Skip to main content

Benign Prostatic Hyperplasia (BPH): Symptoms and Treatment

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on May 20, 2024.

What is BPH or an enlarged prostate?

Benign prostatic hyperplasia, usually abbreviated as BPH, is a male condition where the prostate gland grows larger than normal. This condition can occur as men grow older, and about 60% of men over the age of 60 have prostate enlargement.

As the prostate gland grows, it can squeeze the urethra, blocking the flow of urine and making urination difficult. Benign prostatic hyperplasia is also sometimes called benign prostatic hypertrophy.

The prostate gland is part of the male reproductive tract. It produces a fluid that mixes with sperm to make semen, and is located below the bladder, in front of the rectum, and wraps around the urethra. The urethra is the tube that carries urine through the penis and out of the body.

What are BPH symptoms?

Men with BPH may experience these symptoms:

Not all men have significant symptoms when the prostate enlarges. Several different conditions can lead to symptoms comparable to an enlarged prostate, such as inflammation of the prostate (prostatitis), kidney or bladder stones, prostate cancer, or narrowing of the urethra. If you experience any of these symptoms, be sure to consult with your doctor.

BPH is not a form of prostate cancer but symptoms can be similar. Having BPH does not increase your risk for prostate cancer, but they can occur at the same time.

Why do men get BPH?

The exact causes of BPH are not fully known, but age is certainly a BPH risk factor, and hormone imbalances may also contribute. As men age past 45 years of age, the prostate gland typically grows larger and may squeeze the urethra, blocking the flow of urine and making urination difficult. Symptoms may become bothersome enough to require treatment by the age of 60, on average.

If serious BPH is not addressed, urine may back up into the bladder and lead to urinary infections or kidney damage.

A history of a vasectomy and the frequency of sex do not increase the risk of developing BPH.

How is BPH diagnosed by your healthcare provider?

Your doctor will ask you questions about your symptoms, perform a physical exam, and run common lab tests to diagnose BPH or rule out other conditions.

Other tests or a biopsy may be performed, if needed.

What are the most common BPH treatments?

There are several options for patients who are diagnosed with an enlarged prostate and BPH.

Careful observation (watchful waiting)

Patients with enlarged prostates but no or minimal symptoms typically do not require any treatment at all, and their symptoms can be monitored. Avoid medicines that may aggravate symptoms such as oral decongestants and sedating antihistamines is important. 

Your healthcare provider will monitor your symptoms, like urine flow, urine retention rates, and prostate size every 6 to 12 months For some men, symptoms may ease. If prostate problems become bothersome, several drug  treatments are available.

Common medications used to treat BPH

Medications are frequently used for the treatment of symptoms of BPH. BPH drug treatment is typically long-term and continued until symptoms are no longer controlled with medications; at that time surgery may be needed.

Drug treatment combinations may also be more effective for some patients than use of a single drug.

Alpha-blockers

Alpha-blockers are a class of drugs considered to be first-line treatment for BPH. Alpha-blockers work by blocking the alpha-1a receptor in the prostate and the bladder. They relax the muscles of the bladder neck and prostate and allow an easier urine flow. They can work well in men with small prostates and mild to moderate symptoms.

Alpha-blockers are very effective in the treatment of BPH. Roughly 50% of men see an improvement in symptoms within the first 48 hours to one week after therapy initiation. Patients may only retain symptom relief for up to 4 years, and alpha-blockers do not shrink the prostate or slow down BPH progression. Alpha-blockers are also used to treat high blood pressure.

Alpha-blockers used in the treatment of BPH include:

Side effects that may occur with alpha-blockers include:

Drug interactions which may lead to toxicity are a possibility with alpha blockers, some of which are metabolized by the CYP450 3A4 enzyme system (alfusosin, doxazosin, silodosin, tamsulosin). Always have your pharmacist review for drug interactions. Tamsulosin is also metabolized by CYP2D6 and silodosin is transported by P-glycoprotein. 

Related: Use the Drugs.com Drug Interaction Checker

Alpha-blockers are usually well-tolerated by most patients. If you should experience a serious side effect, contact your doctor immediately. If you are scheduled to have eye surgery while using an alpha-blocker, be sure to tell all of your doctors.

5-alpha-reductase inhibitors

5-alpha-reductase inhibitors work by blocking the conversion of testosterone to dihydrotestosterone (DHT) to shrink larger prostates and increase the rate of urine flow. 5-alpha-reductase inhibitors can take 3 to 6 months to begin working, and this may be a drawback for many patients. But the decrease in prostate volume can decrease the need for surgery for many patients.

5-alpha-reductase inhibitors used in the treatment of moderate to severe BPH include:

They may be used alone or in some cases, these drugs may be combined with alpha blockers for more severe symptoms.

Side effects that may occur with 5-alpha-reductase inhibitors include:

These side effects do not occur frequently. In a small percentage of patients, 5-alpha-reductase inhibitors can also lead to a lowered sex drive, impotence, or depression, but these effects are reversible if the medicine is stopped. Combined use of tadalafil (Cialis) with a 5-alpha-reductase inhibitor like finasteride (Proscar) can decrease these effects, too.

Dutasteride (Avodart) is a substrate of CYP3A4, and use with 3A4 inhibitors may increase its serum concentrations.

Avodart and Proscar should never be taken by a woman or a child.

You should discuss the risk of any side effects with your doctor. Do not stop medications without speaking to your doctor first. If you have questions or think you have experienced a serious side effect, contact your healthcare provider or call 911.

Combination drugs for BPH

Alpha-blockers and 5-alpha-reductase inhibitors, or a phosphodiesterase 5 (PDE5) inhibitor and a 5-alpha-reductase inhibitor can be combined for patients who have more severe urinary symptoms and a larger prostate, or have not had success with single agents. 

If preferred, all of these above agents are available separately in generic form, which may be more cost effective for you. Your healthcare provider can help you determine which treatment is best suited for you.

Learn more: Access the Drugs.com Price Guide and Pharmacy Discount Card 

The manufacturer of Cialis (tadalafil) does not recommended use in combination with alpha-blockers for the treatment of BPH due to possible additive effects of blood pressure lowering.

A 2018 Cochrane review found that combined 5-alpha-reductase inhibitor treatment with tadalafil (Cialis) does not lead to additive effect to lower BPH symptoms.

How do you use Cialis for BPH?

Cialis (tadalafil), a phosphodiesterase (PDE-5) inhibitor, is approved to treat both erectile dysfunction (ED) and the symptoms of benign prostatic hyperplasia (BPH) due to an enlarged prostate, taken as one pill daily. It can also be used to treat either one individually.

The mechanism appears to be a reduction in smooth muscle tone in the prostate, leading to improved urination, but it does not shrink the prostate.

The dose of Cialis when used only for treatment of BPH is 5 mg once daily, taken at roughly the same time every day. Symptom reduction takes about about one month for a maximum effect.

The recommended dose of Cialis for BPH / ED is 5 mg, taken once daily at about the same time every day, without regard to timing of sexual activity. Do not use other ED medicines or ED treatments while taking Cialis.

Related: Enlarged Prostate (BPH) Medications and Alcohol Interactions

Which surgical procedures work for BPH?

Several types of procedures are available if medications are no longer effective or drug treatment is not an option. Surgery is recommended for patients with kidney dysfunction, blood in the urine, or recurrent kidney stones or urinary tract infections.

Surgical procedures, some of which may be minimally invasive, will usually improve urine flow rates and other symptoms. Your healthcare provider will help you decide which type of prostate procedure may work best for you.

Examples of surgical options for an enlarged prostate include:

Lifestyle changes for BPH

Are there any natural treatments for BPH?

Alternative medicines for BPH are not approved by the FDA. Reliable studies with adequate evidence proving the effectiveness of natural medicines are not always available. Further clinical trials may be needed to confirm findings.

Mixed results have been seen with herbal treatments for BPH, such as:

For example, one study found that saw palmetto extract was as good as finasteride (Proscar) in relieving BPH symptoms, but other placebo-controlled studies found no evidence of this. Beta-sitosterol extracts, pygeum and rye grass have been suggested as helpful for reducing enlarged prostate symptoms. However, long-term data on safety and effectiveness is not known.

Always check with your doctor before using any herbal supplements for treatment of BPH symptoms, as products may be ineffective, lead to serious side effects, or have important drug interactions with prescription or OTC medicines.

What is the ICD 10 Code for BPH?

N40.1 is the BPH ICD 10 code (Benign prostatic hyperplasia (BPH) with lower urinary tract symptoms).

What is ICD 10?

ICD-10 is an abbreviation for International Statistical Classification of Diseases and Related Health Problems, 10th Revision. ICD 10 codes are published and updated by the World Health Organization (WHO).

These codes are used by health care providers, Medicare and health insurance for reimbursement for specific medical conditions. Government, public health agencies, and research groups may also use these numbers to identify diseases and track statistics.

Support Groups

Sources

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer