Sewa Mandir Foundation: ENLARGED PROSTATE

The prostate is a reproductive gland in male. It is situated just below the urinary bladder in front of rectum. Of very small size at the time of birth attains size of a walnut and weigh 20 gram by the age of 20 years and remains stable till age 40. The urethra that joins the urinary bladder to exterior helps discharging out urine passes through the prostate.

The prostate squeezes fluid into the urethra as sperms move through during sexual climax. This fluid in semen energizes the sperms and makes the vaginal canal less acidic.

The second phase of growth of prostate usually begins around the age of 45 and often results in benign prostatic hyperplasia or hypertrophy (BPH) in later age. It is not cancer, and it does not increase risk for prostate cancer. It is common to almost all men as they get older. The growth occurs in the central part of the gland pressing on the urethra resulting in urinary trouble but there is no definite relation between the extent of enlargement and severity of symptoms.

Causes

The actual cause of prostate enlargement is not known. There are different theories and explanations. Aging and the testicles may be affecting the growth of the gland. It has been observed men who have had their testicles removed at a young age (for example, as a result of testicular cancer) do not develop BPH. Also, if the testicles are removed after a man develops BPH, the prostate begins to shrink in size.

Men produce testosterone a male hormone and small amounts of estrogen, a female hormone. With age the amount and active testosterone in the blood decreases, leaving a relative higher proportion of estrogen. Studies suggest that BPH may occur because the higher amount of estrogen within the gland increases the cell growth.

The dihydrotestosterone (DHT) derived from testosterone in the prostate gland gets accumulated in it and stimulates its growth. The men who do not produce DHT do not develop BPH.

Symptoms

BPH by itself is not a serious condition unless symptoms interfere with daily activities. Less than 50% of all men with BPH have symptoms of the disease, which include:

Dribbling at the end and after urinating,

Hesitancy, has to wait to start to urinate and stream becomes feeble,

Incomplete emptying of bladder so one needs to strain to urinate and gets frequent urge,

Incontinence – inability to control urine, strong and sudden urge for urine,

The patient wakes two or more times for urination every night,

Painful and bloody urine indicate infection

The size of the prostate does not always determine the severity of the obstruction or the symptoms. Some men with great enlargement of the gland have little obstruction and few symptoms while others with lesser enlargement have more blockage and greater problems.

Sometimes a man remains trouble free until he suddenly finds himself unable to urinate at all. This acute urinary retention may be triggered by taking some cold or allergy medicines as due to their side effect the bladder failed to contract from relaxing and empty urine. In case of partial obstruction urinary retention also can be brought on by alcohol, cold temperatures, or a long period of immobility.

Doctor must be told about the above said urinary problems so that he can rule out other conditions, including prostate cancer.

If remains untreated certain complications as urine retention and strain on the bladder can lead to urinary tract infections, bladder or kidney damage, bladder stones and incontinence—the inability to control urine. 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.

Diagnosis

The symptoms generally indicate Benign Prostatic Hypertrophy but following tests confirm the diagnosis:

Per rectum examination, ultra sonography to confirm size and weight of the prostate gland, Post-void residual urine test to see how much urine is left in the bladder after urination which harbor infection and causes early filling of bladder hence frequency of urine. Urine flow rate and pressure flow studies to measure the pressure in the bladder during passing of urine, routine urinalysis and culture to check blood and infection in urine. Prostate specific antigen (PSA) in blood is tested to screen for prostate cancer. Cystoscopy reveals pathology in urinary bladder.

Treatment

Treatment options include "watchful waiting," lifestyle changes, medication or surgery. Unless there are severe symptoms it is better to wait and watch. Patient should have regular checkups to watch if condition is not getting worse. Other diseased condition should also be ruled out.

Self care is necessary for mild symptoms but also physician should be consulted:

1. Don’t postpone the urge to urinate. Keep bladder empty to reduce chances of infection.

2. Drink plenty of fluid but spread it throughout the day. Avoid drinking fluid within 2 hours of bed time.

3. Don’t take alcohol and caffeine, especially after dinner.

4. Exercise regularly and keep warm. Lack of physical activity and cold weather increases symptoms of BPH. Perform pelvic strengthening exercises.

5. Reduce stress. Frequency of urination increases with tension, apprehension and nervousness.

If self-care for 2 months does not give relief consult the physician for further treatment.

Homoeopathic Medicines –

Some of the commonly indicated homoeopathic medicines for BPH are –

Aloe s., Baryta carb., Benzoic ac., Conium, Digitalis, Ferrum pic., Iodinum, Nux vom., Prostate gland, Sabal ser., Selenium, Staphysagria, Sulphur, Thuja.

Also Chimaphila um., Oxydendron., Populus tr., Senecio, Solidago etc.

· With constipation – Arnica, Silicea.

· With involuntary urination – Iodium, Pareira br.

· With retention of urine – Apis, Belladona, Benz. ac., Cactus g., Chimaphila um., China, Conium, Digitalis, Ferrum met., Hyoscymus, Kali iod., Merc. dul., Morphinum, Pareir, Pulsatilla, Sabal ser., Sepia, Staphysagria, Stramonium, Triticum v., Zincum met.

· Dribbling urine after stool or urination – Selenium.

· After sexual excess – Thymol.

Few conditions and related medicines are indicated but some other medicine may be prescribed by the physician as indicated by patient’s condition.

Surgery

With homoeopathic treatment BPH rarely require surgery. Surgery is generally indicated in case of retention of urine or incontinence. Both the situations can be treated with indwelling catheter for a short time and homoeopathic treatment to reduce infection, inflammation and enlargement of the prostate. A case may need surgical intervention only if does not respond to medicines.

Prostate, now is operated through urethra. Operation by opening abdomen is done in case it is not possible through urethra. In less invasive methods different types of heat is used to destroy prostate tissues.

Radiofrequency energy - transurethral needle ablation (TUNA),

Microwave energy - transurethral microwave thermotherapy (TUMT),

Electrical current - transurethral electro-vaporization of prostate (TUVP),

Hot water - water-induced thermotherapy (WIT) and Laser -interstitial laser coagulation (ILC) and holmium laser enucleation of the prostate (HoLEP) are some methods under trial.

They are useful in elderly patient, cases with diabetes mellitus, serious heart, kidney, lung or liver disease or patient taking blood thinning drugs.

Even after surgical treatment BPH may recur over a period of time. Therefore homoeopathic medical management is preferable.

Case –

Mr. R. S. 60 yrs. male married Hindu vegetarian (now).

Diagnosis – Prostatic Enlargement (weight 82 gms), Prostatic Specific Antigen – 11.52 µg/dl. Diabetes mellitus. Urinary tract infection. Hypertension. Fungus between toes.

Since last 5-6 yrs. often burning at urethral opening after urination. Urinary frequency at night if sleepless for some reason or at change of weather otherwise wakes twice every night for urine.

Sensation of swaying sometimes while sitting or walking since 2001. Taking Aspirin 75mg., parastat 50 once a day.

Known diabetic since 8 years. Controlled with Metformin 100 mg. H/o loss of weight so diagnosed diabetes. Present weight – 80 kg.

Outer side of left hip and thigh is sensitive to touch and rub. Diagnosed lumber spondylitis.

Wetness and itching with peeling of skin in webs of toes.

Sleepless until 1 a. m.. Dreams strange – unrelated to daily life, frightful – shrieks during sleep, unremembered. Talks aloud during sleep. Snoring.

Likes buttered milk, sweets (after diabetes), Alcohol stopped after joining a religious group. Averse milk. Was normal but chilly since one year.

The patient presents himself polite but is proud, egoistic – imposes views. Worried but said that he did not care.

Obese, dark rough skin. Weight 80 kg. Blood pressure 130/80 mm Hg.

19/08/10 Rx 1. Pulsatilla 200 two doses at 10 minutes interval every week

2. S. L. 0/3 10 drops twice a day in a table spoon of water.

3. Advised to test blood glucose fasting and Post prandial.

04/09/10 No episode of burning urethra. Lower lip tingling, biting and sensation of swelling. Papular eruption on right cheek.

Rx 1. Mercurius sol. 200 two doses at 10 minutes interval every fortnight.

2. S. L. 0/3 10 drops twice a day in a table spoon of water.

02/10/10 Urinary frequency and burning off and on. Stream feeble.

Rx 1. Merc.sol 1M two doses at 10 minutes interval every fortnight

2. S. L. 0/3 10 drops twice a day in a table spoon of water.

16/10/10 Cold and cough – dry then white expectoration. Papulo-pustular eruption on scrotum, itching aggravated by scratching.

Rx 1. Platina 1 M two doses at 10 minutes interval fortnightly.