Benign Prostatic Hyperplasia

By Dr. Loretta Lanphier, ND, CN, HHP, CH

An enlarged prostate gland, also known as benign prostatic hyperplasia (BPH), is something that most men will have to deal with in their golden years. However, it hasn’t always been so. The number of BPH cases has increased dramatically over the last few decades.  But, there is some good news here. Steps can be taken to prevent or minimize the problem, and the younger a man is when he begins to implement these preventative measures, the greater his chances of never experiencing any significant problems due to an enlarged prostate. Like with all wellness issues, it is easier to stay healthy than to get healthy, and the prostate is no exception.

What is Benign Prostatic Hyperplasia?

Benign Prostatic Hyperplasia (BPH) is the technical name for an enlarged prostate gland. This donut-shaped gland about the size of a walnut is found in men just below the bladder and surrounding the urethra, the tube that runs from the end of the penis to the bladder. The prostate serves several purposes. Its main job is the production of semen to nourish and transport sperm, and healthy prostate secretions are vital to the success of egg fertilization. The prostate also lubricates the urethra to help protect against infection. BPH is a benign (non-cancerous) enlargement of the prostate gland that is extremely common in men as they age. This can occur in two ways: Hyperplasia means that the cells of the prostate begin to divide at an abnormally accelerated rate, thereby causing the size of the organ to increase. Hypertrophy is a bit different, as it indicates an enlargement of the prostate gland without any new cells being formed, similar in action to swelling. Both of these conditions are labeled BPH.

BPH is very common, and aging is the greatest risk factor for prostate enlargement. It is estimated that over 50% of all men will experience BPH at some point in their lives. Changes in the prostate may begin to occur in men who are in their thirties, but most symptoms begin to appear between 55-75 years of age. Incidence definitely increases in direct proportion to a man’s age, with about 40% of men in their 70’s and up to 90% of men over 85 having an enlarged prostate.

What Are the Signs and Symptoms of BPH?

Signs vary greatly in occurrence and degree from man to man, and many men will never experience any symptoms at all. However, if the prostate becomes enlarged to the point that it begins to cause problems, some of the more common symptoms include:

  • Increased nighttime urination (nocturia) that necessitates numerous trips to the bathroom during the night.
  • Difficulty starting urination
  • Weak caliber (strength of stream) of urination
  • Reduced volume of urine
  • Interruptions (stopping and starting) after urination has begun
  • Dribbling after urination has ended
  • Split stream during urination
  • Feeling that one cannot fully empty the bladder
  • Increased urgency to urinate
  • Increased frequency of urination
  • Blood in the urine (hematuria)
  • Frequent urinary tract infections (UTIs)

Some men may also experience considerable a certain amount of pain in the perineum (between the scrotum and anus), but this is rare and generally only found in cases of extensive prostate enlargement.

What Are the Causes of Enlarged Prostate?

Newborn boys have a prostate that is normally about the size of a pea, and it grows slowly during childhood. Once puberty hits, the prostate goes through a growth spurt, and is usually fully developed by the age of 25. As men get older, the prostate generally undergoes additional tissue growth or enlargement that increases with age. The main reason for this is hormonal changes that are a natural byproduct of aging. As we age, both men and women, our hormonal needs change, and therefore levels will normally vary as needed. The main categories of hormones in men are androgens (“male” hormones), estrogen (“female” hormones), and pituitary hormones. The main culprit that is suspected in BPH is an androgen called testosterone. Beginning in the thirties or forties, men begin to accumulate greater levels of testosterone in their prostate. This is due mainly to two factors:

  • Reduced ability to process and eliminate testosterone from the prostate.
  • Increased amount and effectiveness of an enzyme called 5-alpha-reductase that is responsible for converting testosterone into a more active form called dihydrotestosterone (DHT).

The main issues that result from an enlarged prostate are related to the narrowing of the urethra and the resulting interference with urine flow. As the “tunnel” narrows, it requires more and more pressure to push the urine effectively through the urethra and out of the body.

Other then getting older, there are certain risk factors that are associated with a greater incidence of BPH. Some of the more common ones include:

  • Race:  American and European men have a higher rate of BPH than Asian men. This is most likely due to diet (see below).
  • Family history:  Like so many diseases, if it runs in your family, you have a greater chance of developing an enlarged prostate than if it doesn’t.
  • Marital status:  Statistics tell us that married men are more likely to get BPH than single men. The reason is not known, but there does not appear to be any connection between the level of sexual activity and the rate of BPH.
  • Diet:  There is considerable research that indicates that diet plays a critical role in the incidence and degree of prostate enlargement. Three main dietary factors are believed to be crucial:
    • Avoidance of toxic chemicals in your food, such as pesticides and artificial preservatives. There is hard evidence that links such poisons as dioxin, hexachlorobenzene, and dibenzofurans to poor prostate health. In fact, that is probably the reason why the incidence of BPH, as well as many other diseases, has increased so greatly in recent decades. The best way to stay away from this junk is to eat organic, natural, whole foods.
    • Certain foods are excellent at promoting prostate health. Some specific ones are sunflower seeds and pumpkin seeds, which are high in zinc. Zinc is an important factor in prostate enzymes. Lycopene-rich vegetables are also very good at fighting BPH (and prostate cancer as well). Load up on cabbage family vegetables such as spinach and kale, as well as tomatoes, broccoli, and many kinds of berries. Flaxseeds or flaxseed oil is also high in fatty acids that help prevent swelling and inflammation of the prostate.
    • Some foods (and drinks) tend to interfere with the removal of testosterone from the body, and should be avoided. These include caffeine, alcohol (especially beer), and sugar.
    • Be careful of supplementing with testosterone. It is often promoted as a booster from everything to libido to energy levels, and at times it may be appropriate. But the fact is that statistically speaking, very few men have abnormally low levels of testosterone, and too much can contribute to BPH and other health problems.

What Complications Can Occur From BPH?

Our bodies have a wonderful way of compensating when things are not operating exactly as designed. As the prostate enlarges and urination becomes more difficult, the muscles of the bladder will strengthen in order to push harder in an attempt to overcome the situation. Sometimes this increased pressure will cause small blood vessels in the urethra and/or bladder walls to rupture, causing blood in the urine. However, as time goes on and the blockage becomes greater, it is common for the patient to be unable to completely empty the bladder. This can then become one of the key problems or complications of an enlarged prostate. When urine accumulates in the bladder, several things can happen, and none of them are good:

  • Urinary tract infections (UTIs) are able to occur more easily, due to stagnant urine in the bladder. A burning sensation and/or fever are clues that you may have a UTI.
  • Kidney stones may begin to form. These are a result of minerals in the urine that are not eliminated. Kidney stones can lead to infections, further blockage of the urinary tract, and can be very painful when passed.
  • Urinary retentionmay occur. This is when the urethra becomes completely blocked by an enlarged prostate, and it becomes impossible to eliminate urine from the body. This is not only an extremely uncomfortable situation, but can also be very dangerous, and medical treatment should be sought immediately.
  • On rare occasions, backed up urine can put undue pressure on the kidneys and cause kidney damage, although it is rarely permanent.

How Do I Know If My Prostate is Enlarged?

As with most things regarding modern medicine, there are a slew of available tests and procedures available to diagnose BPH, but there are two that are the most commonly used:

  • Digital Rectal Exam:  This involves your practitioner inserting a gloved finger into your rectum and feeling your prostate, which is located near the rear of your rectum, to determine if it is enlarged. This is also a great preliminary test to check for any lumps that could indicate prostate cancer.
  • Prostate-specific antigen (PSA):  This is a blood test that measures the presence of PSA, which is a substance produced by the prostate that is a component of semen. Small amounts are normally found in the blood, but elevated readings could indicate BPH or other prostate health issues including prostatitis (inflammation of the prostate) or prostate cancer.

What Treatments Are Available for BPH?

The allopathic route is, to no surprise, drugs and surgery. Just a word about one of the more common surgeries. If the prostate has enlarged to the point of totally blocking or greatly diminishing the flow of urine, surgical intervention is sometimes necessary. Learn everything you can about your options, and be sure that surgery is warranted. However, you should be aware that there are significant risks associated with a common prostate surgery called transurethral resection (TUR). One of the most disturbing is the potential for erectile dysfunction (the inability to maintain an erection) that may lead to impotence. While it only occurs in about 10% of cases, it is nevertheless a factor that you would want to be aware of and consider before undergoing TUR.

One of the most common drugs prescribed for BPH is called Poscar (finasteride), which can have considerable unpleasant side effects. The good news is that the use of the herb saw palmetto has been proven to be just as effective as Poscar, and much safer. Saw palmetto can also prevent the onset of BPH and contribute to better overall prostate health.

Many maladies of today are considered inevitable, but with proactive lifestyle choices BPH can be avoided in most cases, and managed well if it does occur. It starts when you’re young guys. The habits we build in our younger years will often dictate the quality of health in our senior years. The choice is yours men.

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