Introduction to BPH Medications (Bladder Control, Urinary)

Benign prostatic hyperplasia (BPH) is a condition that affects the prostate gland and can cause urinary problems. 

BPH is a common disease that typically affects men over the age of fifty. The prostate can become enlarged with age and compresses on the urethra, causing urinary symptoms such as frequent urination and difficulty starting to urinate.

Several medications can help reduce the symptoms of BPH. These include Bethanechol, Finasteride, Terazosin, Tamsulosin, Oxybutynin, and Tolterodine.

Bethanechol works by relaxing bladder muscles so clients have fewer problems with urination.

Finasteride is also used to treat BPH symptoms by blocking an enzyme called 5-alpha-reductase that converts testosterone into the hormone called dihydrotestosterone (DHT). DHT can cause inflammation in the prostate gland and causes the prostate to enlarge, obstructing urine flow from the bladder through the urethra.

Terazosin is a vasodilator, which relaxes muscles in the walls of blood vessels, allowing them to widen and increase blood flow. It can be used for treating BPH and hypertension. Tamsulosin works by relaxing smooth muscle tissue, reducing the amount of urine produced, and increases bladder capacity.

Oxybutynin helps reduce urinary leakage by relaxing muscles that surround the bladder and urethra. Tolterodine helps prevent spasms in smooth muscle tissues near the bladder neck, urethra, and prostate gland. This results in less frequent urges to urinate at night or during the day.

Benign Prostatic Hyperplasia (BPH)

Benign Prostatic Hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland. It results in symptoms such as an increased need to urinate, a feeling of incomplete bladder emptying, and difficulty starting a urine stream.

BPH is usually treated with medications such as alpha-blockers or 5-alpha reductase inhibitors. Cancer of the prostate gland is rare and is usually not a result of BPH.

BPH Signs and Symptoms

• Urinary Retention
  • Sensations of incomplete emptying
  • Feeling the need to urinate again immediately after urinating
• Urinary Frequency & Nocturia
  • Needing to wake up at night with the urge to urinate
• Straining to void
  • Straining to begin a stream of urine
  • Weak or intermittent urine stream (dribbling)

BPH Treatments

The most common treatment for BPH include bladder training and avoiding caffeine. Surgical treatment may be needed and can be invasive. Procedures include:

Transurethral resection of the prostate (TURP)

This procedure can be less invasive but requires a surgical instrument inserted directly through the urethra to remove the prostate.

Prostatectomy 

A three-way Foley catheter is used for continuous bladder irrigation. This gives pressure to bleeding tissue & allows urine drainage. The three-way Foley catheter irrigation will be used until the bleeding has decreased and healing has begun.

Bethanechol 

Bethanechol is a drug that stimulates the parasympathetic nervous system. It is used to treat urinary retention and constipation.

Bethanechol Mechanism of Action

Stimulated cholinergic receptors = more secretions.

Bethanechol Side Effects

• Frequent urge to urinate
• Blurred vision 
• Dizziness or lightheadedness
• Increased watering of the mouth or sweating
• Nausea or vomiting
• Redness or flushing of skin or feeling of warmth

Memory Trick

• Bethan-echol
• Bladder control

Finasteride 

Finasteride is a medication that was originally developed as a treatment for prostate cancer, but has since been found to be effective in treating BPH (benign prostatic hyperplasia). It is also used to treat alopecia (thinning and balding hair).

Finasteride Mechanism of Action 

Finasteride blocks the action of an enzyme called 5-alpha-reductase.

Finasteride Side Effects

• Chills
• Cold sweats
• Bloating 

Memory Trick

If you want a FUN ride on a horse, take FINasterRIDE.

Terazosin and Tamsulosin

Tamsulosin (also known as Flomax) is a medication used to treat an enlarged prostate. It works by relaxing the muscles in the prostate so that urine flows more easily through the urethra. It can also treat benign prostatic hyperplasia (BPH) symptoms, such as difficulty urinating and frequent urination.

Terazosin is another drug that can be used to treat symptoms of BPH. It works by relaxing the bladder, neck, and prostate muscles to make urination easier. 

Terazosin and Tamsulosin Mechanism of Action

Relaxes smooth muscles in the bladder, prostate & periphery to help release urine

Terazosin and Tamsulosin Side Effects

• TeraGOOOsin – Helps with urination
• TeraSLOWsin – Slow position changes (orthostatic hypotension)
• TeraLOW sin – Avoid blood pressure-lowering drugs

Memory Trick

• BPH = Big Prostate Holds back urine

Oxybutynin and Tolterodine

Oxybutynin is a drug that is used to treat an overactive bladder. It works by relaxing the bladder muscle, which helps to reduce the urge to urinate.

Tolterodine is also a drug that is used to treat an overactive bladder. It works by blocking receptors in the brain that cause an overactive bladder. 

Oxybutynin and Tolterodine Mechanism of Action

• Oxybutynin relaxes bladder’s smooth muscle.
• Tolterodine acts as a competitive antagonist of acetylcholine at postganglionic muscarinic receptors.

Oxybutynin and Tolterodine Side Effects 

• Dry mouth or eyes
• Headache
• Dizziness or sleepiness
• Vertigo
• Diarrhea 
• Vomiting
• Constipation
• Stomach pain

BPH Medications (Bladder Control, Urinary) Conclusion

Benign prostatic hyperplasia (BPH) is a condition that affects the prostate gland and can cause urinary problems. The prostate becomes enlarged with age, which causes frequent urination and difficulty starting to urinate.

Several medications can help reduce the symptoms of BPH. These include Bethanechol, Finasteride, Terazosin, and Tamsulosin.

Sources

https://www.merckmanuals.com/professional/genitourinary-disorders/benign-prostate-disease/benign-prostatic-hyperplasia-bph