the amount of urine the bladder can hold.
All of these changes can lead to symptoms that include:
- a hesitant, interrupted or weak urine stream;
- a sudden and urgent need to urinate (a feeling that a man can’t hold it);
- leaking or dribbling of the urine;
- a sense of incomplete emptying;
- more frequent urination, especially at night.
If your symptoms start to interfere with your day-to-day life, your doctor can prescribe medication. Surgical options are available, but your doctor is likely to recommend medication first.
Three types of drugs are available to treat BPH:
- alpha blockers
- 5-alpha-reductase inhibitors
- a PDE5 inhibitor
These drugs work in different ways to improve symptoms, and they often work well in combination. (I’ve put an illustration of how they work below.)
How BPH medications can help
Alpha blockers attach to certain receptors in the prostate, bladder, and urethra, blocking chemical signals that tell muscles in these structures to contract. As a result, the muscles relax, allowing urine to flow more freely.
The 5-alpha-reductase inhibitors block the hormone responsible for prostate growth, eventually causing the prostate to shrink.
Alpha blockers relax smooth muscle to loosen the prostate’s “grip” on the urethra. This allows urine to flow more freely — they improve the “going” problem.
5-alpha-reductase inhibitors help with the “growing” problem. They reduce the size of the prostate so that it doesn’t press as much on the urethra and the bladder.
PDE5 inhibitors — medicines such as sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis) — are normally used to treat erectile dysfunction, but they also improve BPH symptoms.
Before starting a medication, try the following lifestyle changes. They can help relieve symptoms and may take away the need for medication:
- When you urinate, empty your bladder completely. This will reduce the need for return trips to the toilet. Be patient. In men with BPH, it’s very common for the stream of urine to stop temporarily, as if you have emptied your bladder completely. But if you wait a bit, you may notice that urination starts again.
- Talk with your doctor about all your prescription and over-the-counter medications. Some, such as antihistamines and decongestants, may interfere with urination.
- Avoid drinking fluids in the evening, particularly caffeinated and alcoholic beverages. Both can lead to nighttime urination.
- Reduce stress. Exercise regularly and practice relaxation techniques such as meditation.
All of the medicines I discussed above are new since I went to medical school. As a result of research, men get better relief from their BPH symptoms today.