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Benign Prostate Hyperplasia

Benign Prostate Hyperplasia

Benign Prostatic Hyperplasia (BPH), which is the enlargement of the prostate, is a very common condition that affects men as they grow older. Rarely causing complications in men below the age of 40, BPH affects more than 50% of men in their sixties and even more in the later stages of life.

While many men may not experience much of the signs and symptoms of BPH, about 40-50% of those who have BPH do. As the prostate enlarges, the gland presses against the urethra (the canal through which urine passes out of the body). Urine flow becomes obstructed as a result, and consequently, the bladder weakens as it loses the ability to empty itself and its wall thickens and becomes irritable.

The narrowing urethra and partial emptying of the bladder result in the hallmark signs and symptoms of BPH.
These symptoms include

  1. Increased urinary frequency (especially at night)
  2. Increased urgency
  3. Irregular ‘start-stop’ urination
  4. Difficulty initiating urination
  5. Inability to completely empty the bladder

Although the actual cause of BPH is not well understood, male hormones (e.g. testosterone) play a central role in the manifestation of BPH. Dihydrotestosterone (DHT), which is converted from testosterone via a natural process in the body, is mainly responsible for prostatic growth.

The estrogen (female hormones) ratio in males could also possibly play a part in BPH. Men produce testosterone and small amounts of estrogen throughout their lives. As they age, less testosterone is produced, leaving a relatively higher proportion of estrogen in circulation. Animal studies have suggested that a higher estrogen ratio increases the activity of substances that promote cell growth.

Complications of BPH
An enlarged prostate results in urine retention and may require manual drainage through a catheter (a long slender flexible tube for introducing or withdrawing fluid from the body). Residual urine due to the inability to empty the bladder may cause more frequent urinary tract infections as well as bladder stones due to mineral deposits. If left untreated, bladder and kidney damage may result.

Hence, it is imperative that one should seek the medical attention of an urologist when one suspects symptoms of BPH. Tests can then be done to identify the problem and to decide whether surgery is needed or to rule out cancer as a cause of the urinary symptoms.

Medication is often the first line treatment option for those with moderate symptoms of BPH. Two main groups of medication are used to manage the condition:

Alpha blockers
Medication such as terazosin, doxazosin, and alfuzosin relax the smooth muscle in the prostate and the bladder neck, thus reducing obstruction of urine flow. Common side effects include orthostatic hypotension (sudden fall in blood pressure when a person stands up from sitting or lying down) and ejaculation changes.

5α-reductase inhibitors
Medication such as finasteride and dutasteride inhibit the enzyme 5α-reductase, which is responsible for the production of DHT that enlarges the prostate. Commonly used together with alpha blockers, they are usually effective in reducing the progression of BPH in patients. Some common side effects include decreased libido and ejaculatory or erectile dysfunction.

Alternative treatment methods
For those who are not responding to medications, other treatment options are considered. They may include some minimally invasive therapies or ultimately surgery if necessary.

Some herbal remedies show evidence in helping to reduce BPH symptoms. They include saw palmetto extract (Serenoa repens) and pygeum. Pygeum moderately improves urinary symptoms associated with enlarged prostate or prostate inflammation but does not appear to reduce the size of enlarged prostate.

Some alternative lifestyle modifications that may help alleviate signs and symptoms of BPH include:

  • Limiting fluid intake at night;
  • Reducing intake of diuretics (e.g. caffeine, alcohol);
  • Retraining the bladder to urinate at regular times;
  • Staying active (especially for the elderly) by exercising.

While there is no need for a routine check-up on your prostate health, do consult your healthcare professional should you have any symptoms pointing to prostate enlargement especially if you are 40 and above. Any blood in the urine, unexplained swelling in the legs or discomfort at the pelvic area warrants a visit to the doctor to rule out the possibility of prostate cancer.

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