Bening Prostatic Hypertrophy
Symptoms of BPH
Benign prostatic hyperplasia symptoms are classified as obstructive or irritative. Obstructive symptoms include hesitancy, intermittency, incomplete voiding, weak urinary stream, and straining.
Irritative symptoms include frequency of urination, which is called nocturia when occurring at night time, and urgency (compelling need to void that can not be deferred). The severity of symptoms is assessed using the International Prostate Symptom Score (IPSS) questionnaire, designed to assess the severity of BPH ( please visit the following website for self diagnosis :http://www.usrf.org/questionnaires/AUA_SymptomScore.html )
BPH is a progressive disease especially if left untreated. Incomplete voiding results in an increased risk of urinary tract infections due to urine and bacterial stasis . this stasis can also help forming urinary bladder stones from the crystallisation of salts in the residual urine.
Urinary retention, termed acute or chronic, is another form of progression. Acute urinary retention is the inability to void, while in chronic urinary retention the residual urinary volume gradually increases, and the bladder distends. Some patients who suffer from chronic urinary retention may eventually progress to renal failure.
Causes of BPH
Androgens (male hormones such as testosterone and related hormones) are considered to play a role in BPH by most experts. This means that androgens have to be present for BPH to occur, but do not necessarily directly cause the condition. This is supported by the fact that castrated boys do not develop BPH when they age, unlike intact men. Additionally, administering exogenous testosterone is not associated with a significant increase in the risk of BPH symptoms.
Estrogens play a role in the etiology of BPH. This is based on the fact that BPH occurs when men generally have elevated estrogen levels ( elderly ) and relatively reduced free testosterone levels, and when prostate tissue becomes more sensitive to estrogens and less responsive to DHT. Cells taken from the prostates of men who have BPH have been shown to grow in response to high estradiol ( estrogen ) levels with low androgens present.
Other causes not fully researched are alcohol use and excessive driving.
Rectal examination (palpation of the prostate through the rectum) may reveal a markedly enlarged prostate, usually affecting the middle lobe.
Often, blood tests are performed to rule out prostatic malignancy: elevated prostate specific antigen (PSA) levels needs further investigations such as reinterpretation of PSA results, in terms of PSA density and PSA free percentage, rectal examination and transrectal ultrasonography. These combined measures can provide early cancer detection.
Ultrasound examination of the testicles, prostate and kidneys is often performed, again to rule out malignancy and hydronephrosis. Other blood tests such as urea and creatinine may also measure kidney failure.
Patients should decrease fluid intake before bedtime, moderate the consumption of alcohol and caffeine-containing products, and follow timed voiding schedules.
Drug treatments are available. Finasteride (Proscar) and dutasteride (Avodart) block a natural hormone that makes the prostate enlarge ( 5α-reductase inhibitors ) , but it does not help all patients. The side effects of finasteride are rare and mild, but they usually have to do with sexual function. They go away when the medicine is stopped. The prostate may enlarge again when the medicine is stopped, so your doctor may suggest another treatment. For these first kind of medications, you will need to use it for 2 or 3 months o see any benefit.
Another kind of medicine, called alpha-blockers, also can help the symptoms of BPH. Some of these drugs are terazosin (brand name: Hytrin), doxazosin (brand name: Cardura). Newer medications include tamsulosin (brand name: Flomax) and alfuzosin (brand name: Uroxatral). These medicines may not work in all men either. The side effects of alpha-blockers include dizziness, fatigue and lightheadedness. The side effects will go away if you stop taking the medicine.
If medications do not work, surgery is considered the most effective treatment and is used in men with strong symptoms that persist after other treatments are tried. This is also the best way to diagnose and cure early cancer of the prostate. Surgery is usually done through the urethra ( called TURP ) , leaving no scars. Surgery does have risks, such as bleeding, infection or impotence.
A healthy diet is recommended. Also weight loss is sometimes necessary. Vitamin and mineral supplementation plus essential fatty acids ( 3 grams a day ) are needed at times. Use hydrotherapy to increase circulation in the prostate region. One method involves sitting in a tub that contains the hottest water tolerable for fifteen to thirty minutes once or twice a day.
Eliminate from your lifestyle such items as tobacco, alcoholic beverages , coffee and tea, chlorinated and fluoridated water, spicy and junk foods, and tomato and tomato products.
With respect to herbs the three most common herbs are used in Europe to treat BPH. None has been approved by the Food and Drug Administration (FDA) for use in the United States, but they’re widely available here. They are:
A. Saw palmetto. Saw palmetto is extracted from the saw palmetto shrub (Serenoa repens). It’s thought to work similar to the medication finasteride by preventing testosterone from converting to DHT, another form of the hormone associated with prostate tissue growth. However, studies on this herb have produced varied results. As with finasteride, saw palmetto use may lower the level of PSA in your blood. Let your doctor know you’re using saw palmetto when you have your PSA checked.
B. Beta-sitosterol. Beta-sitosterol is extracted from rye grass pollen and other plants. In clinical trials it did provide relief from urinary symptoms. It increased urine flow rates and reduced the amount of urine left in the bladder after urinating, but didn’t shrink the prostate.
C. Pygeum. Pygeum is extracted from the bark of the African plum tree . In clinical trials it relieved symptoms and increased peak urinary flow rates.
Acupuncture and Chinese Herbs can also help. Please visit your local acupuncturist practitioner.