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Harvard Health Blog
Your benign prostatic hyperplasia medication: When to consider a change
- By Harvard Prostate Knowledge
As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.
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Hello, further to my Post of November 17; I have maintained a near Vegan diet, other than occasional fish and to my surprise the health benefits are significant. I no longer need any Omeprazole, I have lost 14lbs and Cholesterol reduced from 7 to 4.1. Most impressive is that I reduced Tamsulosin to alternate days and now enjoy undisturbed sleep and my sinuses are clear most of the time. Hope this helps someone. Best wishes.
My doctor discussed the use of 5 mg per day of cialis for bph. I currently take viagra 100 mg as needed which is rarely effective recently. If I start cialis 5 mg per day for bph, what do patients do when they need something for ed? Also, are there surgical procedures for bph that have minimal side effects on ed?
I am 63 with BPH with PSA of 9. On alfuzosin for about 4 months. Stopped working and had acute urinary retention and have had indwelling catheter for about 3 weeks and soon to have urodynamic study to see if TURP would help. Considering trying to do self catheter for a few months and switch to flowmax and/or other meds to see if condition improves. Is this trial with the self catheter worth it or is it best just move quickly with TURP?
Excellent advice! Thank you. I will certainly pass on the info to my husband and we’ll be able to make an informed decision.
I am 62 and have suffered from severe BPH for a while now. Anyone ever try Floxman and doxazosin together? Meaning alternating doses of each every other day. Each works a little differently, I have been curious about this. The literature warns against it. Also says we should not take PE medication, but many do.
I too am taking 0.4 mg Flomax and 5 mg Finnastride for 2years……want to stop Finnastride as bad side effects….70 years now…any advice?
Hi my name’s Bill and I am 63 years old. I had my first PSA level test 2 months ago and the reading was 4.1. My GP told me that I had a BPH and prescribed me Tamsulosin 0.4 mg taken daily. After taking it for 3 weeks, I went for another PSA test and the reading was 3.17. Does Tamsulosin help lower the PSA level? I stopped using it since after my second PSA test because I noticed that I had trouble sleeping at night and I had to wake up two times to pee. One of the side effects of Tamsulosin is sleeplessness. Should I stop using this medicine and ask my GP to give me another similar prescription to treat my BPH? Are there any serious problems in the future if BPH is not treated?
Any people with same experience please share. Greatly appreciate any help.
I am a 66 year old male, recently retired. I had the Green Laser surgery about 5 years ago to treat my BPH and acute urinary retention. Last week, I had a repeat procedure, but this time it was the TURP. My Urologist had recommended that I start taking Finasteride (5mg) after the surgery. I am concerned with the risk of developing a aggressive type of cancer, is someone in a similar situation? My urologist doesn’t seem to be that much concern with the cancer risk. Thanks for any feedback.
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The subsequent time I read a weblog, I hope that it doesnt disappoint me as much as this one. I imply, I do know it was my choice to learn, however I really thought youd have something interesting to say. All I hear is a bunch of whining about one thing that you could repair in the event you werent too busy looking for attention.
I am 72. I was diagnosed with BPH about 5 years ago and have been taking avodart since. About 2 yrs ago I was diagnosed with sleep apnea (fairly severe) and began using a cpap machine. Looking back I’ve probably had it for more than 30 years.
I understand that there is a fairly well established co-morbidity between sleep apnea and BPH.
Is there any research which would suggest that using cpap might ‘cure’ BPH and eliminate the need for the avodart?
I have had no significant side effects from the avodart but I know that any drug that inhibits anything in the hormonal system affects all kinds of things even if they aren’t obvious.
My experience with the cpap has been life changing – very positive on many fronts – presumably due to hormonal changes that have occurred because I’m now getting deep sleep.
Please update this article – the table has information that is over 7 years old.
I was diagnosed with chronic bacterial prostatitis, bph, and chronic pelvic pain syndrome at only 34 yrs old back in May. He started me immediately on daily Flomax .4mg and I also had a 6 wk course of Cipro followed by 6 wks of doxycycline. The stuffy nose effect of Flomax .4 is so bad for me that I’ve switched to taking it in the morning. I use Flonase sometimes to combat the stuffiness, but when it gets really bothersome for 3 or 4 days in a row then I temporarily switch to every other day dosing. Lately I’m back to getting up 2-4 times during the night to go pee. And I continue having twitching/spasm pains deep inside. I understand with the CPPS diagnosis that it’s a chronic pain issue, but I was surprised at my followup last week the urologist STILL WON’T check my PSA! He tells me I’m too young, etc but my prostate is already almost triple in size and prostate cancer runs rampant on both sides of my family! But since all my tests show I’m thoroughly voiding and my stream is strong, he thinks it’s just my bladder so I’ve now started a trial of 25mg Myrbetriq, will titrate up to 50mg next week if my BP doesn’t spike. The first couple days I could barely pee a dribble and it BURNED…nervous that the main risks are high BP, acute urinary retention, and UTI, but so far so good…
Hello, my name is Nic aged 64 and live in England. 3 months ago I changed my diet to almost Vegan; I eat some oily fish, in order to address digestion issues relating to a minor Hiatus Hernia. I achieved my goal in that after 8 years daily prescription I no longer need Omeprazole but do take half tsp Bicarbonate of Soda before bed. I also have an enlarged Prostate and for about 6 years have taken daily Tamsulosin. An unexpected development is that recently I have improved urine Flow and longer periods of undisturbed sleep. As a consequence I am about to reduce Tamsulosin 400 to alternate days and hope to improve my constant blocked sinuses. If I note reduced Flow or increased urgency I will resume daily Tam; blocked sinus is price I am prepared to pay. Hope this is of some help to someone. Best wishes to you all.
Hello, my name is Nic aged 64 and live in England. 3 months ago I changed my diet to almost Vegan (I eat some oily fish) in order to address digestion issues relating to a minor Hiatus Hernia. I achieved my goal in that after 8 years daily prescription I no longer need Omeprazole but do take half tsp Bicarbonate of Soda before bed. I also have an enlarged Prostate and for about 6 years have taken daily Tamsulosin. An unexpected development is that recently I have improved urine Flow and longer periods of undisturbed sleep. As a consequence I am about to reduce Tamsulosin 400 to alternate days and hope to improve my blocked sinuses. If I note reduced urine Flow or increased urgency I will resume daily Tam; blocked sinus is price I am prepared to pay. Hope this is of some help to someone. Best wishes to you all.
Has anyone been prescribed to take a double dose of Uroxatral (alfuzosin)? My urologist has me taking two 10 mg pills a day and it was working well – good flow and no urgency. I cut back to one dose a day and not working as well – more frequency and less flow. I am concerned about the double dose and was wondering if anyone else uses a double dose. Thanks.
This site is so very informative. Me I’m 65 I was taking Flomaxtra for a benign enlarged prostate they worked well enabling a better flow rate I stopped taking them for a short period whilst I undertook various tests after which the consultant advised I start taking it again but my GP advised me the type I was taking had changed to Flomaxtra XL 400 mg however they did not give me the same relief he then prescribed Alfuzosin 10mg but having read many reviews I have refrained from taking them or any other medication however things have deteriorated like poor flow resulting in taking up to 4 minutes to urinate, frequent visits to the toilet getting out of bed two to three times a night. So now I’m thinking of going back to the Flomaxtra XL 400 mg even though they stopped working. I don’t fancy the Finasteride due to the side effects. Is there another medication or a herbal remedy to help the flow? Thanks.
I am 60 years old and have been on finasteride for 4 years and Rapaflo for almost 3. Both have helped though their effectiveness are declining and now having ED issues and retrograde ejaculation as well as a significant lost of sexual desire. I now have esophageal spasms and one doctor recommended Cialis for that. But I don’t believe I can take Cialis and Rapaflo together. Should I consider switching to Cialis? That might help with a several other issues? Otherwise I’m in great shape but Rapaflo seems to also be zapping my energy much.
I’m a 78 year old male who has been afflicted with BPH and its associated luts for several years. My primary concern was nocturia as I was having to get 6-8 times each night to void. I have tried all the drugs therapies to include doxazosin, tamsulosin, finisteride, cialis, myrbetric, desmopressin, etc., both individually and in combination. None produced any significant improvement in my urinary issues. Finally, after much research, I elected to submit to surgery. In mid July, 2017, I underwent the PVP (Green Light photoselective vaporization of the prostate) procedure. All went well with no apparent complications. I had a Foley catheter for four days. For about two weeks after the surgery everything was perfect. I had a robust stream and felt I could put out a forest fire. Then I noticed a gradual decrease in my flow rate (Q). The decline in my flow rate continued to decline until at my four week post-op follow-up with my urologist/surgeon, my output velocity was less than before the surgery. My urologist attributed the decline to swelling of the prostate and urethra resulting from the surgery. Her plan was to wait an additional two months and re-evaluate. Unfortunately, my flow rate continued to decline to the point that by the first week in September (50 days post op) I had no stream at all and could only drip urine one drop at a time. I had a non-prostate related surgery on the 11th of September and for reasons unknown, I regained some improvement in my stream velocity after that surgery. My output is currently what I would characterize as a minimal dribbling intermittent steam. My urologist has scheduled a flow rate test and a cystoscope exam in the forthcoming weeks. I suspect there is a blockage somewhere and that the current voiding problem is not caused by swelling.
My conclusion is that the PVP procedure itself is safe and effective and I would consider it again. I think something was not done correctly by the surgeon during the procedure. I’m sure I’ll need another surgery to correct whatever is wrong. Meanwhile, as long as I can void by whatever means and avoid acute retention, I will fight on and try to attain a better quality of life by eliminating these troubling BPH issues.
Hi ,I just had TURP procedure done inside my prostate 16 days ago and in ok but I don’t see why I have to take BOTH Tamsulosin AND Finasteride since the prostate tissues blocking my urethra were removed and I can pee again already .I tried to not go the surgery route But as I tried with the Tamsulosin and Finasteride for 3 and half months to be able pee again without a catheter but to no avail was I able to urinate .Everytime the catheter was removed monthly to see if I could urinate normally it wouldn’t happen and another catheter would have to be inserted so after 4 tries of catheter removal to see if I could pee again over the 3 1/2 months catheterized I gave in to the operation.i just don’t think I need to be on the BPH Medications anymore or at least not both of the them.i think if one I have to take maybe Finasteride because it would continue to shrink my prostate and keep it shrunk and so there should be no future problem of prostate blockage ,thanks ,I feel for you guys , especially the guys who have experienced complete urinary retention and catheterization,aside from the really I’m formative article you guys helped too with information on BPH MEDS and processes
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Great article when written. But it badly needs updating. For example, generic Viagra is now available. I get it for 50 cents a pill (20mg). Yes, the pills are made here in the USofA. These pills can help with enlarged prostate problems. And to use them for ED you simply increase your dose on whoopee day.
If you can get away with not taking Finisteride and only using Tamulosulin that is about as good as it gets for me. Finisteride really crushes your t-levels and some docs will prescribe both in combination which is not needed. Very helpful information regarding BP levels and Tam. I do experience a bit less energy while taking it and found this article very helpful in understanding the medicine. I was considering testosterone therapy but will probably just adjust to the new normal. Bummer:)
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I was dx with Prostate CA somewhere around 2003-2008 (5% of 1 of 6 cores) and Gleason of 3+3. After 8-10 years and a 12-Core it was still confined to 1 core and increased from 5% to 10% of 1 core and no rise in the Gleason. I’ve been taking Finasteride for almost 10 years and latest PSA was 1.4 so I’m happy with the results and my Urologist is even happier. From my research, and more importantly with discussion with my urologist, I give a lot of credit to Finasteride’s 5-alpha reductase inhibitor’s ability for this achievement.
I see a lot of questions by guys who have posted above, but no answers…why is that? There are some very good questions that I would have liked to answers to….like, once you start taking Tamulosin, if you stop taking it, do you develop urinary retention or other problems? That would seem to indicate that once you start it, you become dependent/hooked on it!
I am in my 70s, Finasteride seems to work too well for me, in terms of promoting urination. However, frequency and urgency continue to be a problem. Also, I seem to bruise easily — like someone taking a blood thinner. Why is Finasteride not produced in a dosage below the 5 mg pill? I should add that I also take Tamsulosin 0.4 mg.
This is one of many high-quality articles by the Harvard prostate team and I really appreciate it! But…it was written over a decade ago, and only updated six years ago. Much has happened since then medically and so this piece DOES need to be rewritten or at least updated. 🙂
One of the best articles on the current state of medication for BPH. It says it was last reviewed in 2011, so an update seems to be in order. Perhaps you can add something about Free PSA too. Thank you.
Many thanks indeed to the Harvard writers, it is the best article of its scope that I have seen. And thanks too to the many who have written, may I join you now. I am 76 and have had enlarged prostate problems for many years. 3 years ago I was put on Duodart, the two component pill. My prostate was in excess of 120 cc, I made 30 or so trips to void the bladder each day. etc. Now my prostate is greatly reduced in size and depending on the amount of coffee, well the trips are greatly reduced. Downside – large boobs, smaller balls, body hair greatly reduced. weight increase, plus possibly other side effects.Now I am considering ceasing the Duodart medication.
I am 44 and I take Alfuzosin and Dutasteteride in the evening. I was hoping this medication is short term but I have since found out it’s long-term. I have pain when trying to get an erection and when I do retrograde ejaculation is frustrating.
Most people I tell ie dentist and so on say I’m far too young for an enlarged prostate.
READ YOUR ARTICLE AND FOuND IT VERY INFORMATIVE. tHANKS FOR HAVING IT AVAILABLE.
My last post was 29 August:
Had the TURP (rotor rooter) procedure. Chose this one over microwave or hot wire material removal as it enables the doctor to recover material to send away (other procedures burn it all away) for pathology analysis = results NO signs of Cancer!!
Recovery required Cather in for three days and then all was great. No pain encountered. Strict rule is NO sex for 6 weeks. It has been three months now and I am doing great. If it snows I can now write my name in that snow from 5 ft away = lots of velocity!!! Most Urination urges have gone away and I sleep through the night Only draw back is when I urinate the volume is around 200 ML (regular) each time (yes – test indicate badder is empty after urination).
Sexual climax is different with no fluid out the penis but rather it goes backwards into the bladder and eventually out through normal urination. This sort of reduces the SUPER PEAK climax experienced before but still very satisfying — Also no mess!
I am very happy with the path I took!!!!
I am a 68 year old man who developed a problem of night time dribbling. Saw Urologist who put me on daily tamulosin and finasteride. Went for flow test and found out I was retaining urine. Started self catherisation x3 times a day. Been doing that for almost a year. Seems to be OK but wonder where it is all going?
Saw urologist last week, he was only interested in whether I wanted an op to assist in placing catheter.
Unfortunately, I have been on various antibiotics for last 4 months which initially shift infection but which returns days after course finishes. Now starting three month palliative antibiotic course.
I have a very enlarged prostate and an atonic bladder, not sure if the drugs will improve my situation. No ejaculate at all but no loss of libido.
I am 54 years old and was taking flomax and found it gave me an erection lasting 4 hours uncomfortable. Can I take flow max on an as needed basis.
I am 64 and taking Duodart. I have noticed decreased libido, impotence, Gynecomastia and runny nose. Sounds like Viaga can work for the occasions it is necessary and this dose can vary, as required
I am a 73 old male with diagnosed IC and OAB For the last 3 years i have received a Botox intraversical operation each year in my detrusor muscles to eleviate the problem of excessive wetting accidents Just recently my urologist also suggested i needed to take Duodart for the in between very limited urine flow. however it has been determined for some years ago that I cannot take any medication with anticholenergic conternt – like Flomax and Doudart since it makes me non responsive to anything. So is a prostate reduction operation now the only alternative or whar di “we” do?
Anyone on here have the 4K Score test done or there’s a new procedure called Rezum, anyone have this done ?
Has anyone here used or know of Trospium Chloride?
Trospium Chloride tablets USP are a muscarinic antagonist indicated for the treatment of overactive bladder (OAB) with symptoms of urge urinary incontinence, urgency, and urinary frequency.
I have had BPH for several years now and have taken several medications mentioned in this article, all to no avail. Currently, my urologist put me on oxybutynin chloride 5mg, twice a day. I have had no results from that either.
This medication is not mentioned in this article. Why not?
This article has been one of the better articles I have read but noticed, as one poster above stated, that there are no answers to questions from knowledgeable doctors.
My last post was 26 July 2016
Stopped the Cather process and am still on those pills, and NOT real happy with the pill consequence. #1 sex libido is down a lot. #2 Sex climax results in no fluid released which really diminishes the act of sex enjoyment.
Talked to the doctor and looked into Cialis as as an alternate to Finasteride, but found even though my medical plan would cover Cialis (once a day) for BPH, but the deductible cost was still close to $200 a month.
Really want to get off of these pill requirements, so I am going with the rotor router process, which my doctor noted (from experience) will relieve the prostrate restriction to flow problem for a good 8-10 years; where after that time estimate the process will be required again.
While waiting for the rotor rooter appointment (and still on both pills) I started to have to get up at night 3-4 times (this is after 4 months on the pills), so I started to use the Cather again but only just before bedtime (on average releasing about 300-400 ML) and thus being able to sleep through the night.
Very useful article. I am 86 and have BPH since I was 63. Now I take tamsulosin .4 mnd and finasteride 5 mg. I am happy with the result except I do have to Pee three times each night every 2.5 hours. I am on this regimen for the last two years. My concern is will i develop aggressive prostate cancer?
I read in this article that this was a possibility. So, should I drop Finasteride? What can happen if I do so. Please help.
Sure wish there were some answers posted to all these comments / Questions!!!!!
Prior to going to China I went my Urologist (noted to my General Practictinser during annual physical of frequent low volume urination issues) and he said PAS #’s looked OK over my last five years of Annual physicals and prostrate is slightly enlarged (I am 71 and very active), and come back and see him in 6 months.
Went to China for 20 days half way through the trip developed this sharp pain in my lowere left back. Everyone on the trip (including the chinees doctor on the riverboat) noted it sounded like a kidney stone symptom and that I should drink lots of water —
—–After 2 days of pain a trip to the emergency room identified a full bladder and a Cather was installed (1,250 ML of liquid came out within a 5 minute period).
A new Urologist back home removed the fixed cath installed in China and put me on daily self caturizations 3 X a day and prescribed .6 MG Tamsulosin (Generic Flow Max to relax prostrate). After one month she added 5 MG Finasteride (shrink prostrate) noting there would be side effects of Lowering my Libido. She also noted after two month to try reducing my self cath to daily (before bed) = and that worked out well. She noted to try and stop the once a day cath after one additional month.
That month is now over and I am into day 2 with no cath. Urination is like all this was before all this started (9-10 X daily with low volumes of around 100 – 150 ML) and a once or two time night trip urinate.
Draw back is low to no volume in sex ejaculations and a reduced libido.
Doctor (at last visit) did note Calais is another option to talk about before a surgical approach and I have found our insurance will cover Calais for BPH.
Will Cialis help and can it get me off the other medication that appears to be dampening my life enjoyment of sex?
I am very apprehensive of taking the approach of the surgery direction of enlarging (sapping out) the inside of the urethra!
Very clear explanation of the overall subject. I’m approaching a healthy 87, had X-ray and hormone therapy for Prostate cancer, stopped Flomax years ago but continue with PROSCAR. My “very large” prostate still allows tolerable urination cycles. Post radiation moderate ED issues are being addressed with trials of 100mg Viagra or 20mg Cialis to some satisfaction. I suggested an 8 week trial of 5mg Cialis daily and no Proscar followed by PSA and Testosterone tests which was agreed upon. I’ll be patiently waiting for the truckload delivery of the 5mg Cialis just ordered. Things could be looking up for wife and I.
Good article. Needs the review and update. Very helpful.
Thanks for the enlightenment! Needed it badly. Considering another PSA test shortly. Results will provide progression clue! And the way forward.
Tamsulosin is not an anticholinergic drug (like atropine, oxybutynin…), tamsulosin does not block the muscarinic receptor. Tamsulosin specific blocks the prostate alfa-adrenereceptors with Kd 0.04nM (Urol Res, 1994,22,273-278).
I have read your many reviews, my husband has been on Tamslosin for about 3 yr.s now,, since he started taking the pill, he had been having fogging thinking..
now it is worse and we are seeing a neaurologis , he is 77 yr.s i just read in an article that it is an anticholinergic drug. and could cause demensia…excuse my spelling..
need an answer..
Thanks for article helped me .
This was a good article. It’s time to revise and update it now. For example, Avodart IS now available in generic, and the cost is reasonable. You’ve done a beneficial service for your readers. Keep it up.
In my case of BPH, the drug AVODART raised the liver enzyme γ-GT, that is gamma-glutamyltransferase, to the (double checked) value of 116 U/L . After discontinuing it, the γ-GT returned to normal values of 11-50 U/L. The size or volume of the prostate gland is measured by the ultrasonographing apparatus in cubic centimeters and not in grams.
Question: when a drug shrinks the outer dimensions of the prostate (the only thing seen on ultrasonography display), who knows what happens to the unseen internal diameter of the gland? Does it shrink too (which worsens the urine flow) or it is being enlarged? In other words, which is the three- dimensional displacement of the shrinking gland cells?
My Name Is Ron I Take Flomax Twice za Day Sometimes Not Always Pee Comes Out By Itself And I Get Burning What Do You Suggest Thank You
I’m a healthy, fit, active 53 year old, who has been taking tamsulosin, avodart, and daily cialis for the past two years. I’ve had three episodes of acute urinary retention over the past years, with a trip to the ER and a catheter for a day or two in each case. Each time it involved alcohol use. I also have retrograde ejaculation during nearly every orgasm.
I would like to begin taking a daily multivitamin or supplement pack. A friend has had good success with Mega Men 50 Plus from GNC. Any thoughts on whether adding this would have any effect on my prostate issues?
Does Cialis for daily use contain finasteride?
I just read Norms post about coming off of Tamsulosin and ending up in ER unable to void his bladder. I have just started taking this medicine so I have been surfing the web looking for information about it. My symptoms have all cleared up but I have developed retrograde ejaculation. I have my first follow up in a few weeks and was going to ask about stopping the drug because I don’t want to be on any drug long term. Is this bladder retention common when coming off this drug and am I going to be stuck on it for life?
Kevin, I hope you decided to stay on Tamsulosin. The day I was prescribed it a few years ago, I went to dinner and drank several glasses of water thinking that taking the Tamsulosin before I went to bed would cause no urinary issues. How wrong I was! I couldn’t urinate all night and I finally had to drive myself to the ER with Acute Urinary Retention. The pain was unbearable! If I had a gun I probably would have used it on myself. The ER Doctor inserted a cathader and the problem was solved. I’ve been on Tamsulosin for a few years and it just takes a little bit of time for your body to accept the medication. A fact of life for a lot of us guys. Good luck and accept fate.
Thank you very much!
Maurice H. If you have breathing problems, i dont know if it is because of the tamsulosin. What i do know is that i went off
tamsulosin thinking i was ok. Well, i gradually was not fine.
Eventually, no drops came out. So had to go to emergency and
install a catheter for relief. \my advice is stay and do not
stop tamsulosin, it is not good. After having the indwelling
catheter for 1 month, i reverted to a temporary catheter and
used tamsulosin and finasteride. And improvement has risen
where i can void , albeit slowly gradually, but that was
an improvement from 0 drops 1.5 months ago.
my advice is do not come off tamsulosin, keep on taking it
and try finasteride as well , they both work together fine,
one relaxes the muscles, the other ..finasteride.. shrinks
I made the mistake of getting off tamsulosin for 2 months
and suffered for it, having to go to emergency.
so my advice do not stop taking it.. regards
Recently, I was diagnosed with BPH of .5. My PSA is okay at1.3, and the DRE also showed no cancer. But after two days of Tamsulosin I started having breathing problems and went off the tamsulosin. I also do not want to have retrograde ejaculation, as I am sexually active with my lady. I am going to wait and see how much urine flow is obstructed. I am getting a pretty good stream now, but that may because of the two days I took the tamsulosin. There is pain though in the penis and rectum when I urinate, and it seems to stay there indefinitely. I am wondering if going off the Tamsulosin will have an adverse effect.
Just over two years ago, my gradually but steadily worsening BPH symptoms suddenly spiked to the point where I ended up in the hospital with acute urinary retention. This led to being on a full time indwelling catheter while I started taking tamsulosin to if it could improve my condition enough to atop needing a catheter and start planning for green laser (or other) surgery.
The medication ended up giving effectivly ZERO relief, and it was clear that I needed the laser procedure sooner rather than later. Being an uninsured self pay patient at the time, I struggled to be financially able to afford the cost of this treatment plan.
I quickly adapt to having an indwelling catheter, and I learned how to become a “self cath” patient, replacing my catheter every 4-8 weeks.
Over these now two plus yers, I always tried to go as long as possible between old catheter removals and swapping in a new one. After removal I could typically have some poor degree of bladder control and flow, but within 24-48 hours I would revert to the acute retention status.
My observations of what happens with the progression of BPH to the severe level over time, and what doctors never clearly explain, is that as the prostate steadily pinches tighter around the urethra, the minimum level of bladder PRESSURE needed to initiate flow gets steadily higher, and the bladder muscles start having difficulty producing this level of flow starting pressure by themselves.
The result is that the bladder gets stretched further, and this extra stretching raises the PRESSURE inside the bladder to the level where the combination of BOTH the bladder muscles AND the stretching induced extra pressure, together allow for reaching a high enough pressure level to overcome urethra pinching and initiate flow.
However, when flow does finally start, is only at enough pressure establish weak flow, and after only a fairly small per cent of the bladder’s total urine “inflation” has emptied, the subsequent reduction of pressure from the loss of bladder stretch drops it below the point where flow can be maintained, choking it down to a sporadic dribble level.
How, as a result of the bladder’s PARTIAL urine evacuation lowering pressure in the bladder, the previously backed up kidneys jump for joy and immediately resume sending some of their excess urine accumulation down into the bladder, causing pressure there to rise again, and to reach the point where flow from the kidneys drops off. This fresh and rapid rise in bladder pressure from backed up kidneys’ unloading into a NON-EMPTIED bladder, is what gives the urge to pee again so soon after just having peed, and the boost of bladder pressure is just enough to trigger the urgent need for another PARTIAL voiding of the bladder to needed, often just a few minutes after the prior urination ended. This vicious cycle of weak and partial urination only gets worse with time unless treated.
This summarizes my view of what happens at the more severe stages of the BPH condition.
It certainly is no good for the kidneys to keep having to “inflate” the balloon size of the bladder to higher and higher pressure levels, in order to sufficiently assist the bladder muscles to reach the high enough levels of EXCESS PRESSURE needed to allow some limited amount of urine flow starting to pass through a thoroughly pinched urethra, but only lasting long enough to give a partial bladder evacuation. -RRLedford
Been taking Alfuzosin for the past 5 years… Starting to wonder if the extreme fatigue I am feeling is from this med???… stuffy nose and a very dry mouth …
At 87 and having never taken these drugs before and not having ED, I started on tamsulosin 10 days before a hernia repair operation. Reason is to offset the shock to the bladder because of the operation and it might otherwise shut down. Prior to this I regularly take zinc, magnesium and L-argenine. The L-argnine produces the nitric oxide that viagra would produce and much cheaper. Have had reduced urine flow and frequent night trips to bathroom. With 2 doses of the tamsulosin 0.4 mg, already the stream is like a fire hose. Doc says I may want to continue it after the operation. It appears that a half dose probably will be plenty.
In the column to the far right it states that “you may not want to use it” for the very reason it was prescribed?! Alpha- one blockers are prescribed for BPH so if you have frequent UTIs one shouldn’t take the meds? Or am I interpreting this all wrong?!
200 mg of Ibuprofen at bedtime has eliminated my nightime
urination problem…I am 84 years old and take no prescription drugs although all those mentioned in the article have been prescribed. I choose not to deal with
side effects. Why don’t doctors tell male patients to try
this first??? It works for me and my urologist admits it
works for other patients of his?
Great article. I am 64 yo. After taking Avodart daily for several years I experienced ED. I got off the Avodart and erection returned. I now only take Avodart as needed, approx one pill every 10 days. When I have to urinate more than once a night it is time for a pill. This strategy was approved by my doctor. Your comments please.
Many thanks for such an informative easy-to-read article. I am 63 and have been taking Avodart and Xatral for several years due to BPH. I was concerned about taking Viagra in combination with the BPH meds but after reading your article I am clear about the precautions to take.
Thank you again.
I was given Tamsulosin 0.4mg by a Urologist because I have 2 kidney stones. He said that the Tamsulosin will relax the ureters and bladder to help the stones pass better.
I noticed on everything I have seen including the information sheet that comes with the prescription regarding side effects that one possible side effect is that you could get an erection that lasts longer than 4 hours. I have not seen this side effect mentioned in your article. This side effect worries me as I’m drinking a lot of water to flush the stones out and if I get this side effect I will not be able to urinate making my situation worse. Is the lengthy erection a possible side effect?
Also can I take Tamsulosin if I have a heart murmur?
Nice and highly educative article on BPH. I am 72 years old and on Tamsulosin .4 mg for the last five years. My flow of urine has reduced from 15 ml/sec to 7ml/sec and my PSA has increased from 1.7 ng to 2.08 ng in these five years Wt of prostate is 36gms. At times I have difficulty in passing the urine and I feel pain and tenderness in my Hypogastrium. My urine exam reports show 3-4 pus cells. Pl. advise how to overcome this problem and for how long I can take Tamsulosin safely.
This is all great information but my question is:
I am 68 yrs old and have been taking Flomac and Finisteride daily, I would like to switch to more of an herbal remedy such as Zinc, Pommagranite juice, Saw Palmetto etc. for an enlarged prostate, although the Doc, after last exam, said it was at a normal size for my age
What would be the side effects to stopping the Flomac and Finisteride? My PSA is 12 and has been consistant for over a yr. I have been on Flomac and Finisteride for a year also.
I too am taking 0.4 mg Flomax and 5 mg Finnastride for 2years……want to stop Finnastride as bad side effects….70 years now…any advice?
Thanks very much for this article. My Urologist started me on Tamsulosin about a year ago. I had some side effects such as ED. He swithced me to Uroxatral which I have been taking for several months. Last week he had me start taking Cialis with the Uroxitral.
In you opinion is the combination safe and should I be taking them both at the same time?
Thank you for your help.
ANY FACTUAL BENEFIT BETWE EN AVADART AND FINISTRIDE . pLEASE COMMENT. sb
Thanks for providing such incredible information.
A very well written, easily understood article – thank you. I am a 63 yr old male taking both Tamsulosin and Avodart for the past 2-3 years. This has helped my urinary symptoms considerably. A new insurance plan is no longer covering the Avodart so I am contemplating asking my urologist about switching to Finasteride which is a covered drug. This article has helped that decision process.
I have been taking 0.4mg of Tamsulosin every morning for over two years with good results except that I frequently could not sleep through the night with out urinating. About a year ago I experience a pulled muscle in my lower back from lifting a heavy object. To help with the discomfort I began taking two  200 mg of ibuprofen each evening prior to going to bed.
I noticed that I was no longer having to go to the bathroom during the night. Is it possible that the ibuprofen help relax the smooth muscles in the prostate to alleviate the problem of nightly needing to urinate?
I have noticed the same results.Can you share more since this observation?
Thanks for your article.I need some help. My age is 83 Currently have 8MG of Terazoni at bed time. Get up 2 time every night. Have enlarge prostate. PSA reading is 12.5 to 13. Have readings done every year and the numbers remais about the same. Whay is your advise. Thanks. HE.
Very informative article. I wanted to know when to consider taking Proscar as recommended by my urologist. I do not have acute urinary retention yet. I am 69 and have been on Flomax for 10+ years. I increased from 0.4mg to 0.8mg but still get weak stream at times. Those times are; after sitting for 2 hours at a movie, after waking up during sleep once or twice at night. I mentioned that to my doc and he suggested taking proscar. I would think flomax would also be taken at the same time until the prostate shrinks. I am not sure at this time what size I have but recall the doc saying about the size of an apple. Not a good comparison IMHO…apples vary in size. I also have ED but my med plan only allows for Levitra and at full price. I have not found Levitra to work very well. Viagra has worked well in the past but not available to me. I am uncertain if proscar is right for me at this time.
Seems that nothing is ever told to patient about side effects or long term use of drugs. Very little information is given about dangers of surgical interventions. Thanks for good article. Most informative.
Very informative article. I am 63 and taking both thamsolin and avadit for the last two years. How long one can have and when should I stop taking these.
Thanks for a very wide information. I am 64, enjoyed warm water therapy for three months and notice improvement but not as I observed when my Dr recommend Doudart, But I noticed also headache nose blockage and low libido/erectile dysfunction just after 3 weeks dosage but the swelling of my lower belly due to my (BPH) prostate problem reduced drastically. Please advise.
Excellent write-up, very informative. I am 60 and have been taking Cardura (4mg/daily) for approx. 5 yrs. for BPH, my PSA has risen from 4 to10 over this period of time, I have had 4 biopsies, all negative for cancer. However, around the time of my last biopsy, I had started experiencing pressure on my stomach and bladder, the biopsy was negative and I have since had an endoscope, which was normal and a colonoscopy which was fine. I am not getting any answers from my urologist. I feel like something abnormal is happening but i dont know what. Do you have any suggestions for my next step? Many Thanks .
My PSA was on 2.2 and taking Avodart the dr. prescribe Cardura because of erectyle.disfunction and know after a year taking this medication my PSA is up to 3.1, could it be the cardura. Please help me because I dont see my urologist until the middle of October an I worry too much. Thank you.
I am a 64 year old man in good health (PSA .5) with the exception of some prostate issues. I am told that my prostate is not very enlarged. However, I have been on all of the typical medications mentioned here with nothing but detriment side effects. My problems: For about 2 years, the rate of my urination has reduced. This is not a significant because a few more seconds of urination does not adversely affect my life. However, having to wake to urinate once or twice a night has had a huge detrimental effect on life. Now my issue, there are lots of discussions, but none address my question. During a nightly urination, the volume of urine seems to be about half of a full bladder. If urine is collected for the entire night, it seems to be of a normal volume. With enlargement of the prostate, why has the volume of the bladder been cut in half requiring multiple urinations? The reason I usually read is that the prostate protrudes into the region of the base of the bladder. For the prostate to decrease the volume of the bladder by a half, it would have to be approximately half the size of the bladder and be in the perfect upward position which I never see in drawings or, push only the bladder opening (to the prostate) up approximately to half its height. I am wondering if the problem is actually coelomic adipose tissue in the region just protruding against the bladder wall instead of the prostate. Your comments please.
Richard: Your bladder has become more muscular and when you relax at night it takes half the force to make you need the loo. During the adrenaline stops this.
Great summary (I wish my urogists provided this info). Tha nk you!
How does the supplemental testosterone therapy relate to BPH treatment?
At ~65, over a year ago, I was put on supplemental testosterone (injection, 1ml/2weeks) to cope with fatigue due to lower T-levels (no sexual problems).
Now I developed (after an episode of prostatitis) a BPH (30-40mg), and I am contemplating a proper course of threapy. It seems that perhaps I should quit supplementary T (which may contribute to BPH). On the other hand, I know that lower T-levels (extending my 2-week period) result in unpleasant physical weakness.
This is a very good article and covers all the bases. I take both Flomax and Avodart (for only 6 months). The Avodart hasn’t made any difference so far, but apparently that is normal. I’ve been taking Flomax for about 10 years and recently have started having more problems than usual with light headedness and fatigue. I’m going to try the “every other day” Flomax regimen discussed in the article.
Great write-up.Simple precise and comforting.
I m taking 5 mg Finnastride and 0.4 mg Flomax….thinking of stopping the 5 mg…now……after 2 years….rsvp
Thorough and easy to comprehend. Lots of information provided in a short, easy to digest format. Thank you.
The information have been very helpful to me thank you so much.
There are ample web resources that help understanding the probable causes and treatment of breast enhancement in males, which is commonly known as gynecomastia, so you can seek more information about the topic, and try finding out the best medical aid.
I presently take both Tamsulosin and Finasteride and was wondering if I should quit taking the Finasteride because the increased risk of getting prostate cancer plus the cost of my
generic meds increased by 5.00 a month this year which isn’t a whole lot though. But my doc said that the chances of getting prostate cancer from taking finasteride are very minimal and I think it is shrinking my prostate. Although, I don’t notice any difference by taking it!
Very informative. Thank you!
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