Benign Prostatic Hyperplasia (BPH): Causes, Symptoms & Treatment

Overview

Benign Prostatic Hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland, commonly affecting men over the age of 50. The prostate surrounds the urethra, and its enlargement can compress the urethra, leading to urinary difficulties. BPH is not linked to prostate cancer but can significantly impact quality of life. In India, BPH affects a large proportion of aging men, with prevalence increasing with age.

Causes

The exact cause of BPH is not fully understood, but it is believed to be related to hormonal changes associated with aging. Key factors include:

• Age: Risk increases significantly after age 40.
• Hormonal Imbalance: Changes in levels of testosterone and dihydrotestosterone (DHT) play a role.
• Genetics: Family history may increase risk.
• Lifestyle: Obesity, lack of exercise, and diet high in red meat may contribute.

Symptoms

Symptoms of BPH can range from mild to severe and may include:

• Frequent urination, especially at night (nocturia)
• Urgency to urinate
• Weak or interrupted urine stream
• Difficulty starting urination
• Dribbling after urination
• Inability to empty the bladder completely

Diagnosis

Diagnosis typically involves:

• Medical History and Symptom Assessment: Using the International Prostate Symptom Score (IPSS) questionnaire.
• Digital Rectal Exam (DRE): To assess prostate size and texture.
• Urine Tests: To rule out infection.
• Blood Tests: PSA (Prostate-Specific Antigen) to screen for prostate cancer.
• Imaging: Ultrasound or MRI to measure prostate size.
• Urodynamic Tests: To evaluate bladder function.

Treatment Options

Lifestyle Modifications

Mild cases may be managed with lifestyle changes: reducing fluid intake before bed, avoiding caffeine and alcohol, and practicing double voiding.

Medications

Common medicines include:

• Alpha-blockers: (e.g., tamsulosin, alfuzosin) relax prostate and bladder neck muscles.
• 5-alpha-reductase inhibitors: (e.g., finasteride, dutasteride) reduce prostate size over time.
• Combination therapy: For better symptom control.

Minimally Invasive Procedures

Options like transurethral microwave thermotherapy (TUMT) or laser therapy may be used.

Surgery

Transurethral resection of the prostate (TURP) is the gold standard for severe cases.

Prevention

While BPH cannot always be prevented, a healthy lifestyle may reduce risk:

• Maintain a healthy weight
• Exercise regularly
• Eat a diet rich in fruits, vegetables, and healthy fats
• Limit red meat and processed foods
• Stay hydrated but avoid excessive fluids before bed

Ayurvedic Perspective & Remedies

In Ayurveda, BPH is often correlated with Mutrakricchra (difficulty in urination) due to imbalance of Vata and Kapha doshas. Ayurvedic management focuses on:

• Herbal Remedies: Punarnava (Boerhavia diffusa), Gokshura (Tribulus terrestris), and Varuna (Crataeva nurvala) are commonly used for their diuretic and anti-inflammatory properties.
• Panchakarma: Therapies like Basti (enema) and Uttara Basti (medicated enema through urethra) may be recommended under expert supervision.
• Dietary Advice: Avoid spicy, oily foods and alcohol. Include pumpkin seeds, flaxseeds, and warm water.
• Yoga and Pranayama: Specific asanas like Pavanamuktasana and Bhujangasana may help improve pelvic circulation.

Always consult a qualified Ayurvedic practitioner before starting any treatment.