Medicines

What treatments are available for BPE?

 

There are a number of different treatments for BPE. The treatment(s) you are offered will vary depending on your medical history, the type of symptoms you have, how severe they are, and how they affect your life.

Self-management of symptoms

You can actively manage, and potentially even improve, your own BPE symptoms by:
  • Taking your time to completely empty your bladder each time you urinate. It may help to sit down.
  • Double voiding. This involves waiting a few moments after you have finished urinating before trying to wee again. This can help to empty your bladder fully.
  • Using an absorbent pad in your underwear to soak up any leaks.
  • After urinating, pressing under your scrotum onto the urethra with your fingers, and then sliding your fingers from the base to the tip of the penis to squeeze out any last drops of urine. This can help to avoid wetting your underwear.
  • Using breathing exercises to distract yourself when you feel an urgent need to urinate.
  • Trying to hold on for longer when you feel the need to urinate. This will train the bladder to hold more urine before the urge to urinate comes.
  • Eating plenty of fibre to avoid constipation.
  • Bladder training to lengthen the time between urinating, by setting a target of, for example, 2 hours, and using relaxation techniques and muscle exercises to increase that length of time (your doctor can provide more information about this).
  • Keeping a bladder diary so that you have a record of when you go to the toilet and your symptoms. After the event, it is often difficult to remember when symptoms worsened or became more bothersome. A diary can help your doctors to monitor your condition and lead to the best management of your BPE.

Watchful waiting

You may wish to consider ‘watchful waiting’ if your symptoms are mild to moderate and they aren’t bothersome enough to noticeably affect your quality of life.
A watchful waiting programme involves:
  • Assessment of your symptoms during a consultation appointment with a doctor
  • physical examination
  • Blood and urine tests
  • Education and advice about your condition
  • Ongoing support with managing your BPE
During watchful waiting, mild to moderate BPE symptoms can often be treated with lifestyle changes such as:
  • Drinking at least 1 litre of fluid every day.
  • Drinking less fluid before going to bed or before long trips to reduce the need to urinate during these times.
  • Drinking less alcohol, caffeine, fizzy drinks and artificial sweeteners, which can irritate the bladder and make your symptoms worse.
  • Taking regular exercise (at least 2-3 times a week). Lack of movement can make it more difficult to urinate.
  • Having a balanced and varied diet.
  • Keeping your lower abdomen warm and dry. Cold and damp increases the urge to urinate.
  • If your urine sprays when you go to the toilet, it can be helpful to sit down to urinate instead of standing or if you prefer to stand, to urinate into a cup and pour that into the toilet.
  • Discuss with your doctor, all medication you are taking for any condition as some medicines, such as ‘water tablets’ (called diuretics), may cause urinary symptoms to worsen.
You will be offered regular check-ups as part of watchful waiting, to make sure that your condition has not got any worse, or more troublesome to you. If it has, your doctor can discuss treatment options that are available to you.
 

Medicines

 
If lifestyle changes are not enough to manage your BPE symptoms, you may be offered medicines for your BPE. Many of these work by either relaxing the muscle of the prostate gland or bladder or shrinking the prostate gland, so that it doesn’t press on the urethra. Sometimes a combination of these medicines can be used.
If your symptoms are mainly related to the urgent need to urinate or having to urinate multiple times through the day and night, your doctor can recommend medications that affect the bladder alone, or which combine to act on the prostate as well, to improve your symptoms.
Many medicines cause mild to moderate side-effects and your doctor will discuss these with you before you make any decisions about medical treatments.
Types of Medicines
Medicines to treat BPE symptoms work by relaxing the muscles in the prostate or bladder to reduce the number of times you feel you need to urinate, or by preventing the prostate from growing, thereby stopping symptoms from worsening. They fall into several categories, depending on the way they work.
  • Alpha-blockers are a group of drugs which help the symptoms and the flow of urine by relaxing the smooth muscles of the prostate. This is the most commonly recommended group of drugs for men with BPE.
  • Beta-3 agonists are a type of medicine that can help to relax the bladder. These drugs are usually prescribed for the treatment of overactive bladder (OAB) symptoms, but they can also help men with specific symptoms caused by BPE.
  • 5-alpha-reductase inhibitors (5ARIs) are a group of drugs which prevent the prostate from growing and may even shrink it. These drugs work better in prostates larger than 40 mL and are only prescribed when prostate enlargement symptoms cause significant problems.
  • Muscarinic receptor antagonists (MRAs) are a group of drugs which reduce abnormal contractions, or squeezing, of the muscles in the bladder. These drugs are usually prescribed for the treatment of overactive bladder (OAB) symptoms, but they can also help men with specific symptoms caused by BPE, such as an urgent need to pee. These medicines are generally not prescribed if the bladder does not empty completely after urination.
  • Phosphodiesterase 5 inhibitors (PDE5Is) are a group of drugs used for the treatment of erectile dysfunction. These drugs can also improve some symptoms caused by BPE.
  • Phytotherapy, which is also known as plant extracts or herbal drugs. Hexane-extracted Serenoa repens, in particular, is also now recommended by the EAU as phytotherapy can provide moderate benefits for men to help ease their BPE symptoms. Phytotherapy also has very few side-effects.
Combinations of medicines
The combination of alpha-blockers with 5ARIs is recommended if:
  • your prostate is larger than 40 mL;
  • your prostate-specific antigen level is 1.5 ng/mL or higher;
  • your symptoms are severe, and you have slow flow of urine.
This combination of drugs is only advised for long-term treatment.
The combination of alpha-blockers and MRAs or beta-3 agonists is recommended if you have symptoms such as an increased or sudden need to urinate and your symptoms have not improved when taking one type of drug.
A healthy prostate is between 15 and 25 mL, which is about the same size as a golf ball.
Prostate-specific antigen, or PSA, is a protein made only by the prostate gland. The amount of PSA in your blood is called your PSA level.