Benign prostatic hyperplasia refers to the non-cancerous enlargement of the prostate gland that naturally occurs as men age. The prostate is a small, walnut-sized gland located below the bladder that surrounds the urethra, the tube that carries urine from the bladder out of the body. When the prostate enlarges, it can squeeze or partially block the urethra, causing urinary symptoms.
Common Benign Prostate Enlargement Symptoms
Men with BPH typically experience:
- Frequent urination, especially at night (nocturia)
- Difficulty starting urination
- Weak urine stream or a stream that stops and starts
- Inability to empty the bladder
- Urgent need to urinate
- Straining while urinating
- Dribbling at the end of urination
BPH is ubiquitous, affecting approximately 50% of men in their 50s and up to 90% of men in their 80s. While BPH itself is not life-threatening, its symptoms can significantly impact quality of life and, if left untreated, may lead to complications such as urinary tract infections, bladder stones, or kidney damage.
Does BPH Cause Erectile Dysfunction?
A question many men ask is: Can an enlarged prostate cause erectile dysfunction? While BPH and erectile dysfunction often coexist, particularly in older men, the relationship between these conditions is complex.
Connection Between Prostate Problems and Erectile Dysfunction
Several factors explain why BPH and erectile dysfunction frequently occur together:
- Shared Risk Factors: Both conditions share common risk factors, including aging, cardiovascular disease, diabetes, obesity, and metabolic syndrome.
- Psychological Impact: The urinary symptoms of BPH can cause stress, sexual anxiety, and depression, which may contribute to erectile dysfunction.
- Lower Urinary Tract Symptoms: Studies have shown that the severity of LUTS associated with BPH correlates with the severity of ED. Men with more severe urinary symptoms tend to have more significant erectile difficulties.
- Vascular Changes: BPH may be associated with changes in pelvic blood flow and nitric oxide signaling, essential in erectile function.
- Autonomic Nervous System Hyperactivity: This condition, which can be associated with BPH, may also affect erectile function.
Research suggests that while an enlarged prostate does not directly cause ED, the conditions are linked through multiple pathways. Approximately 70% of men with BPH also experience some degree of erectile dysfunction.
BPH Medication and ED Connection
Some medications prescribed for BPH can affect sexual function, potentially causing or worsening Erectile Dysfunction:.
BPH Drugs to Avoid if Concerned About Erectile Dysfunction
Not all BPH medications carry the same risk of sexual side effects. Here are some BPH drugs that may potentially impact sexual function:
- 5-alpha-reductase inhibitors (5-ARIs): Medications like finasteride and dutasteride can cause sexual side effects, including ED, decreased libido, and ejaculation disorders in some men.
- Certain Alpha Blockers: While many alpha blockers used for BPH have minimal impact on erectile function, some can cause ejaculation problems or reduced ejaculate volume.
- Anticholinergics: These medications, sometimes used for overactive bladder symptoms in BPH, may indirectly impact sexual function in some men.
It’s important to note that not all men experience these side effects, and the benefits of treating BPH often outweigh the risks. Additionally, some newer medications and combination therapies may have fewer sexual side effects.
PDE5 Inhibitors for BPH and ED
In recent years, phosphodiesterase type 5 (PDE5) inhibitors, initially developed for erectile dysfunction, have shown promise in treating both erectile dysfunction and BPH symptoms simultaneously.
Sildenafil for BPH: Benefits and Effectiveness
Sildenafil (Viagra) was initially approved for treating erectile dysfunction, but research has shown it may also help alleviate BPH symptoms. Here’s what the research tells us about sildenafil and BPH:
- Mechanism of Action: Sildenafil inhibits PDE5, an enzyme that breaks down cyclic guanosine monophosphate (cGMP). This increases cGMP levels, promoting smooth muscle relaxation in blood vessels supplying the penis, as well as in the prostate and bladder.
- Clinical Studies: Research indicates that sildenafil can improve urinary symptoms in men with BPH, particularly when taken regularly.
- Sildenafil for BPH Dosage: While sildenafil is typically prescribed as needed for ED, daily lower doses may be more effective for managing BPH symptoms. The exact dosage of sildenafil for BPH should be determined by a healthcare provider based on individual needs and response.
- Limitations: Although sildenafil can help with BPH symptoms, it is not FDA-approved specifically for this indication. Its effects on BPH might be less consistent than those of medications specifically approved for prostate enlargement.
Viagra and Enlarged Prostate: What Research Shows
Studies examining the relationship between Viagra (sildenafil) and BPH have found:
- Regular use of sildenafil may improve urinary symptoms and quality of life in men with BPH.
- Sildenafil appears to be most effective for men who have both BPH and ED.
- When combined with alpha blockers (common BPH medications), sildenafil may provide greater symptom relief than either medication alone.
- Viagra does not shrink an enlarged prostate; instead, it relaxes smooth muscle tissue in the prostate and bladder neck, making urination easier.
Tadalafil for Enlarged Prostate: An FDA-Approved Option
Unlike sildenafil, tadalafil (Cialis) has received FDA approval for treating both erectile dysfunction and BPH, either separately or when the conditions occur together. Here’s what makes tadalafil particularly effective:
- Longer Half-Life: Tadalafil remains active in the body much longer than sildenafil (up to 36 hours versus 4-6 hours), making it suitable for once-daily dosing.
- FDA Approval: In 2011, the FDA approved tadalafil at a 5mg daily dose for treating BPH symptoms, alone or in combination with ED.
- Clinical Effectiveness: Studies show that daily tadalafil significantly improves both BPH symptoms and erectile function.
- Treatment of BPH with Cialis: Regular use of tadalafil has been shown to improve urinary flow rate and reduce residual urine volume in men with BPH.
- Cialis Reviews for BPH: Patient satisfaction with tadalafil for BPH treatment is generally high, with many men appreciating the dual benefit of improved urinary symptoms and sexual function.
Other Treatment Options for BPH and ED
While medications like sildenafil and tadalafil can help many men with both BPH and ED, they’re not the only options available.
BPH Medications with Minimal Sexual Side Effects
For men concerned about sexual function, certain BPH meds have a lower risk of causing ED:
- Selective Alpha Blockers: Medications like tamsulosin (Flomax) and alfuzosin (Uroxatral) relax smooth muscles in the prostate and bladder neck without significantly affecting erectile function in most men. However, they may cause ejaculation problems in some cases.
- Combination Therapy: Some research suggests combining alpha blockers with PDE5 inhibitors may provide better symptom relief than medication alone, potentially with fewer side effects.
Surgical Options and Sexual Function
For men with severe BPH who don’t respond adequately to medication, surgical interventions may be necessary. A common question is: does TURP (transurethral resection of the prostate) cause impotence?
- TURP and ED: While earlier forms of prostate surgery had high rates of erectile dysfunction, modern TURP techniques have significantly lower risks. Studies suggest that about 5-10% of men may experience new-onset erectile dysfunction after TURP.
- Minimally Invasive Alternatives: Newer procedures like UroLift, Rezūm water vapor therapy, and prostatic artery embolization may have even lower risks of causing erectile dysfunction.
Ejaculation Changes: While TURP and some other BPH surgeries may not necessarily cause ED, they often lead to retrograde ejaculation (where semen goes into the bladder instead of out through the urethra).
Important Medication Considerations
When treating both BPH and ED, specific medication interactions and considerations are essential:
Can Viagra and Tamsulosin Be Taken Together?
Many men with BPH are prescribed alpha blockers like tamsulosin (Flomax) and wonder if they can also take erectile dysfunction medications:
- Potential Interaction: PDE5 inhibitors and alpha blockers can lower blood pressure, so combining them requires caution.
- Timing Matters: Most doctors recommend taking these medications at least four hours apart to minimize the risk of significant blood pressure drops.
- Start with Low Doses: When beginning combination therapy, starting with lower doses of both medications may reduce the risk of side effects.
- Medical Supervision: Combined use should always be supervised by a healthcare provider.
BPH Drugs to Avoid with Erectile Dysfunction Medications
Certain medications used for BPH may interact poorly with erectile dysfunction treatments:
- Nitrates: Men taking nitrates for heart conditions should not use PDE5 inhibitors due to the risk of dangerous blood pressure drops.
- Alpha Blockers: While some alpha blockers can be safely combined with erectile dysfunction medications, others may cause significant blood pressure decreases. Careful dosing and monitoring are essential.
- Other Blood Pressure Medications: Some blood pressure medications may cause excessive blood pressure drops when combined with PDE5 inhibitors.
Lifestyle Changes That May Help Both Conditions
In addition to medications, certain lifestyle modifications may improve symptoms of both BPH and ED:
- Regular Exercise: Physical activity can help reduce BPH symptoms and improve erectile function.
- Healthy Diet: A diet rich in fruits, vegetables, whole grains, and lean proteins may benefit both prostate and sexual health.
- Weight Management: Maintaining a healthy weight can reduce BPH progression and improve erectile function.
- Limited Alcohol and Caffeine: Reducing consumption of these substances may help decrease urinary symptoms and improve sexual performance.
- Pelvic Floor Exercises: Kegel exercises can help strengthen the muscles involved in urination and erection.
- Stress Reduction: Managing stress through techniques like meditation, yoga, or deep breathing may improve both conditions.
When to See a Doctor
Men experiencing symptoms of BPH, ED, or both should consult a healthcare provider if:
- Urinary symptoms are bothersome or affecting quality of life
- There’s blood in the urine
- Unable to urinate
- Experiencing pain with urination
- Erectile difficulties are causing distress or relationship problems
- Currently taking medications for either condition and experiencing troublesome side effects
Early intervention often leads to better outcomes for both conditions.
FAQ About BPH and ED
Can an enlarged prostate keep a man from ejaculating?
Yes, an enlarged prostate can affect ejaculation. Some men with BPH experience reduced ejaculate volume, painful ejaculation, or retrograde ejaculation (where semen flows backward into the bladder rather than out through the urethra). Additionally, some medications used to treat BPH, particularly 5-alpha reductase inhibitors and certain alpha blockers, may cause ejaculation problems as a side effect.
Does Cialis shrink the prostate?
No, Cialis (tadalafil) does not shrink the prostate. Instead, it works by relaxing smooth muscles in the prostate and bladder neck, making it easier to urinate despite the enlarged gland. For actual prostate shrinkage, medications like finasteride or dutasteride (5-alpha reductase inhibitors) would be needed.
How does Cialis help with urination?
Cialis improves urination by relaxing the smooth muscles in the prostate, bladder neck, and urethra. This relaxation reduces the blockage caused by the enlarged prostate, allowing urine to flow more freely. Daily use of low-dose tadalafil (5mg) has been shown to improve urinary symptoms in men with BPH significantly.
Can prostate issues cause permanent ED?
Prostate issues themselves typically don’t cause permanent erectile dysfunction. However, some treatments for prostate conditions, including certain medications and surgeries, can potentially lead to long-term erectile problems in some men. Modern treatment approaches aim to minimize these risks, and many cases of erectile dysfunction related to prostate treatments can be successfully managed.
Is it safe to take Erectile Dysfunction medication if I have BPH?
PDE5 inhibitors like sildenafil (Viagra) and tadalafil (Cialis) are generally safe for men with BPH and may even help improve urinary symptoms. However, caution is needed when combining these medications with alpha blockers commonly used for BPH, as they may cause an additive blood pressure-lowering effect. Your doctor can provide guidance on safe timing and dosing.
Can medicine help the prostate?
Yes, several medications can effectively help manage prostate conditions. Alpha blockers relax prostate muscles to improve urine flow, 5-alpha reductase inhibitors can shrink the prostate over time, and PDE5 inhibitors like tadalafil can improve urinary symptoms and erectile function. The best medicine depends on your specific symptoms, prostate size, and medical history.
Do all men with BPH develop ED?
No, not all men with BPH develop erectile dysfunction, though the conditions frequently co-exist, especially in older men. About 70% of men with BPH experience some degree of erectile problems, but this doesn’t mean BPH directly causes ED. The association is due to shared risk factors, effects of BPH medications, and related changes in pelvic blood flow and nervous system function.
