Start with simple measures
For mild symptoms, small changes often make a real difference, and they help alongside any medication:
- Spread your drinks through the day and reduce fluids in the two hours before bed
- Cut down on caffeine, alcohol and fizzy drinks, which irritate the bladder
- Try double voiding: wait a moment after passing urine, then try again
- For dribbling after passing urine, gently press behind the scrotum to empty the urethra
- For urgency, bladder training can gradually stretch the time between visits
- Review other medicines with your doctor; some decongestants, antihistamines and water tablets can worsen symptoms
The main types of medication
| Type | Examples | How it helps | Works within |
|---|---|---|---|
| Alpha blockers | Tamsulosin, alfuzosin, doxazosin | Relax the muscle in the prostate and bladder neck to improve flow | Days to weeks |
| 5-ARIs | Finasteride, dutasteride | Shrink the prostate and reduce the long term risk of retention and surgery | 6 to 12 months |
| Combination | Alpha blocker with a 5-ARI | Faster relief plus long term shrinkage, for larger prostates | Weeks, building over months |
Alpha blockers
Usually the first tablet tried. They improve flow quickly but do not shrink the prostate. Common side effects are dizziness on standing, tiredness, a blocked nose and reduced or absent ejaculation. If you are due to have cataract surgery, tell your eye surgeon you take one, as it can affect the operation.
5-alpha reductase inhibitors (5-ARIs)
These reduce the size of the prostate gradually and are most useful when it is enlarged. They take at least six months to work fully. Side effects can include reduced sex drive, erection difficulties and reduced semen. Importantly, they lower the PSA level by about half, so your PSA results need to be interpreted with this in mind. Always tell whoever checks your PSA that you take one.
Combination treatment
For men with bothersome symptoms and a larger prostate, taking both types together reduces the risk of symptoms getting worse more than either alone, as shown in large trials. The trade off is the side effects of both.
Other medicines
- Tadalafil 5 mg daily is licensed for urinary symptoms and is recommended in European guidelines, particularly when erectile difficulties are also present. NICE does not recommend it for urinary symptoms alone.
- Bladder relaxing medicines such as solifenacin or mirabegron can help urgency and frequency. They are usually added once the bladder is known to be emptying well.
- Desmopressin reduces urine production overnight in men who make too much urine at night. It needs blood sodium monitoring, especially over the age of 65.
- Herbal remedies such as saw palmetto are widely sold, but good quality trials have not shown a benefit over placebo, and NICE does not recommend them.
When medication is no longer enough
Surgery is not a last resort, and for some men it is the better first choice. It is usually recommended if you have:
- An episode of urinary retention, being unable to pass urine
- Repeated urine infections, bladder stones or bleeding from the prostate
- Kidney problems caused by the blockage
- Symptoms that still affect your life despite medication
- Side effects from tablets you do not want to live with, or a wish not to take medication long term
Long standing obstruction can weaken the bladder muscle over time, so it is worth reviewing the options before that happens. Mr Ameen offers Aquablation, which preserves ejaculation better than any other surgical option, along with Rezum and TURP.
Frequently asked questions
Alpha blockers usually help within days to a few weeks. 5-ARI tablets take at least six months to shrink the prostate and reach their full effect.
Symptoms usually return when the tablets are stopped, because they control the problem rather than cure it. Talk to your doctor before stopping.
Finasteride and dutasteride lower the PSA by about half after six months of treatment. Your doctor will allow for this when interpreting the result, so always mention that you take them.
It can. Alpha blockers can reduce or stop ejaculation, and 5-ARIs can reduce sex drive and erections in some men. If side effects bother you, there are alternatives, including procedures that preserve sexual function.
Large, well designed trials have not shown saw palmetto to work better than a placebo, and NICE does not recommend herbal treatments for prostate symptoms.