Benign Prostatic Hyperplasia (BPH) or Prostate Enlargement

Prostate enlargement is as common a part of aging as gray hair. As life expectancy rises, so does the occurrence of BPH. BPH is not a life-threatening disorder, but its symptoms can be quite troublesome and distressing.

What is benign prostatic hyperplasia (BPH)?

BPH is a non-cancerous enlargement of the prostate gland. BPH stands for benign prostatic hyperplasia (also known as Benign Enlargement of the Prostate or BEP). As age advances, the prostate gland slowly grows bigger (or enlarges). The word "benign" means the enlargement that it isn't cancerous. The word "hyperplasia" means enlargement.

Because the prostate surrounds the urethra, when it gets bigger, it may press on the urethra. This may pose difficulty in passing urine. The individual usually seeks medical advice for these urinary problems rather than complaints of prostate per se.

Incidence:

BPH rarely causes symptoms before age 40, but more than half of men in their sixties and as many as 90% in their seventies and eighties have some symptoms of BPH.

What happens in BPH?

As the prostate enlarges, the capsule or membrane surrounding it stops it from expanding, causing the gland to press against the urethra like a clamp on a garden hose. As a result, the bladder has to work harder to empty the urine. Thus the gland becomes thicker and prone to excessive contractions. The bladder begins to contract even when it contains small amounts of urine, causing more frequent urination. Over time, this extra effort causes the bladder muscle to weaken and lose the ability to empty itself. As a result, urine remains in the bladder even after urination. The combination of these problems leads to the discomfort and complications associated with an enlarged prostate.

Common symptoms of an enlarged prostate

Most symptoms of BPH start gradually over time. Many symptoms of BPH stem from obstruction of the urethra and gradual loss of bladder function. The symptoms of BPH vary, but the most common ones are as follows:

• Urinary frequency (especially at night)

• Urinary urgency

• Decreased force of the stream

• Difficulty in starting to pass urine (Hesitancy)

• The sensation of incomplete emptying

• Dribbling of urine, especially at the end of the stream.

• Burning during urination; chills and fever whenever infection has set in.

• Overflow incontinence or total retention: As the condition worsens, the bladder cannot expel urine and it becomes distended. This can cause swelling and pain in the abdomen. If the pain is severe or if only a few drops of urine can be passed, this is called acute urinary retention and needs immediate medical treatment.

What causes BPH?

It is still uncertain as to what causes BPH, but it may be linked to changes in hormone levels caused by the aging process.

Throughout their lives, men produce testosterone, an important male hormone, and small amounts of estrogen, a female hormone. As men age, the amount of active testosterone in the blood decreases, leaving a relatively higher proportion of estrogen. Studies have suggested that BPH may occur because of the relatively higher amount of estrogen, which within the gland increases the activity of substances that promote cell growth.

It appears that some cases of BPH may be forms of prostatitis. Patients with the same symptoms are often diagnosed with prostatitis if they are under 50 and with BPH if they are older. There is also speculation that untreated prostatitis can eventually become BPH.

How is the condition diagnosed?

One may first notice symptoms of BPH himself, or the doctor may find that the prostate is enlarged during a routine checkup. Several tests help the doctor confirm the problem. The tests vary from patient to patient, but the following are the most common

• History
  As the first step in the diagnosis, the doctor will ask a set of questions to rate the severity of urinary symptoms.
• A rectal exam is the next step
  It is called Digital Rectal Examination (DRE). Since the prostate is an internal organ, the physician cannot look at it directly. However, the prostate lies in front of the rectum and the doctor can feel it by inserting a gloved finger into the rectum. This exam gives the doctor a general idea of the size, shape, and consistency of the gland.
• Urine Flow Study
  Sometimes the doctor will ask a patient to urinate into a special device, which measures how quickly the urine is flowing. A reduced flow often suggests BPH.
• Intravenous Pyelogram (IVP)
  IVP is an x-ray of the urinary tract. In this test, a dye is injected into a vein, and an x-ray is taken. The dye makes the urine visible on the x-ray and shows any obstruction or blockage in the urinary tract. One of the extensions of this test is a post-voiding cystogram. In this, the patient is asked to void or empty the bladder completely and then an X-ray is taken to see how much urine is left in the bladder following voiding.
• Cystoscopy
  In this exam, the doctor inserts a small tube through the opening of the urethra in the penis. This procedure is done after an anesthetic solution is applied inside the penis so all sensation is lost. The tube, called a cystoscope, contains a lens and a light system, which help the doctor see the inside of the urethra and the bladder. This test allows the doctor to determine the size of the gland and identify the location and degree of the obstruction.
  
  If the prostate gland is enlarged, it can be either due to BPH or prostate cancer. Diagnosis of BPH can be confirmed by ruling out the possibility of prostate cancer. To do so, the doctor may do the following tests:
• Prostate-Specific Antigen (PSA) Blood Test
  In order to rule out cancer as a cause of urinary symptoms, the doctor may recommend a PSA blood test. PSA, a protein produced by prostate cells, is frequently present at elevated levels in the blood of men who have prostate cancer.
• Rectal Ultrasound
  If there is a suspicion of prostate cancer, the doctor may recommend a test with rectal ultrasound. In this procedure, a probe inserted in the rectum directs sound waves at the prostate. The echo patterns of the sound waves from an image of the prostate gland are seen on a display screen.

In addition, urine will be tested for infections and a blood test may be needed to check the function of the kidneys.

Prognosis

Approximately one-third of men with enlarged prostates progressively worsen and require medical or surgical intervention. But one good point is that it is not cancer and there is no proof that it can lead to cancer.

Complications

If the bladder does not empty completely, urinary retention can lead to potentially serious complications. The stagnant urine is a prime location for the growth of bacteria, which makes urinary tract infections common. Also, urinary stones can form in the bladder lining due to an accumulation of debris and chemicals. Other problems include blood in the urine from broken blood vessels in the prostate. Unchecked urinary retention can become so severe that urine backs up into the kidneys, potentially leading to kidney malfunction.

It is possible to avoid surgery...

In cases of BPH, the decades-long notion is to remove the gland. However, homeopathy can treat these problems gently and effectively without using a knife. As now perceived BPH is thought to be related to the aging process and hormonal deviations associated with it. Homeopathy, which works at the deep, constitutional level, brings back these deviations to normal, thus preventing further enlargement. To a certain extent, it can shrink the enlarged gland. Moreover, relief of symptoms associated with urinary problems obtained with homeopathy is without the side effects of surgery.

The common conventional practice followed for treatment of BPH is surgery, which is of course not without side effects. However, it is possible to avoid surgery with timely administered homeopathic medicines.

Written & Approved by-

Dr. Rajesh Shah

M.D. (Hom.)