What Is Benign Prostatic Hypertrophy (BPH)?

As men age, many begin to suffer annoying urinary problems, frequent trips to the bathroom, waking at night to urinate, inability to fully empty the bladder, and increased sensations of urgency. These annoyances are often caused by benign prostatic hyperplasia.

The prostate is a walnut-sized gland that forms part of the male reproductive system. The gland is made of two lobes, or regions, enclosed by an outer layer of tissue. The prostate is located in front of the rectum and just below the bladder, where urine is stored. The prostate also surrounds the urethra, the canal through which urine passes out of the body.

Scientists do not know all the prostate's functions. One of its main roles, though, is to squeeze fluid into the urethra as sperm move through during sexual climax. This fluid, which helps make up semen, energizes the sperm and makes the vaginal canal less acidic.

It is common for the prostate gland to become enlarged as a man ages. Benign Prostatic Hypertrophy (BPH): Nonmalignant (noncancerous) enlargement of the prostate gland. It is also known as benign prostatic hyperplasia (also abbreviated as BPH).

As a man matures, the prostate goes through two main periods of growth. The first occurs early in puberty, when the prostate doubles in size. At around age 25, the gland begins to grow again. This second growth phase often results, years later, in BPH.

Though the prostate continues to grow during most of a man's life, the enlargement doesn't usually cause problems until late in life. BPH rarely causes symptoms before age 40, but more than half of men in their sixties and as many as 90 percent in their seventies and eighties have some symptoms of BPH.

As the prostate enlarges, the layer of tissue surrounding it stops it from expanding, causing the gland to press against the urethra like a clamp on a garden hose. The bladder wall becomes thicker and irritable. The bladder begins to contract even when it contains small amounts of urine, causing more frequent urination. Eventually, the bladder weakens and loses the ability to empty itself. Urine remains in the bladder. The narrowing of the urethra and partial emptying of the bladder cause many of the problems associated with BPH.

It is not clear whether certain groups face a greater risk of getting BPH. Studies done over the years suggest that BPH occurs more often among married men than single men and is more common in the United States and Europe than in other parts of the world. However, these findings have been debated, and no definite information on risk factors exists.

The cause of BPH is not well understood. For centuries, it has been known that BPH occurs mainly in older men. However, it has been noted that eunuchs (men who have had their testicles destroyed or removed) do not develop BPH. Furthermore, after castration, benign prostatic hyperplasia has been observed to regress. Since the presence of normally functioning testicles appears to be necessary for the development of BPH, it is supposed that the tumor tissue uses the androgenic (male) hormones differently than normal prostate tissue does. Although the tumor is benign (not cancerous), progressive growth of the tumor may cause significant obstruction of the urethra and interfere with the normal flow of urine.

Throughout their lives, men produce both testosterone, an important male hormone, and small amounts of estrogen, a female hormone. As men age, the amount of active testosterone in the blood decreases, leaving a higher proportion of estrogen. Studies done with animals have suggested that BPH may occur because the higher amount of estrogen within the gland increases the activity of substances that promote cell growth.

Severe BPH can cause serious problems over time. Urine retention and strain on the bladder can lead to urinary tract infections, bladder or kidney damage, bladder stones, and incontinence. If the bladder is permanently damaged, treatment for BPH may be ineffective. When BPH is found in its earlier stages, there is a lower risk of developing such complications.

Men who have BPH with symptoms usually need some kind of treatment at some time. However, a number of recent studies have questioned the need for early treatment when the gland is just mildly enlarged. These studies report that early treatment may not be needed because the symptoms of BPH clear up without treatment in as many as one-third of all mild cases. Instead of immediate treatment, they suggest regular checkups to watch for early problems. If the condition begins to pose a danger to the patient's health or causes a major inconvenience to him, treatment is usually recommended.

Since BPH may cause urinary tract infections, a doctor will usually clear up any infection with antibiotics before treating the BPH itself. Although the need for treatment is not usually urgent, doctors generally advise going ahead with treatment once the problems become bothersome or present a health risk.

Self-help measures may prove beneficial if the degree of obstruction is minimal. These include hot baths, avoiding alcohol or excessive fluid intake (especially at night), urinating upon the earliest urge to do so, and sexual activity or ejaculation on a regular basis. Herbalists suggest that saw palmetto berries and extracts may potentially ease prostate symptoms. Until the 1950s, saw palmetto berry tea was listed on the U.S. national formulary as a treatment for BPH. Although saw palmetto (and all other herbs) later fell out of favor among physicians in the United States, European physicians continued to explore its potential benefits. In present-day Germany, saw palmetto (along with nettle root and a few other herbs) is virtually the only medication used for BPH.

Saw palmetto extract has become the sixth best-selling herbal dietary supplement in the United States. In Europe, several pharmaceutical companies sell saw palmetto-based over-the-counter (OTC) drugs for treating benign prostatic hyperplasia.

Saw palmetto berries contain sterols and fatty acids, especially beta-sitosterol-3-D-glucoside, together with anthranilic, caffeic, and chlorogenic acid; tannin; sugars; flavonoids; and polysaccharides. Although the pharmacologically active constituents are known to reside in the lipo-philic fraction of saw palmetto, precisely which constituents are most active remains unknown.

Saw palmetto has also been used to relieve difficult urination that may be associated with BPH and to relieve the symptoms of an irritable bladder. Nettle root and African plum tree bark (pygeum) have both been approved in Europe for treatment of BPH and have been widely used there for over 20 years.

  • Prostate Enlargement: Benign Prostatic Hyperplasia. NIH Publication No. 02-3012. The National Kidney and Urologic Diseases Information Clearinghouse

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