All About Benign Prostatic Hyperplasia

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We all change as we get older, and some changes are gender-specific, like prostate problems. Your prostate gland is part of the male genital tract and surrounds part of your urethra, the tube through which urine and sexual fluid exits the body. The prostate is responsible for producing some of that fluid.

The prostate gets larger as men age. As the mass of the prostate gland increases, it applies pressure to the urethra, causing a number of changes that can affect quality of life, including:

• A weaker stream of urine
• Difficulty beginning the process of urination (also called “hesitancy”)
• A sudden urge to go (also called “urgency”)
• Waking up frequently with an urge to urinate
• Obstruction of urine flow
• Bladder and kidney infections (otherwise rare in males)

This condition is known as benign prostatic hyperplasia (BPH). 50% of men over 50 years of age have the condition. At 80 years of age, 80-90% of men have it. Obesity, diabetes, heart disease, and a family history are among the risk factors.

As the name suggests, it is not prostate cancer, which is also common the older you get. In addition to performing a rectal exam, tests to identify one from the other include the blood exam PSA (elevated in prostate cancer) and various other diagnostic studies. Official proof is obtained by performing a biopsy (taking a small sample of tissue and sending it for analysis).

In BPH, symptoms occur partially because you’re not completely emptying your bladder each time. If there’s a lot of urine left inside (residual urine), your chances of getting an infection increase and you might experience fever and pain, especially if the infection ascends to the kidneys. This is identified by a post-void residual measurement, where a tube is placed in the urethra after the patient is asked to completely empty their bladder. An ultrasound of the bladder is another, more popular, option. If more than 50-100 cc remains after an attempt to void, it’s considered abnormal.

In significant cases, patients may be completely unable to urinate despite the need to go. My father-in-law actually experienced this on a cross-country flight a few years back. He described it as feeling as if he was going to “burst”.

Treatment may involve surgery to remove a portion of the prostate to relieve pressure around the urethra. The classic treatment is “transurethral resection of the prostate (TURP)” where an instrument is inserted in the urethra and small pieces of prostate are shaved off. Lately, less invasive procedures have proven to be promising as well, such as transurethral microwave or laser therapy.

Of course, surgery shouldn’t be the first option. Various medications can relieve many of the symptoms of benign prostatic hyperplasia. Medications that can relieve urinary issues include:

Alpha blockers: These drugs make urination easier by relaxing muscles in the prostate and bladder neck. They include Terazosin, Doxazosin, Tamsulosin, and Alfuzosin.

5-alpha reductase inhibitors. These medications, including dutasteride and finasteride, shrink the prostate by inhibiting certain hormones that cause enlargement.

A combination of the above might work in stubborn cases where one alone fails to achieve relief.

Recently, I was asked about natural alternatives to conventional medicines and surgery. These often come in dietary supplements. Saw palmetto, beta-sitosterol, Pygeum, Rye Grass, and others are common natural substances used to treat BPH.

According to the NIH, a few small-scale studies report that saw palmetto 160 mg twice a day might be effective for relieving BPH symptoms. It’s generally well-tolerated but hard data still needs to be presented for its effectiveness.

Another substance present in various plants, including the saw palmetto, are sitosterols or phytosterols. Several studies have suggested that beta-sitosterol can improve the strength of urine flow and other BPH symptoms.

Pygeum comes from the bark of the African plum tree and is used in Europe to treat BPH symptoms.

Rye grass extract is made from the pollens of rye, timothy, and corn. In one study, men who were taking rye grass pollen extract reported less frequent nighttime trips to the bathroom than those given a placebo.

Besides these that you mentioned, various others have been used with varying results:

• Stinging nettle
• Red clover
• Flaxseed
• Milk thistle
• Dried cranberry
• Selenium
• Zinc

The problem with all of the above is the lack of consistent hard data of the effectiveness of these products for BPH.

Dietary changes may be helpful. Studies show that diets high in fruits, pumpkin seeds, dark, leafy vegetables, and tomatoes cause less prostatic enlargement and, thus, less symptoms.

It might be worth considering combining a number of the above. Various supplements of this type include Prosta Relief, Prostate Support X, Prostarex, Maximum Prostate, and others.

One theory behind combination supplements is that, if one component doesn’t work, another might. Another suggests that the effect might be stronger if several are used together.

(disclaimer: I have no connection, financial or otherwise, to any of the above products or their manufacturers)

Benign Prostatic Hyperplasia isn’t the worst diagnosis to have, but it can sure affect your quality of life. Know how to recognize the symptoms and consider treatment before going “number one” becomes your number one medical problem.

Joe Alton MD

Joe Alton MD

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