Q: I have an appointment with my family doctor next month for what I suspect is a prostate issue as I have been having difficulty with urine flow over the last year. Could you tell me a bit about the medications that are used to treat this condition before I head to my appointment?
I suspect the condition you are referring to is benign prostatic hyperplasia (BPH), commonly referred to as an enlarged prostate. During adulthood, the prostate gland begins to grow again and in cases of BPH it may grow from the size of a walnut to the size of a tennis ball. As this happens the urethra which is the tube that carries urine down to empty the bladder becomes squeezed which can affect urine flow.
Your doctor can order bloodwork to measure your PSA levels which helps them to estimate the size of your prostate. Usually around the age of 50 your doctor begins checking your PSA levels every few years. You can review the results of your bloodwork by logging into your MyHealthNB account online.
Symptoms of BPH include difficulty starting or stopping urination, a decrease in the strength of urine stream or the amount of urine passed, still feeling the urge to urinate after you have stopped or feeling like your bladder is not empty, feeling sudden urges to urinate or urinating more frequently especially at night, and pain or burning during urination. Symptoms may also include difficult or painful ejaculation and blood in your urine or semen. It is important anyone experiencing these symptoms see their primary care provider as some of these symptoms also present when you have an infection.
When symptoms are mild lifestyle changes may be tried before medications such as restricting fluid in the evening and limiting caffeine, alcohol and spicy food. Pelvic floor physiotherapy may help to strengthening bladder muscles to reduce urgency and frequency of urination, and treating constipation may help reduce extra pressure on your prostate.
Your doctor may also need to make changes to some of your medications if they are known to make symptoms of BPH worse. Tricyclic antidepressants such as amitriptyline and nortriptyline and muscle relaxants such as cyclobenzaprine can cause urinary retention making it harder for you to empty your bladder. Diuretics that are commonly used to treat high blood pressure, such as furosemide, can cause you to urinate more often, which puts extra strain on your urine flow when you have BPH.
Many over-the-counter medications can worsen your symptoms as well, so be sure to always check with your pharmacist before self-selecting any products. We can help you find alternatives to the allergy, cold and sinus, anti-nausea and sleep aid products that contain ingredients that can make it more difficult for you to empty your bladder.
If your symptoms are moderate or are bothersome to you, your doctor may start you on a medication from a group called alpha blockers. They help to relax the muscles in the prostate and bladder neck which helps to take pressure off your urethra to improve urine flow. They help to manage symptoms such as difficulty starting and stopping urination and decreased strength of urine stream. Some examples include alfuzosin, doxazosin, silodosin, tamsulosin and terazosin.
Medications used to treat overactive bladder can be used to manage some of the symptoms of BPH as well and can be used in combination with alpha blockers. These medications help your bladder muscle relax and may help relieve sudden urges to urinate and reduce your frequency of urination. Some examples include tolterodine and mirabegron.
For more severe symptoms, such as having a blocked urethra where at times you cannot empty your bladder, a medication from a group called 5-alpha reductase inhibitors may be added, such as dutasteride or finasteride. They help to slowly reduce the size of your prostate over time by as much as 25-30 per cent. Your doctor will help you weigh the risks and benefits before starting a medication from this group as their use can be associated with some unpleasant side effects in a small percentage of men that include decreased libido, erectile dysfunction and increased breast tissue.
Erin Thompson (BSc, BScPharm) is a graduate of Dalhousie University and a community pharmacist practicing at Shoppers Drug Mart in Quispamsis N.B. Her opinions expressed in this column are published for educational and informational purposes only, and are not intended as a diagnosis, treatment or as a substitute for professional medical advice, diagnosis or treatment.