Benign Prostate Hyperplasia (or hypertrophy), (aka, BPH) is a common condition for older men. It is a non-cancerous enlargement of the prostate gland that affects men as they age.
Experts estimate that about 40 percent of men over the age of 50 suffer from it, with the percentage increasing to near 90 percent for older men. 1
The prostate is one of the few organs in the body that tends to grow in size with aging. This growth, known as BPH, may hardly be noticed by some men, but for others, it can cause the prostate to push and surround the urethra, reducing or blocking the urinary flow.
BPH progresses slowly, and the symptoms can often be mediated with natural techniques, medication, and sometimes surgery. In severe cases, surgery may be needed.
Still, it is usually not a life-altering situation, so most men can avoid surgical risks and decide what kind of approach they can take to solve it. Men with mild to moderate symptoms may find that changes in lifestyle can noticeably relieve BPH’s bothersome effects.
While the progression of BPH is usually slow, a critical condition can occur suddenly, resulting in a total blockage of urine flow. This typically occurs in the early morning hours, when the patient awakens to urinate and finds he cannot get the urine stream started. Often a trip to the ER is necessitated where the patient is catheterized to empty his bladder.
A total blockage can occur for no known reason or can be trigger by a dietary item or medication for another condition.
Typical Symptoms of BPH
An enlarged prostate typically causes a change in normal urinary habits. It may also introduce some sexual issues such as erectile dysfunction or inability to have an orgasm, regardless of stimulation. Typical symptoms include:
- Feeling that the bladder is full, even right after urinating
- A weak urine flow
- Urinary urgency
- A urinary stream that starts and stops several times
- Delay in starting the urine stream, especially in early morning hours
- Feeling that the bladder is not completely emptied
- Erectile or orgasmic dysfunction
For some men, BPH reduces urinary output significantly and can result in an inability to empty the bladder completely on a regular basis. This condition, known as chronic urinary retention, can cause kidney damage.
BPH can also result in a complete blockage and inability to urinate. This acute urinary retention is a medical emergency that usually results in a visit to the ER to manually empty the bladder. Long term inability to completely empty the bladder is known to contribute to recurrent urinary tract infections.
For younger men, the complete urinary blockage is rare, but men over the age of 80 might be more likely to encounter it. Often, a trip to the ER and subsequent catheterization results in a recommendation for surgery or other treatment.
Older men should consult their doctors about self-catheterization. It is a simple procedure, done at home, to temporarily relieve the urinary blockage. Several companies are marketing personal catheters that can be carried in a man′s pocket and used discreetly. For an older man, especially one with other health concerns, self-categorization can be a safe and effective solution to the problem. 2
Techniques to Overcoming Urination Issues
Men with BPH can relieve some of the urinary symptoms of BPH and make urination easier with natural techniques such as;
- Stress management – Stress has many effects on the body. Most significantly, it negatively affects hormone levels and oxidative inflammation, both of which can exacerbate BPH. Stress can have several effects on an enlarged prostate, making symptoms like painful urination, urinary frequency, and urgency associated with BPH more bothersome. In addition, men should also be aware of the strong relationship between oxidative inflammation, obesity, and zinc deficiency in the prostate and BPH. 3
- Kegel exercises – Muscles around the bladder and pelvic region become weaker with age. Kegel exercises can strengthen these muscles to help improve control of urination. They can be done at almost any time and do not require any special equipment. 4
- Double voiding – A technique whereby the man waits a few minutes after normal urination and then attempts to urinate again. The second voiding and bladder contraction may produce more urine and help to empty the bladder more effectively.
- Excessive consumption of caffeine or alcohol – Caffeine is a diuretic. It can increase the production of urine as well as the urge to urinate. Like caffeine, alcohol can stimulate urine production. While neither item has been associated with causing or worsening BPH, both tend to add to the symptoms and effect a man′s quality of life.
- Weight management – Several recent studies have found a strong correlation between overweight and obese men and symptomatic BPH. It is more likely to develop among men with larger waist circumference and body mass index (BMI).
Men with excess adipose tissue usually have a disruption in their normal hormone levels. Disrupted hormone levels are known to have a profound effect on BPH. Regular exercise can help balance the body’s hormones. Many men with BPH suffer from central obesity, which increases the intra-abdominal and bladder pressure that can exacerbate BPH symptoms. Regular exercise can also help to achieve and maintain a healthy weight that can significantly reduce the risk of prostate problems. 5
- Antihistamines and decongestants – Most over the counter cold and flu medications contain decongestants and/or antihistamines.
These drugs, which are called vasopressor adrenergic, antihistamines, or pseudoephedrines, can worsen BPH symptoms. Most cause the muscles in the prostate and bladder neck to tighten, thus slowing urine flow. These medications (Benadryl, Sudafed, and others) are typically used to treat congestion associated with a cold or flu but can have debilitating effects on a man with BPH, and in rare cases, cause acute urinary retention.
Prescription Medication That Might Help
There are two classes of medicines that are commonly used to help alleviate the symptoms of BPH; alpha-blockers and 5-alpha-reductase inhibitors. Each medication in either class carries a substantial risk of the side effects listed below. These side effects are common with any of the medications in either class.
- Alpha-blockers – There are several medications in this class. Tamsulosin, popularly known as Flomax, is the most frequently used in the US, but they are all equally effective. They relax the prostate and bladder muscles allowing urine to flow more easily. While this reduces one of the symptoms of BPH, it does not have any curative effect on the prostate or reduce its size.
- 5-alpha reductase inhibitors – These medications help prevent hormonal changes that can cause prostate growth. They can help shrink the size of the prostate, but it may take several weeks or even months before symptoms improve. The most common medications in this class are dutasteride, sold under Avodart and finasteride, and marketed for BPH as Proscar. Finasteride is also used for hair loss at a higher dosage and is marketed as Propecia.
The principle side effects of Alpha-blockers include:
- Dizziness caused by sudden drops in blood pressure when sitting up or standing up.
- Headaches or nausea.
- Swollen legs or ankles.
- Lightheadedness, tiredness, weakness, feeling lethargic, or fainting.
The principle side effects of 5-alpha reductase inhibitors include:
- Erectile dysfunction
- Reduced or non-existent libido (sex drive)
- Retrograde ejaculation. (Semen goes backward into the bladder instead of exiting via the penis)
- Anorgasmia (inability to have an orgasm regardless of stimulation.)
In addition, according to an FDA Drug Safety Communication – 5-alpha reductase inhibitors (5-ARIs) may increase the risk of a more serious form of prostate cancer.
Natural Remedies That Can Help
Many natural remedies are available for men with BPH, and certain natural plants help keep the prostate healthy.
The most studied natural herbs used for general prostate health are extracts of saw palmetto, a palm-like shrub that grows primarily in South Florida, and extracts of the bark of the prunus Africanus (Pygeum) tree that grow all over Africa and other similar locals.
However, many other herbs and nutrients can also be used to strengthen the prostate and relieve some of the symptoms of prostate enlargement. Many dietary nutrients may become deficient in a standard American diet (SAD).
Some of the recommendations in books and on websites list foods such as; pumpkin seeds as a prostate nutrient. Pumpkin seeds are extremely high in the mineral zinc, which is critical for prostate health. For more information on herbals that can help maintain prostate health see 6
Two elements that are critical for a man with BPH to consider are listed below:
Zinc – A zinc deficiency can cause the prostate to become enlarged. Zinc is a necessary element for many cellular processes and an element of particular importance to the prostate, which has the highest concentration of zinc of any organ in the body. A unique metabolic capability gives the prostate the ability to accumulate zinc, and long-term zinc deficiencies can be significant. One effect of this zinc accumulation is the inhibition of abnormal growth of the prostate, primarily by increasing the rate of normal programmed cell death (apoptosis). 7
Flower Pollen – Pollen extracts have been studied extensively and be clinically beneficial in increasing urine flow in men with BPH. Pollen extracts, often labeled as Swedish flower pollen, are natural products produced from a type of ryegrass pollen. They do not seem to have any significant side effects or adverse events associated with them. 8 [ ref. Tommaso Cai ]
Patients with BPH should investigate the use of several over the counter herbal supplements for general prostate health. Prostate enlargement is a general indicator that the health of the prostate is not optimal. This might be due to lifestyle issues, hormone levels, medications, obesity, or a deterioration in general health.
In any event, a visit to a natural health practitioner, herbologist, or a naturopathic doctor help reduce symptoms and prevent further deterioration.
While BPH is not a life-threatening condition, it can have a serious impact on a man′s quality of life. There are many natural ways to alleviate the problem, as well as some medications and supplements that can help.
Some doctors recommend surgery, but older men or men with other co-morbidities should consider non-invasive techniques such as self-categorization to avoid the inherent risks associated with surgery and other procedures.