BPH Medications, Explained

If you’ve noticed a weaker urine stream, more frequent trips to the bathroom, or trouble emptying your bladder, you may be among the 38 million men in the United States who have symptoms of an enlarged prostate, called benign prostatic hyperplasia (BPH). BPH becomes more common with age, affecting about 33% of men in their 60s and 50% of men over 80. Treatments for BPH, including medications, can help address your symptoms.

We cover how these treatments work, their benefits and drawbacks, and how you can figure out the best option for your health.

How Does BPH Medication Work?

Medications treat BPH in different ways. The urethra is the tube that carries urine out of the body. Some drugs, like alpha blockers and phosphodiesterase inhibitors, help widen the tube to make urination easier. Other drugs, like 5-alpha reductase inhibitors, prevent the prostate from blocking the tube.

Without surgery, you will likely need to take BPH medication indefinitely to keep symptoms from coming back. Some patients take more than one BPH medication to manage their symptoms.

Alpha Blockers

Alpha blockers enhance the flow of urine by relaxing the muscles around the urethra. They often provide BPH symptom relief within days. Examples of alpha blockers include:

• Alfuzosin (Uroxatral)
• Tamsulosin (Flomax)
• Doxazosin (Cardura)
• Terazosin (Hytrin)
• Silodosin (Rapaflo)

Alpha blockers can also lower blood pressure, which can cause dizziness, especially after standing up. You may need to monitor your blood pressure more closely when taking an alpha blocker to make sure it does not drop too low (hypotension). If you already take blood pressure medications, talk to your doctor before using an alpha blocker. 

5-Alpha Reductase Inhibitors (5-ARIs)

5-ARIs can slow prostate growth and may reduce prostate size by blocking the effect of dihydrotestosterone (DHT), the hormone that drives prostate enlargement. 5-ARIs reduce BPH symptoms and may lower the likelihood of needing prostate surgery. However, it can take up to six months before your symptoms get better.

Examples of 5-ARIs include:

• Finasteride (Proscar)
• Dutasteride (Avodart) 

5-ARIs can have sexual side effects, including decreased libido, erectile dysfunction, and problems ejaculating. These drugs may also provoke feelings of depression. Keep track of your symptoms to make sure none are impacting your quality of life or worsening over time.

Combination Therapies

Combination therapy means taking more than one medication at the same time. For example, taking both an alpha blocker and a 5-ARI for BPH. Your doctor may recommend this approach if your symptoms are severe, you have a large prostate, or treatment with just an alpha blocker hasn’t been effective.

If you have persistent issues with urinary urgency or leakage, your doctor may suggest a combination of an alpha blocker and a drug designed to treat an overactive bladder, such as mirabegron (Myrbetriq) or vibegron (Gemtesa). Combination therapy may better control your symptoms, but can also cause more side effects from the multiple medications. 

Daily Tadalafil

Another treatment option is to take tadalafil (Cialis), which is more commonly prescribed to treat erectile dysfunction (ED), but can also improve BPH symptoms. Like alpha blockers, tadalafil relaxes muscles in the prostate and bladder to improve the flow of urine. Because of its dual effects, tadalafil may be recommended if you have both ED and BPH. It usually does not have significant side effects, but may cause headaches, body aches, and stomach issues.

What Are Other BPH Treatments?

While medications are the most common and non-invasive treatment for BPH, other treatment options include surgery and lifestyle changes. The right choice depends on your symptoms, prostate size, and overall health.

BPH Surgery

BPH surgery may be an option if medications don’t resolve your symptoms. Surgery may also be recommended if you have or used to have serious kidney or urinary problems. The different BPH surgeries work by removing, reducing, or repositioning prostate tissue to relieve pressure on the urethra. These include:

• Transurethral resection of the prostate (TURP): During this procedure, a large portion of the prostate is removed via a special tool (called a scope) that is inserted into the urethra. A TURP frequently resolves BPH symptoms, but it can cause sexual side effects.
• Transurethral incision of the prostate (TUIP): A TUIP involves making small cuts in the prostate rather than actually removing tissue. This less-invasive option is most frequently used if your prostate hasn’t enlarged significantly and you have other health issues that could cause complications from other operations.
• Prostatic urethral lift: In this outpatient procedure, a special device widens the urethra, and implants are put in place to keep the urethra from narrowing again. A prostate lift typically doesn’t cause as many side effects as a TURP.
• Technology-assisted prostate tissue removal: These procedures use different technologies to destroy prostate tissue (ablation). Examples of tools for prostate ablation include lasers, water vapor, robotic waterjets, and electric currents.

Overall Lifestyle Changes

Lifestyle changes alone typically can’t resolve moderate or severe BPH symptoms. However, they may allow you to feel more comfortable alongside your other BPH treatment(s), and they may be enough to avoid other treatments entirely if you have only mild symptoms. 

• Mind what you eat and drink. Avoid spicy foods and drinks if they irritate your bladder. Limit caffeine and alcohol since these are diuretics that can increase your need to urinate. Cut back on fluids before leaving the house or going to bed to avoid emergencies.
• Stay active and maintain a healthy weight. Studies suggest that regular physical activity and avoiding obesity may help reduce inflammation and hormonal changes that can worsen BPH symptoms.
• Urinate regularly. Urinating on a schedule, instead of going only when you feel the urge, may help with emptying your bladder.
• Do not “push” to urinate or defecate. Straining too hard puts extra pressure on your urinary tract. Try to empty your bladder without pushing excessively.
• Strengthen your pelvic floor muscles. Your pelvic floor muscles support bladder function. Doing exercises to strengthen these muscles (Kegel exercises) can help control the urge to urinate and reduce leakage. 
• Relax. Being stressed out can make you feel even more of an urge to urinate. Managing tension as much as possible may help with your BPH symptoms.

Finding the Best Medication for BPH Symptoms

No single treatment works for everyone. Finding the best medication for BPH depends on a few important questions worth thinking through with your doctor.

• How severe are your symptoms?
• How much do those symptoms interfere with your everyday life?
• Do you have other health issues that affect your treatment options?
• Do you take other drugs that could interact with BPH medications?
• How concerned are you about different side effects, including sexual side effects?
• How do you feel about BPH drugs and surgical options?

If your symptoms are minimal, you can see if making lifestyle changes is enough. 

With more bothersome symptoms, medications are typically the first treatment that doctors suggest because it is the least invasive approach. Most often, doctors prescribe an alpha blocker first. If symptoms persist, your doctor may recommend trying a different dosage, a different drug, or combination therapy. 

All in all, the best BPH medication is the one that addresses your symptoms with the fewest side effects, and your doctor can work with you over time to dial in your BPH management regimen.

Side Effects Management

Side effects from BPH treatment will depend on which drugs you take. Some potential side effects include: 

• Dizziness
• Headaches or body aches
• Upset stomach, nausea, or diarrhea
• Sexual problems (affecting libido, erections, or ejaculation)

Let your doctor know about any side effects you experience, especially if they impact your quality of life or worsen over time. Your doctor may be able to adjust your dose or switch you to a different medication. 

Seek emergency help if you are having a severe reaction to BPH medications. For example, stop taking your medication and get medical help if you show signs of a dangerous drop in blood pressure, such as feeling faint, heart palpitations, or bluish skin. These are symptoms that may require immediate medical intervention.

Your Next Steps

An enlarged prostate can cause frustrating urinary symptoms, but effective treatments for BPH are available. Knowing your options puts you in a better position to work with your doctor to find a treatment plan that fits your symptoms, your health, and your life. Once you know what medication(s) you need, TelyRx can help you get your BPH treatment delivered to your door.