Until recently, men who wanted relief from benign prostate hyperplasia (BPH) had only one main option: surgery. In recent years, that has changed. Drugmakers have come out with a number of medicines that give you more choices to treat your symptoms.
BPH (commonly known as enlarged prostate) can cause problems such as a weak urine stream or having to pee a lot throughout the day. Some medicines ease these symptoms by calming the muscles in the bladder and prostate. Others stop prostate growth and/or shrink the size of the prostate.
Medicine is now the most common way to treat those with mild-to-moderate BPH. Researchers are still learning about their long-term effects and when drugs can be most helpful. Talk to your doctor to find out which medicine may be best for you.
Alpha-Blockers
Alpha-blockers work by relaxing the muscles in your bladder and prostate, which makes it easier to pee. They don’t change the size of your prostate, but they do help with urine flow, the number of times you wake up at night to pee, and other symptoms. And you won’t have to wait long to see results; they usually work right away.
If you have high blood pressure and BPH, alpha-blockers may be a good option for you because they treat both the conditions.
If you are planning to have cataract surgery, it’s best to avoid them. They can lead to problems during the procedure.
Side effects
Since alpha-blockers affect your blood pressure, they can make you feel very tired and cause other problems such as:
- Dizziness
- Fainting
- Headaches
- Lightheadedness
- Low blood pressure
They may also lead to what you may hear a doctor call “retrograde ejaculation.” This is when your semen (sperm) goes backward into your bladder instead of out through your penis. It doesn’t cause any harm, but it means you may not have any sperm when you ejaculate. Men who still want to have children should keep this in mind.
Names of alpha-blockers
Your doctor might suggest one of these alpha-blockers:
- Alfuzosin (Uroxatral)
- Doxazosin (Cardura)
- Prazosin (Minipress)
- Silodosin (Rapaflo)
- Tamsulosin (Flomax)
- Terazosin (Hytrin)
5-Alpha Reductase Inhibitors
These drugs (5-alpha reductase inhibitors, or 5-ARIs) stop your body from creating one of the hormones that makes your prostate larger. They prevent its growth and, in some cases, even shrink it. This can improve your urine flow and ease other BPH symptoms as well. They seem to be most helpful to men with very large prostates.
These drugs have two other benefits as well. They may:
- Lower the odds that BPH will lead to other problems, such as bladder damage
- Make you less likely to need surgery
It can take up to six months to see the full effects of 5-ARIs, and you have to keep taking them to get results.
Side effects
This medication is not for use by women. Pregnant women should not be exposed to it because it can lead to birth defects in male babies.
Side effects when men take it include:
- Erectile dysfunction
- Lower sex drive
- Retrograde ejaculation
Some of these side effects may get better as your body gets used to the medicine.
5-ARIs may also lower your prostate-specific antigen (PSA) levels, which can make it harder for doctors to look for prostate cancer. That isn’t harmful, but it may help if you get a PSA test before starting these drugs. Also, the FDA now requires labels on 5-ARIs to include a warning that they may be linked to an increased chance of high-grade (or aggressive) prostate cancer.
Names of 5-ARIs
There are two main 5-alpha reductase inhibitors:
- Dutasteride (Avodart)
- Finasteride (Propecia, Proscar)
Phosphodiesterase-5 Inhibitors
Phosphodiesterase-5 inhibitors are the same medicines used to treat erectile dysfunction (ED). They act on smooth muscles in the bladder and prostate, which can help ease BPH symptoms.
Of the many kinds of phosphodiesterase-5 inhibitors, the FDA has approved only tadalafil (Cialis) to treat BPH. It’s not used as often as other drugs, but if you have ED and BPH, it’s another option.
Side effects
When you take Cialis, you might get:
- Back and muscle pain
- Headaches
- Redness and warmth or burning on the face, neck, and upper body
- A stuffy nose
- An upset stomach after eating
- Vision problems
Drug Combinations
If one medication on its own doesn’t help with the symptoms, your doctor may suggest taking two. Common combinations include:
- Doxazosin and finasteride
- Dutasteride and tamsulosin — this comes in a single pill (Jalyn)
- Alpha-blockers and antimuscarinics (drugs used to treat overactive bladder)
While these combos can be more helpful than a single drug, they may also result in more side effects because you’re taking two medications instead of one.
Considerations for BPH Treatment
Your doctor will help you figure out the best treatment plan for you. Options may include:
Watchful waiting
If your symptoms don’t bother you much and you don’t have any complications, you may choose for your doctor to keep a regular eye on things.
This means seeing your doctor once a year — or sooner if your symptoms change.
Some things to watch for include:
- Needing to pee a lot
- The sensation that your bladder is full even after you’ve just gone to the bathroom
- An urgent need to go, out of the blue
- A weak stream or dribbling at the end
- Trouble starting
- Having to stop and start peeing many times
- Urine leakage
Reasons to consider monitoring an enlarged prostate:
- Your symptoms are mild.
- You don’t want the side effects of medications.
- It’s less costly than medical or surgical treatments.
- Some men with mild BPH symptoms find they get better without treatment.
If you choose to monitor or observe, there are a couple of things you can do to ease things:
- Make simple changes to your daily habits. Drink fewer liquids before bedtime. Drink less caffeine and alcohol generally.
- Avoid some over-the-counter medications. Don’t take cold and sinus medicines that have decongestants or certain antihistamines, such as diphenhydramine (Benadryl), that can make a prostate problem worse. Read labels on these products before you buy them.
Supplements for BPH
Supplements aren’t as closely regulated as the medicines your doctor prescribes. That means their safety, quality, and effects can vary.
Saw palmetto is one of the best-studied and most commonly used supplements to treat BPH. Some small studies have shown benefit. But many large studies do not show that it reduces the size of the prostate or eases urinary symptoms.
Three other supplements are:
- Beta-sitosterol
- Pygeum
- Rye grass
Talk to your doctor before you start any supplement. They may cause problems with prescription medicines, BPH treatments, or tests you might need.
BPH procedures
Sometimes, BPH doesn’t respond enough to lifestyle changes, medications, or supplements. If that’s true for you, there are both minimally invasive procedures and surgical options available.
Your doctor may suggest surgery when you can’t pee at all or have:
- Kidney damage
- Lots of urinary tract infections or bleeding
- Stones in the bladder or urinary retention
With the minimally invasive procedures, doctors make much smaller cuts or are able to work with probes they insert through your penis. These types of treatments often mean faster recoveries and less pain and scarring.
Traditional, open surgery is the other option.
Some studies have shown differences in the way people were treated for their BPH. At least one large study showed Black men were less likely than White and Latino men to have surgery for BHP. Another study showed when men of color did have procedures for BPH, they were inpatient rather than outpatient procedures. Both studies noted that more research is needed to find out why the differences by race exist and to make sure equal access to outpatient BPH surgeries.
Medications to avoid if you have BPH | |
Medication | Potential Negative Side Effects |
| Dimenhydrinate (Dramamine) | Can cause urinary retention, as an antihistamine |
| Diphenhydramine (Benadryl) | Can cause urinary retention, as an antihistamine |
| Doxylamine (Unisom) | Can cause urinary retention, as an antihistamine |
| Pseudoephedrine (Sudafed) | Can cause tightening in the neck of your bladder, as well as in the prostate and urethra |
| Tricyclic antidepressants (Pamelor) | Can limit bladder from tightening and cause urinary retention |
| Muscle relaxers (Amrix, Fexmid) | Can cause urinary retention |
| Diuretics | Can put extra strain on your bladder as you feel the urge to pee more |
Takeaways
If you’ve begun noticing symptoms of BPH, such as feeling a frequent, urgent need to pee or having urine leakage, talk with your doctor about what treatment options may be right for you. Depending on how serious your case is, your doctor may recommend watchful waiting or trying one of the types of drugs available to treat the condition. But if your case of BPH becomes more severe, you may need to have surgery to treat it.
BPH FAQs
Will taking BPH medications prevent or reduce my risk of developing prostate cancer?
Taking 5-alpha reductase inhibitors (5-ARIs) such as dutasteride (Avodart) or finasteride (Proscar) can slightly lower your risk of developing low-risk prostate cancer. But they also slightly raise your risk of developing more aggressive prostate cancer.
How long can I take BPH medications before needing surgery or a minimally invasive procedure?
It depends on how your case responds to medication. If you have good results, you can stay on them for life.
Can enlarged prostate medications cause weight gain or hair growth?
The 5-alpha reductase inhibitor finasteride won’t cure hair loss, but it will increase the amount of scalp hair, or the hair that grows on your head. Weight gain is an uncommon, but possible, side effect of this drug.
Will enlarged prostate medication lower my blood pressure?
Alpha-blockers may lower your blood pressure.
