September 23, 2014
BPH: Coping With Enlarged Prostate

BPH: Coping With Enlarged Prostate

by Berkeley Wellness  |  

If you are experiencing mild symptoms of benign prostatic hyperplasia (BPH), you may be able to manage with some of the self-help steps below.

  • Avoid over-the-counter cold or allergy drugs and sleep aids that contain antihistamines or decongestants; these may worsen symptoms. Review your medications with your doctor or pharmacist.
  • Cut down on fluids, especially alcoholic beverages, in the evening to decrease the need to urinate during the night.
  • If you cannot empty your bladder, try sitting when you urinate rather than standing. Running the water in the sink may help. Also try “double voiding”: Urinate, relax and wait a moment, then resume.
  • Be active. Some research suggests that exercise, such as walking, may help reduce symptoms.
  • Stay warm. Cold weather can make it more difficult to urinate and also can increase the urgency to urinate in some people.
  • Plan ahead. If you are attending a long meeting or concert, cut down on fluids beforehand. Visit the bathroom in advance. On a long car trip, don’t pass up too many rest stops.
  • Try not to postpone urination until the last minute. An overdistended bladder can make urination more difficult.
  • There’s no question that the symptoms of BPH can be frustrating. If you feel anxious and depressed by all this, have a discussion with your doctor.

BPH: When self-care isn’t enough

If your symptoms reach a point where they seem unmanageable, talk to your doctor about medication. Surgery also is an option you can discuss.

Prescription drugs. If your symptoms worsen, the first line of treatment is usually a prescription drug. The Food and Drug Administration (FDA) has approved a total of nine drugs for BPH, including finasteride (Proscar) and dutasteride (Avodart). Both of these drugs have been shown to shrink the prostate or at least prevent further growth.

Potential side effects include reduced sexual function and desire, and possibly a slight increase in the risk for aggressive prostate cancer. The newest drug to be approved for treating the symptoms of BPH is tadalafil (Cialis), which was first approved for treating erectile dysfunction. The most common side effects of tadalafil include headache, indigestion, back pain, muscle aches, flushing and stuffy or runny nose; unusual side effects include a sudden decrease or loss of vision or hearing.

Other drugs that may be helpful are five alpha-blockers—terazosin (Hytrin), doxazosin (Cardura), alfuzosin (Uroxatral), tamsulosin (Flomax) and silodosin (Rapaflo)—which relax the muscles in the prostate and bladder neck and improve urine flow. But they, too, can have side effects, including reduced sexual function, low blood pressure and dizziness. Alpha-blockers can also cause serious adverse effects when taken with drugs for erectile dysfunction; ask your doctor about precautions you should take.

Saw Palmetto and Urinary Problems

Don’t take saw palmetto to relieve urinary problems caused by an enlarged prostate. The largest and longest study so far has confirmed that this herb doesn’t help.

Minimally invasive treatments. If drugs do not work for you, several treatments are available that fall just short of surgery. Among the procedures to reduce prostate size are transurethral microwave thermotherapy (TUMT), transurethral needle ablation (TUNA) and interstitial laser coagulation (ILC). All three use heat—either microwaves (TUMT) or radio waves (TUNA, ILC)—to vaporize some of the prostate tissue surrounding the urethra. They can be performed on an outpatient basis and typically produce fewer complications than surgery (see below). But symptoms may not improve as quickly, and more than half of men need further treatment at some point.

Other minimally invasive approaches, including the use of high-intensity ultrasound, are under study but have not been approved by the FDA.

Surgery. If your symptoms continue to worsen, surgery to reduce the size of the prostate also is an option—though fewer men are choosing surgery now that effective medications are available for treating BPH. Surgery provides more reliable and longer-lasting improvement of symptoms than do less invasive treatments. But it usually requires a hospital stay and is associated with a greater risk of long-term complications, such as erectile dysfunction, incontinence and retrograde (“dry”) ejaculation. If your doctor recommends surgery, get a second opinion and carefully consider what will work best for you.

The most common surgical treatment—making up 90 percent of all BPH surgeries—is transurethral resection of the prostate (TURP). No incision through the skin is required; the surgeon passes a long thin instrument through the urethra and cuts away prostate tissue. About 90 to 95 percent of men with severe symptoms and 80 percent with moderate symptoms experience significant improvement, which is better than treatment with medication or self-help measures.

Two other procedures, transurethral incision of the prostate (TUIP) and transurethral electrovaporization (TUEVP), are similar to TURP. Laser surgery is another transurethral method for treating BPH; it utilizes bursts of laser energy to shrink and destroy prostate tissue. Several laser procedures are available, and the newest, photoselective vaporization (PVP, also called GreenLight laser vaporization), offers several advantages over other BPH treatments, including shorter hospital stays, better symptom improvement, lower cost and less risk of serious complications. But because it is new, its long-term effectiveness hasn’t been established.

For men with very large prostates or certain other medical problems that do not allow transurethral approaches to be used, the treatment of choice is open prostatectomy, which requires making an incision below the navel so that the surgeon can reach and remove prostate tissue. Recovery time is longer and complications are more common than with other procedures for BPH.

Who Benefits Most from BPH Drugs

An analysis published in a medical journal has found some BPH medications are most effective at treating benign prostatic hyperplasia (BPH) in certain men. See if you're in that group.