Enlarged Prostate (BPH)

The prostate is a walnut-sized gland below the bladder that makes the fluid carrying sperm, with the urethra running through its middle. An enlarged prostate is the age-related multiplication of its cells until they squeeze that urethra.

The main driver is the change in male hormones with age, particularly DHT building up in the gland, with family history, obesity and diabetes as secondary risks. It is benign, not cancer, and having it does not raise your risk of prostate cancer later.

Symptoms fall into two groups that usually appear together.

Voiding symptoms include a weak or weakening stream, straining, waiting before flow begins, an intermittent stream, and dribbling afterwards. Storage symptoms include daytime frequency, less ability to hold on, and waking at night, which usually affects quality of life most.

Severity does not track gland size reliably: where the growth sits and how sensitive the bladder is differ from man to man.

Two approaches are used, working in completely different ways.

Muscle relaxants (alpha-blockers) do not shrink the gland; they relax the smooth muscle of the prostate and bladder neck so the outlet widens, with a difference felt within days. Gland shrinkers (5-alpha reductase inhibitors) lower DHT so the gland slowly becomes smaller, but take several months.

The range here is the first group, the fast-acting relaxants. Gland-shrinking medicines need specialist assessment first.

The smooth muscle around the urethra where it passes through the prostate is controlled by alpha-1 receptors. When it tightens, the passage narrows; alpha-blockers occupy those receptors so the muscle relaxes and the outlet opens.

Subtype A receptors concentrate in the prostate and bladder neck, while subtype B sits in blood vessel walls and governs blood pressure. A drug more selective for subtype A works where it is needed while disturbing blood pressure less, and because it acts on muscle directly the effect peaks at roughly 72 hours.

The biggest factor in choosing is your own blood pressure.

• Urief (Silodosin) — the most prostate-selective, so it affects blood pressure least, at the cost of changing ejaculation more often.
• Cazosin (Doxazosin) — non-selective, lowering blood pressure at the same time, for men who also have hypertension.
• Cardura XL (Doxazosin XL) — extended-release, once daily, steadier levels and less early blood-pressure dipping.

In short: normal blood pressure and wary of dizziness — choose the selective option; already treated for hypertension — ask about doxazosin. Full range in the high blood pressure collection.

Most side effects come from the same muscle-relaxing action, which also affects blood vessels.

Common ones are dizziness on standing, especially in the first week and more so with non-selective drugs, then nasal congestion, fatigue and headache. A change in ejaculation, with reduced or absent semen, occurs more with highly selective drugs; it is not harmful and reverses after stopping.

The key precaution is eye surgery: this class is linked to intraoperative floppy iris syndrome, so tell your surgeon before cataract surgery.

Urinary symptoms in older men have several possible causes, so assessment before treatment is not a step to skip.

Doctors take a history and score symptom severity, examine the prostate, test the urine for infection and blood, and may check PSA and kidney function. The purpose is to exclude urinary infection, stones, an overactive bladder and prostate cancer, each treated completely differently.

If symptoms come with burning, cloudy urine or fever, think of infection first — see the cystitis treatment collection.

Order online from Intimo Life by choosing from the range above. Delivery across Thailand takes 1-3 business days, packed discreetly with no product name on the parcel.

If you are unsure which to start with, or already take blood-pressure or other medicines, message our pharmacist before ordering at no charge.