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
