Medical treatment of BPH

1- Watchful waiting (no treatment)

Waiting and watching without any treatment is the preferred method for men with mild BPH symptoms that don't bother them. But watchful waiting doesn't mean just waiting and doing nothing to reduce BPH symptoms.

• During watchful waiting, one should make lifestyle changes to reduce the symptoms of BPH and also have regular checkups annually to see if these symptoms will improve or worsen.
• Make simple changes in your urination and fluid consumption habits.
• Empty your bladder regularly. Do not hold urine for a long time. Urinate as soon as you have the urge to do so.
• Double emptying. This means crossing urine twice in a row. First, empty your bladder normally in a calm manner, wait a few moments, and try to empty it again. Do not strain or force yourself to empty it.
• Avoid drinking liquids containing alcohol and caffeine at night. Both can affect bladder muscle tension and both stimulate the kidneys to excrete urine, resulting in frequent urination throughout the night.
• Avoid excessive fluid intake (drink less than 3 liters of fluid per day). Instead of consuming a lot of fluids at once, spread your fluid intake throughout the day.
• Reduce your fluid intake a few hours before going to bed or going out.
• Don't take over-the-counter cold or sinus medications that contain decongestants or antihistamines. These drugs can worsen symptoms or lead to urinary retention
• Change the time of the medication that increases urine volume (eg diuretics).
• Keep warm and exercise regularly. Cold weather and a lack of exercise can worsen symptoms.
• Learn and perform pelvic strengthening exercises because it helps prevent urine leakage. Pelvic exercises strengthen the pelvic floor muscles that support the bladder and help close the sphincter.
• Bladder training focuses on complete and timely emptying. And try to urinate at regular times.
• Constipation treatment.
• Reducing stress. Nervousness and stress can lead to frequent urination.

2- The medical treatment

Medications are the most common and preferred way to control mild to moderate symptoms of BPH. The medications significantly reduce symptoms in about two-thirds of men treated.

A- Alpha-blockers

Alpha-blockers (tamsulosin, alfuzosin, terazosin, doxazosin) are prescription drugs to relax the muscles in and around the prostate, relieve urinary obstruction, and allow urine to flow more easily. The most common side effects of alpha-blockers are headache, dizziness, and fatigue.

B- Alpha-reductase inhibitors

• Alpha–reductase inhibitors (Finasteride-Dutasteride) are drugs that can reduce the size of the prostate gland. These drugs increase the urine flow rate and reduce symptoms of BPH.
• They do not work as quickly as alpha-blockers (improvement is seen within six months of starting treatment) and generally work best in men with BPH.
• The most common side effects of alpha-5-reductase inhibitors are problems with erection and ejaculation, decreased interest in sex, and impotence.
• No surgery, medical treatment is simply the preferred method of treating mild to moderate BPH symptoms.

3- The combination of treatment

Alpha-blockers and alpha-5-reductase inhibitors work differently and have an additive effect when taken together.

Therefore, the combination of drugs leads to a significant and noticeable improvement in the symptoms of benign prostate tutumorshan taking one of them.

Combination therapy is recommended for men with severe symptoms, a large prostate size, and an inadequate response to high-dose alpha-blockers.