Managing Enlarged Prostate: Insights on Medication and Lifestyle Changes

Hello, Dr. Lee?

I visited a urologist due to issues with nocturia and frequent urination.
Prior to that, my lifestyle was irregular, and because of the frequent urination, I wasn't drinking enough water.
After undergoing a urinary tract and rectal ultrasound, blood tests, and urinalysis, I was diagnosed with benign prostatic hyperplasia (BPH) and bladder sensitivity.
The doctor prescribed Alfuzosin and Betanechol.
However, due to side effects like dizziness from Alfuzosin and needing to ride my motorcycle for training during those days, I chose not to take it.
I only used Betanechol, and during those days, my nocturia was reduced to once, and my frequent urination improved significantly.
Following the doctor's advice, I drank small amounts of water every 10 minutes, resulting in urination every two hours.
During my follow-up appointment, I inquired about Alfuzosin, and I decided to start taking it at home.
However, the day after starting the medication, I experienced side effects, including the absence of ejaculation after masturbation, which I later learned is a common side effect of this medication, known as retrograde ejaculation.
Additionally, my urine did not contain any semen, and although this medication is supposed to help with BPH, my nocturia increased to 3-4 times a night.
For example, if I fell asleep around 11 PM, I would wake up to urinate around 1-2 AM, again at 3-4 AM, and once more around 5-6 AM.
In contrast, when I only took Betanechol, I would typically wake up once around 4 AM and then sleep until morning.
However, taking Alfuzosin caused me to wake up multiple times, leaving me more fatigued, and I would end up sleeping in until 10 AM since I work from home.
Therefore, not only did my condition not improve, but it also seemed to worsen, leading me to choose to stop the medication.
The doctor mentioned that if the side effects were intolerable, I could switch to another medication, but I feel that relying solely on Betanechol has already improved my condition significantly.
I believe that maintaining a good routine should be sufficient.
I would like to ask the doctor: I understand that BPH is generally irreversible and can only be managed through maintenance.
Besides medication, what other methods can help maintain my condition? Additionally, does retrograde ejaculation caused by this medication result in the semen turning into fluid in the bladder over time, and does this have any adverse effects on the body?

Mr. Chen, 30~39 year old female. Ask Date: 2022/10/12

Dr. Li Xinyi reply Urology

Given your age, it is unlikely that you would consider having true benign prostatic hyperplasia (BPH), and medications like alfuzosin are generally not necessary, as they do not prevent prostate enlargement.
If you are genuinely concerned about enlargement, it is advisable to visit a urologist for an annual check-up starting at age 40 and discuss any concerns with your physician.
Retrograde ejaculation does not have any significant impact on health.
Prostate health essentially means maintaining overall bodily health, and there is a wealth of information available online that I will not reiterate.

Reply Date: 2022/10/12

More Info

Managing an enlarged prostate, also known as benign prostatic hyperplasia (BPH), involves a combination of medication, lifestyle changes, and regular monitoring. Your experience with medications like Alfuzosin (活路利淨) and Betamethasone (貝坦利) highlights some common concerns among patients dealing with BPH, particularly regarding side effects and the effectiveness of treatment.

Understanding BPH and Its Treatment
BPH is a common condition in older men, characterized by an enlarged prostate gland that can lead to urinary symptoms such as frequent urination, urgency, and nocturia (waking up at night to urinate). The condition is primarily driven by hormonal changes associated with aging, particularly the conversion of testosterone to dihydrotestosterone (DHT), which promotes prostate growth.

Medications for BPH
1. Alpha Blockers (e.g., Alfuzosin): These medications help relax the muscles in the prostate and bladder neck, making it easier to urinate. However, they can cause side effects such as dizziness, fatigue, and retrograde ejaculation (where semen enters the bladder instead of exiting through the penis). Retrograde ejaculation is generally not harmful, but it can be concerning for some men. The semen is eventually absorbed by the body, and while it may seem unusual, it does not pose any health risks.

2. 5-alpha-reductase inhibitors (e.g., Finasteride): These medications work by reducing the levels of DHT, potentially shrinking the prostate over time. They may take several months to show benefits and can also have sexual side effects.

Lifestyle Changes to Manage BPH
In addition to medication, several lifestyle modifications can help manage symptoms of BPH:
1. Dietary Adjustments: A balanced diet rich in fruits, vegetables, and healthy fats can support prostate health. Foods high in antioxidants, such as tomatoes (rich in lycopene), and those containing omega-3 fatty acids, like fish, may be beneficial.

2. Hydration Management: While it’s important to stay hydrated, managing fluid intake, especially in the evening, can help reduce nocturia. Drinking smaller amounts of water throughout the day and limiting intake before bedtime can be effective.

3. Regular Exercise: Engaging in regular physical activity can improve overall health and may help alleviate some urinary symptoms. Activities like walking, swimming, or cycling can be beneficial.

4. Avoiding Irritants: Reducing the intake of caffeine, alcohol, and spicy foods can help minimize bladder irritation and improve urinary symptoms.

5. Pelvic Floor Exercises: Strengthening the pelvic floor muscles through Kegel exercises can improve bladder control and reduce urinary urgency.

Monitoring and Follow-Up
Regular follow-up with your healthcare provider is essential to monitor the progression of BPH and the effectiveness of treatment. If you experience significant side effects from medications, it’s important to communicate this with your doctor, as they may recommend alternative treatments or adjust dosages.

Conclusion
While BPH is a chronic condition that may not be reversible, a combination of appropriate medication, lifestyle changes, and regular monitoring can significantly improve quality of life. If you find that a particular medication exacerbates your symptoms, as you experienced with Alfuzosin, it is wise to discuss this with your healthcare provider. They can help tailor a treatment plan that best suits your needs, potentially exploring other medication options or non-pharmacological interventions. Always prioritize open communication with your healthcare team to ensure the best management of your condition.

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