Treatments for BPH

Whether to have treatment and the choice of treatment, depends on how much bother the symptoms are causing.

Are your symptoms
MILD
MODERATE
SEVERE


If the urinary symptoms of BPH are mild, you might decide not to have any treatment. It can be helpful to reduce the amount of caffeine (in tea as well as coffee) and alcohol that you drink, and limit your total fluid intake, especially in the evening. Avoiding constipation, losing some excess weight, having good control of diabetes and blood pressure, stopping smoking and increasing your level of exercise may also help.

Retraining your bladder to hold on longer can help some men who have to urinate frequently.

Talk to your doctor about other medications you are taking, including decongestants and antihistamines, as they can affect your symptoms.

Medication taken as tablets is usually the next step for men with moderate to severe BPH symptoms. Three main types of medicines are used:

  • Alpha-1 blockers relax muscles in the prostate and neck of the bladder, letting urine flow more easily. Alpha-1 blockers act quickly, within one or two weeks. They usually reduce symptoms by about 30-40% and improve the flow of urine by about 20%. However, they do not affect the size of the prostate.
  • 5-alpha-reductase inhibitors (5-ARIs), is another class of medicines, they slowly reduce the size of the prostate by blocking the effects of testosterone on prostate tissue. They act much more slowly than alpha-1 blockers, and need to be taken for many months before there is a benefit. Acute urinary retention - being unable to empty the bladder - is a possible complication of BPH. 5-ARIs can reduce the risk of acute urinary retention occurring.
  • PDE 5 inhibitors is another class of medication that can also help relieve the symptoms of BPH.

Some tablets contain a combination of alpha-1 blockers and 5-ARIs. They aim to provide relief of symptoms and also reduce the risk that BPH will get worse.

Anticholinergic tablets can be used to treat the symptoms of overactive bladder. These symptoms include needing to rush to the toilet to urinate without warning, needing to urinate frequently, or wetting yourself because you did not get to the toilet in time. These medications are used only when there are symptoms of bladder overactivity as well as BPH. Your doctor can advise on whether you might benefit from treatment.

All medications have the potential to cause unwanted side effects. Talk with your doctor about the balance between the likely benefits and the possible risks for you.

If BPH and its symptoms are severe, then surgery or newer approaches including laser treatment of the prostate are an option.

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References

  1. Prostate Enlargement: A guide to urinary symptoms in men. Andrology Australia, 4th edition, 2013
  2. Marberger. M. Medical management of lower urinary tract symptoms in men with benign prostatic enlargement. Advances in Therapeutics. 2013; 30 309-319