For most, benign prostatic hyperplasia is a mild inconvenience that can be treated with a drug called Flomax. But Flomax does not work well for everyone. Some alternatives can help men with this condition relieve their symptoms and feel better.
Benign prostatic hyperplasia (BPH) or an enlarged prostate can cause painful and frequent urination, bladder stones, and incontinence. According to one estimate, nearly 1 in 5 men between 55 and 74 experience this condition.
Flomax, the branded version of the drug tamsulosin, is often prescribed to relieve the symptoms of BPH. Flomax is one of a group of drugs called alpha-1 blockers that can help urine flow more easily.
Commonly known as alpha-blockers, these drugs change the behavior of the hormones adrenaline and noradrenaline. This can relax muscles in the urinary tract, making it easier to urinate.
Flomax is considered a selective alpha-blocker, which means it targets the urinary tract specifically and has less effect on other muscles.
In men with a moderately enlarged prostate who have no serious health issues, Flomax often works well. But for some, it causes unpleasant side effects. Common side effects of Flomax include:
- low blood pressure
- nasal congestion
- swollen ankles
- dry mouth
- headaches and dizziness
- problems with ejaculation
For some men, however, the cost is also a significant concern. Flomax can cost more than $200 per month and might not be entirely covered by insurance. Flomax may be no more effective than other alpha-blockers, but the manufacturing company spends more than $100 million marketing it to consumers, so it is often the only BPH drug many people know about.
Other alpha-blockers work in much the same way as Flomax. A generic form of Flomax, called doxazosin, may cost as little as $10 per month.
Hytrin, another generic drug, also works well. Both drugs are nonselective alpha-1 blockers, which means they can lower a person's blood pressure.
Selective alpha-blockers, such as Flomax, can also lower blood pressure but not quite as much as nonselective alpha-blockers.
Some alternative selective alpha-blockers to Flomax include:
- Uroxatral (alfuzosin)
- Rapaflo (silodosin)
- non-branded tamsulosin
Alpha-blockers are not the only option for treating BPH. Several other drugs may help:
DHT can cause the prostate to grow, putting pressure on the urethra and making it difficult for the urine to flow. Drugs in this group include Avodart (dutasteride) and Proscar (finasteride).
These drugs may lower libido, cause problems with ejaculation, or lead to erectile dysfunction (ED). Rarely, they can cause gynecomastia, a condition in which a man develops breasts.
Phosphodiesterase-5 inhibitors are drugs for erectile dysfunction (ED). They may also treat the symptoms of BPH, particularly in men who also have ED.
Sometimes phosphodiesterase-5 inhibitors are used alongside other BPH drugs to combat erectile side effects. Drugs in this group include:
- Viagra (sildenafil)
- Cialis (tadalafil)
These drugs can cause headaches, nausea, and drops in blood pressure. Rarely, they may cause a painful erection that does not go away.
Combining certain medications may help when a single drug does not work. For example, alpha-blockers combined with drugs for an overactive bladder may be more effective.
Occasionally, doctors use other drugs on an off-label basis to treat BPH. It is crucial for a person to discuss the risks and benefits of BPH medications with their doctor.
When drug treatment fails or when there are other problems with the prostate, such as frequent prostate infections, a doctor might recommend a prostatectomy. A prostatectomy is a procedure in which the surgeon removes all or a portion of the prostate.
In some people, this can alleviate symptoms with few or no side effects. However, a prostatectomy may cause incontinence, sexual dysfunction, and other health concerns.
People should carefully weigh the benefits and risks of a prostatectomy, and talk to their doctors about which form of prostatectomy is likely to be the most effective.
A less invasive treatment heats the prostate, often with a laser, and can slow prostate growth. This procedure may require general anesthesia.
Less frequently, a doctor may recommend the temporary or permanent use of a catheter. A catheter is a tube that goes through the urethra to help empty the bladder. It can help people whose prostates are very large and swollen.
A catheter can also be used as a temporary remedy when the prostate has swollen due to surgery or another medical procedure.
Some herbal remedies may help with some symptoms of BPH. Those include:
- Cernilton is an herbal remedy made from rye-grass pollen. This supplement is available over the counter, and most studies suggest it causes few side effects. It may moderately improve urological functioning.
- Saxifrage, an herbal remedy made from the Chinese herb Saxifraga stolonifera, may improve prostate function in some people, although research into its effectiveness is mixed.
- Babassu, another herbal remedy, is made from a Brazilian palm tree. Animal studies suggest it is safe to use. It may work by slowing prostate growth and causing some prostate cells to die.
- Ganodermataceae is a type of fungus that may work similarly to some 5-alpha-reductase drugs. Research on rats showed that it could reduce testosterone's effect on the prostate. Testosterone is a major culprit in the prostate growth associated with BPH.
- Saw palmetto is a herbal remedy sometimes used to treat prostate problems. While some studies have shown promise, the best-designed studies suggest that saw palmetto does not work any better than a placebo.
It is essential to speak with a doctor before using any supplements. A person should also be aware that the United States Food and Drug Administration (FDA) do not monitor the effectiveness, quality, or safety of supplements.
A few lifestyle changes may improve symptoms, but they will not reverse BPH. Those remedies include:
- not drinking fluids a few hours before going to bed
- avoiding caffeine and alcohol
- not straining to empty the bladder
- double voiding
Men should see a doctor if they suspect they have BPH, as some other disorders, including prostate cancer, might cause similar symptoms to BPH.
A person should see a doctor if they experience difficulty urinating, painful urination, or frequent urination. A person with BPH whose symptoms suddenly worsen should also see a doctor.
BPH is a manageable condition but left untreated it can be uncomfortable and even dangerous. Not everyone responds to Flomax, so people who continue to experience strong urges to urinate or other urinary symptoms should discuss this with their doctors.
Another drug, a combination of multiple drugs, or the right lifestyle changes might improve symptoms.