'Benign Prostate Hyperplasia', a male health problem that can be solved.

  Benign Prostatic Hyperplasia – BPH
        BPH is a condition that is common in middle-aged men and older. According to statistics, it is found that BPH can be found by 50% in men aged 40-60 years and up to 90% in men age over 80 years old. BPH is a health problem that can be just as annoying or frustrating to the point that it can become more serious, leading to various complications.      

   Prostate gland
      Prostate gland is one of the organs in the reproductive system found only in males, next to the bladder and around the proximal area of the urethra. The prostate gland is similar to a chestnut, 4 centimeters wide, 3 centimeters long, and 2 centimeters thick. It serves to produce fluids and nutrients that nourish the sperm to keep them healthy and intact to perform reproductive functions.        

    Causes of Benign Prostatic Hyperplasia
      The pathogenesis of BPH has not been clearly defined, but it is believed to be related to age and an imbalance in the serum levels of male and female hormones as people get older. Testosterone levels tend to be lower in older men. BPH symptoms are caused by the enlargement of the prostate gland, lead to the obstruction of urethra and bladder neck, thereby causing the following abnormal urination:
  Frequent urination both day and night,     
  Urinary incontinence,         
  Difficult urinating, need to push or strain to urinate, a weak flow of urine or dribbling urine stream,


    Trouble starting to urinate and once the urine has passed, it takes a long time to pass urine,
  Unable to completely empty the bladder.  
  Sometimes the symptoms get severely worse until the following symptoms develop: 

1. Unable to urinate, blood in urine (hematuria) caused by the rupture of the prostate blood vessels due to a need to push or strain to urinate. 
2. Urinary incontinence.       
3. Urinary retention from an incomplete bladder emptying.
4. Urinary Tract Infection (UTI) from the remaining of urine in the bladder.         
5. Formation of bladder calculi may occur in some cases.  
6. Deterioration of kidney function which is the most dangerous condition.         
 
Diagnosis
1. Diagnosis using the International Prostate Symptom Score (IPSS) which is a questionnaire asking about your urination, a popular universal prostate self-assessment and evaluation questionnaire that can be scored and classified patients into 3 categories according to the severity of symptoms; mild, moderate and severe respectively. The scores can be calculated as shown in the table.

After combining the scores from all 7 questions, 0–7 points are considered as asymptomatic or mildly symptomatic, 8-19 points are considered as moderately symptomatic, and 20-35 points are considered severely symptomatic.    
2. Diagnosis by a doctor      
2.1 A doctor will examine the rectum to see how big the prostate is using rectal examination, endoscopy or ultrasound.        
2.2 Blood test to exclude prostate cancer (PSA - Prostate Specific Antigen).

Current Treatment Guidelines for Benign Prostatic Hyperplasia.  

    Watchful waiting (active surveillance)
       This management strategy will be used in case of an enlarged prostate gland with no symptoms or mild symptoms without the presence of clinical complications. Watchful waiting can be used to assess and monitor whether an enlarged prostate is causing a health problem then treat accordingly.

   Medical Therapy (Pharmacotherapy)
Pharmacotherapy may be indicated in patients with mild to moderate symptoms and had been ruled out the possibility of prostate cancer. There are 2 types of medication.    
 
2.1 Medications used for shrinking the size of the prostate
        include 5-alpha reductase inhibitors. This enzyme (5-alpha reductase) stimulates the prostate to grow in size. When this drug (an enzyme inhibitor) is given, the prostate may shrink in size. However, this group of drugs may reduce sexual desire and performance. Other than that, it may reduce the serum level of prostate cancer markers (PSA - Prostate Specific 

2.2 Alpha blockers    
       is the class of medications works by relaxing smooth muscle such as the bladder neck muscles and the muscle fibers in the prostate. The relaxation of the muscles decreases the tightness of the prostate, thus improving urination.  But this group of drugs may have side effects that lower blood pressure.

   Surgery
    Surgical therapy might be recommended in patient with moderate to severe symptoms or presented with clinical complications. There are many types of surgery. The first choice of surgeries for BPH is Transurethral resection of the prostate (TURP) using a lighted scope to insert into a urethra and remove prostate tissue obstructing the urethra with an electrical loop to improve urine flow. In case of a significantly enlarged prostate, an open prostatectomy is generally required.   

    Prostate thermal therapy
    Prostate thermal therapy is performed to heat the prostate tissue through various source of heat including microwave, radio frequency, ultrasound wave or laser. The heat causes the prostate to shrink and widen the urethra.  Due to the high cost, this method is not quite popular nowadays.

    Herbal remedies
    Although, modern medicine used to treat BPH is effective, however there are side effects such as erectile dysfunction and decreased sex desire, low blood pressure. Therefore, “Saw Palmetto”, an evidence-based herbal medicine is currently being used as an alternative therapy for Benign Prostatic Hyperplasia (BPH).

What is Saw Palmetto?
   Saw Palmetto is an herbal remedy specifically for the enlarged prostate. Its botanical name is Serenoa repens. This herbal remedy has been studied for over 200 years and has been featured in both American and European Herbal Pharmacopoeia. Saw Palmetto is well recognized and most popular because it is as effective as modern medicine, safe and has no side effects that are detrimental to quality of life. According to medical research studies, Saw palmetto extract was shown to exert the following properties:         
 
     Improve symptoms in patient with mild to moderate benign prostatic hyperplasia, and alleviate difficulty urinating, improve ability to pass urine and urine flow, reduce a frequent need to urinate, especially at night.

      Improve quality of life. 

      Safe with no side effects. 

      Do not affect tumor markers in prostate cancer (PSA)

      No side effect on sexual performance and desire.

      Do not cause low blood pressure.    

Recommendations for men with benign prostatic hyperplasia

    Avoid drinking water before bed to reduce the number of times to visit a bathroom during the night.

    Reduce alcohol and coffee as they have diuretic effect and could exacerbate symptoms.
    Be cautious with certain medications, such as cold remedies or certain drugs for stomachaches, as they may worsen BPH symptoms.
    Frequent pelvic floor muscle training to improve control of urinary tract muscle function.