BPH-Benign Prostatic Hypertrophy
Prostate Enlargement—What It Is, What It Does, How It’s Treated
Nov 10, 2008
It’s almost universal that as a man gets older his prostate begins to cause trouble. It may start as early as age 40, but usually by age 60 a man finds he is annoyed at times by the natural need to empty his bladder. What’s going on? he may ask.
His doctor may diagnose benign prostatic hypertrophy (BPH).
Anatomy
The prostate gland is about the size of a walnut. It’s positioned in front of the urinary bladder. Here’s the basic anatomy: Urine is made in the kidneys, located in the back just under the rib cage. Urine flows down to the bladder at the bottom of the abdomen, where it is stored until it can be conveniently released. The path of release is through the urethra, a tube that goes through the prostate and the penis in the male.
Function
The urethra is also the pathway for sperm and associated reproductive materials. The prostate contributes to the reproductive materials.
What’s Going On
As can be seen, the prostate has nothing to do with the production and elimination of urine. So why does it cause so much annoyance related to urination?
The traditional explanation is that as the prostate enlarges with age, it squeezes down on the urethra, much as a clamp might squeeze a garden hose. The hose then will have a decreased force of flow at the nozzle. This does happen in BPH, and causes obstructive symptoms. These are mostly decreased force of stream and dribbling at the end of urination.
What many men find more annoying are the irritative symptoms. These are the urgent need to urinate and awakening from sleep to urinate. Frequent urination can also be an irritative symptom, although sometimes it is the result of advanced obstruction. Irritative symptoms come from hyperactivity of the bladder—the bladder squeezes down, which sends insistent alerts to the brain to get to a toilet. Why enlargement of the prostate causes this reflex is not really understood.
The constellation of symptoms BPH can cause is called Lower Urinary Tract Symptoms (LUTS). LUTS can also be caused by some medicines, neurological diseases, infections, and problems in the bladder.
What You Can Do To Improve BPH Symptoms
Physical Activity. Scientists pooled the results of eight studies and found that men who regularly had moderate or heavy physical activity were about 25% less likely to have LUTS. Another study showed that running longer distances reduced BPH symptoms.
Saw palmetto. Studies have shown little benefit in flow measurements, yet some men benefit from Saw Palmetto.
Diet. A study of over 800 men with BPH found that they were more likely to have a diet higher in fat and with fewer vegetables than comparable men. They were also less likely to have moderate alcohol use. Taking antioxidants made no difference. The scientists concluded, “A diet low in fat and red meat and high in protein and vegetables, as well as regular alcohol consumption, may reduce the risk of symptomatic BPH.” (American Journal of Epidemiology, 2008, v 167, pgs 925-934).
Medical Ways to Improve BPH Symptoms
Here are some topics you might want to discuss with your medical care provider.
Medications to reduce obstruction. Most of these help relax the sphincter muscle at the bladder. This can reduce the total resistance to urine outflow. Adverse events (side effects) can include a dangerous fall in blood pressure, urine leakage, and interference with some types of glaucoma, among other effects. These medications also have been implicated in “floppy iris syndrome” during cataract surgery.
Medications to reduce prostate size. These medications require longer-term use to reduce symptoms.
Possibly In the Future?
Sildenafil (Viagra) improved symptoms in 75% of men in one preliminary study. Whether this leads to a new approach to treating LUTS remains to be seen.
