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Benign Prostatic Hyperplasia

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Benign prostatic hyperplasia (BPH) —it is the expansion of the prostate gland. It is a very common condition among older men. The prostate is a walnut-sized gland that secretes fluid to nourish and protect sperms. It is located between the urinary bladder and the penis. Anteriorly, the prostate is in front of the rectum and the urethra runs through the center of the prostate gland, from the bladder to the penis, letting the urine to flow out of the body. Its primary function is to produce about 25 percent of the semen during every ejaculation. It plays an important part in the male reproductive system. An enlarged and expanded prostate gland can cause discomfited urinary symptoms, like blocking the flow of urine out of the bladder, increased frequency, and urgency to urinate. It can also cause bladder, urinary tract or kidney problems.

There are respective effective treatment plans for prostate gland enlargement, which include medications, surgery, and minimally invasive therapies. To determine the best preferable option, the doctor will consider your symptoms, the size of the prostate, other health conditions you might have and suggest you accordingly.

Symptoms of Benign prostatic hyperplasia:

The severity of symptoms varies in people who are suffering from prostate gland enlargement. In most cases, the symptoms tend to gradually worsen with time. Common signs and symptoms of Benign Prostatic Hyperplasia include:

  • Urgency to urinate
  • Increased frequency of urination, mostly at night (nocturia)
  • Difficulty to start urination
  • A weak stream or poor flow of the urine
  • Intermittent stream (a stream that stops and starts)
  • Dribbling at the end of urination
  • Inability to empty the urinary bladder (sensation of urine in the bladder)
  • Hesitancy
  • Episodes of near retention of urine
  • Urge incontinence,
  • Low flow rate and high voiding pressure(as a consequence of bladder outflow obstruction)
 

Other symptoms that may be resent along with BPH include:

  • Inability to micturate
  • Urinary tract infection
  • Blood in the urine
 

The severity of symptoms is not necessarily determined by the size of the enlarged prostate. Occasionally, it noticed that men with only slightly enlarged prostates had significant symptoms, while other men with very enlarged prostates had only minor urinary symptoms. In some men, symptoms eventually become steady and even ameliorate over time.

How does the enlarged prostate gland cause urinary symptoms?

The prostate gland is situated below the urinary bladder. The tube(urethra) that transports urine from the bladder to the penis passes through the middle of the prostate. When the prostate enlarges, it compresses the tube beneath it and therefore, it begins to block urine flow.

The true cause of the enlarged prostate is yet to be found. However, changes in the balance of sex hormones in men with the growing age are ascertained to be the leading cause for change in the size of the prostate gland.

Risk factors for an enlarged prostate gland include:

  • Aging. Prostate gland enlargement is mostly seen in males between the age of 45 and 74. Its incidence rate increases to 75-80% in men above 80 years. Very rarely the signs and symptoms of prostate enlargement are noticed in men younger than age 40.
  • Family history. You are more likely to face the problem of prostate enlargement if a blood relative, such as a father or a brother, is already suffering from prostate problems.
  • Diabetes. Conducted studies have given evidence that men suffering from diabetes may also suffer from signs and symptoms of an enlarged prostate.
  • Heart disease. Studies show that heart disease and the use of drugs like beta-blockers might increase the chances of BPH.
  • Lifestyle. Lifestyle modifications like exercise can lower the risk of BPH while obesity increases the risk.
  • Hormone: Local role of male hormone, DHT(dihydrotestosterone) in the development and growth of the prostate gland
 

Complications:

  • Complications of an enlarged prostate include: In most cases, the men with an enlarged prostate don't develop the following complications. However, acute urinary retention and kidney damage can lead to ineluctable serious health threats.
  • Retention of urine. Due to the compression of urethra by an enlarged prostate, the flow of urine is sometimes blocked and retention is experienced. There might be a difficulty experienced by the person to empty the bladder. You might need to have a catheter inserted into the bladder to drain the urine. Some men with an enlarged prostate gland may need surgery to relieve urinary retention.
  • Urinary tract infections (UTIs). A common complication of enlarged prostate is frequent UTIs due to the inability to fully empty the bladder. Surgery might be required to remove part of the prostate in case of recurrent UTIs.
  • Bladder stones. Retention of urine in the bladder can lead to the formation of bladder stones. These stones can irritate the lining of the bladder causing pain and infection, other symptoms include blood in the urine and obstruction of urine flow.
  • Bladder damage. The incompletely emptied bladder can stretch and weaken over time. Ergo, the muscular wall of the bladder loses elasticity and can no longer contract properly, making it difficult to fully empty the urinary bladder.
  • Kidney damage. Increased pressure in the bladder due to urinary retention can directly damage the kidneys. It may also allow the infections to reach the kidneys from the bladder.
 

Other leading causes of urinary symptoms: Apart from BPH other possible cause that can lead to similar urinary symptoms that should be kept in mind, include the following:

  • Urinary tract infection
  • Prostatitis i.e., Inflammation of the prostate
  • Narrowing of the urethra due to urethral stricture
  • Scarring in the bladder(As a result of previous surgery)
  • Bladder stones or kidney stones
  • Neuritic troubles to control the muscles of the bladder
  • Cancer of the prostate or cancer of the bladder
 

When to see a doctor? If there is an inability to pass urine, blood in urine, dribbling, frequency or urgency seeks immediate medical attention. Discuss any bothersome urinary symptoms faced by you with your doctor. Even if you don't find troublesome urinary symptoms, it's very important to identify and rule out any underlying issues. Untreated, urinary trouble can lead to infections and obstruction of the urinary tract.

Diagnosis and evaluation of Benign Prostatic Hyperplasia: Diagnosis is mostly made by a urologist. The doctor may evaluate the condition by asking questions about the severity and type of symptoms you are experiencing. He may also ask and evaluate the impact of the symptoms on your daily routine.

    • Tests include: Routine blood test, urine flow study, Urinalysis (urine test), prostate-specific antigen (PSA) blood test for screening of prostate cancer, Urinary blood test to screen bladder cancer, cystoscopy, ultrasound or prostate MRI are used to confirm the diagnosis. A physical exam may also be performed that involves a digital rectal exam (DRE). Cystoscopy to look at the urethra or bladder with the help of a scope. Early diagnosis of BPH is given prime importance because if left untreated it can lead to urinary tract infections, bladder stones, bladder or kidney damage, and incontinence. Diagnosis also plays an important role in distinguishing BPH from more serious diseases like prostate cancer.
    • Tests may vary from patient to patient, but the series of questions and evaluation procedures remains the same for all the patients. Filling out a questionnaire: Your doctor is most interested in the severity and type of symptoms you have, and how much they bother you or impact your life. A simple questionnaire is a common starting point. The American Urological Association (AUA) has made-up a BPH Symptom Score Index. It’s a series of questions that help to evaluate the severity and intensity of the disease. It scores BPH from mild to severe. The questionnaire contains questions about urinary symptoms like how often it happens. The doctor will give you the test and review the symptom score with your medical history.
    • Transrectal ultrasound and Prostate Biopsy: It is mostly recommended in suspicious cases of prostate cancer. An ultrasound probe is used to acquire images of the prostate. The probe guides a biopsy needle into the prostate to remove small pieces of the tissue for microscopic examination. It may simply be used to determine the exact size of the prostate in case of pre-planned prostate surgery for BPH. In such cases, only an ultrasound image will be obtained without any provision to use needles.
    • Transabdominal ultrasound: It is performed to measure the size of the prostate. It may also be used to measure the amount of urine left in the bladder after urination.
    • Prostate magnetic resonance imaging (MRI): MRI provides a better view with excellent soft-tissue contrast of the entire prostate gland.
 

Treatment options for BPH:

A wide variety of management plans and treatments are available for enlarged prostate, including medicament, minimally invasive therapies, and surgical procedure. The treatment choice entirely depends on several factors, including: The size of the prostate, age, overall health of the person ans the amount of discomfort or bother being experienced

If the symptoms are permissible and easy to tolerate, surgical procedures can be postponed. You can decide to use medical aid and simply monitoring your symptoms. For some men, symptoms can ease without any medical treatment.

Drug therapy including conventional and homeopathic medicines: Several drugs are used to relieve the common symptoms associated with an enlarged prostate, including drugs both conventional and homeopathic that relax the smooth muscle of the prostate gland and bladder neck to improve urine flow, that inhibit the production of the hormone DHT,that alleviate any associated symptom and urinary troubles.

Conventional Medication for Benign Prostatic Hyperplasia: Medication is the most common treatment method for mild to moderate symptoms of an enlarged prostate. The conventional medicinal options include Alpha-blockers, Combination drug therapy, Tadalafil (Cialis) which is often used to treat erectile dysfunction, can also be used to treat prostatic enlargement.

Homeopathic treatment for Benign Prostatic Hyperplasia: Homeopathy can provide a safe, nonsurgical, and effective treatment plan to a case of prostatomegaly and urinary troubles. Homeopathy is also a good treatment option for males suffering from BPH. Research study has shown the efficacy of homeopathic medicines in the treatment of BPH in elderly men. Homeopathy has proved its efficacy in the treatment of prostatic enlargement along with surgical and conventional treatment strategies. Hyperplasia of the prostate is common condition in men of senior age. The common symptoms of enlarged prostate like retention of urine, irritation, increased urgency and frequency of urination, nocturia, incontinence resulting due to bladder irritation are terrifically treated with homeopathic aid. Even in extreme unattended cases with complete retention of urine homeopathic medicine can provide relief. Homeopathic medicines also provide relief in cases of inflammation of the prostate gland, dysuria, pollakisuria, painful defecation. Self medication should be avoided. The medicine should be taken under proper supervision of homeopathic physician.

Minimally invasive therapies or surgical procedures: Minimally invasive therapies or surgical procedures are recommended if:

  • The symptoms experienced by the person are moderate to severe or, recommended medication is not providing desirable relief.
  • The person is suffering from any of the following: Urinary tract obstruction, bladder stones, blood in the urine or kidney problems
  • The person prefers a definitive treatment plan.
 

Types of minimal invasive therapies or surgical procedures: Transurethral resection of the prostate (TURP), Transurethral incision of the prostate (TUIP), Transurethral microwave thermotherapy (TUMT), Transurethral needle ablation (TUNA), Laser therapy (Ablative procedures, Enucleative procedures), Prostatic urethral lift (PUL), Embolization, Open or robot-assisted prostatectomy

Minimally invasive or surgical procedures are usually might not suggested, in the following scenarios:

  • An untreated urinary tract infection
  • A case of urethral stricture
  • A history of prostate radiation therapy
  • A history of urinary tract surgery
  • A neurological disorder, like Parkinson's disease or multiple sclerosis
 

Any type of surgical prostate treatment can cause complications and side effects. Complications after the surgical procedure might include Retrograde ejaculation. temporary difficulty while urinating, urinary tract infection, bleeding, erectile dysfunction, incontinence i.e., loss of bladder control.

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