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Enlarged Prostate
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“The silent condition”

The prostate is a small organ about the size of a walnut. It lies below the bladder (where urine is stored) and surrounds the urethra (the tube that carries urine from the bladder). The prostate makes a fluid that becomes part of semen. Semen is the white fluid that contains sperm.

Prostate problems are common in men 50 and older. Most can be treated successfully without harming sexual function. A man's prostate gland usually starts to enlarge after he reaches age 40 years or middle age. This condition is called benign prostatic hyperplasia (BPH).

The function of the prostate gland is to secretes a fluid that is discharged with sperm. The gland itself surrounds the urethra, which is the tube that carries urine from the bladder out through the tip of the penis (see Media file 1). As the prostate grows larger, it may press on the urethra. This narrowing of the urethra can cause some men with prostate enlargement to have trouble with urination. Prostate enlargement may be the most common health problem in men older than 60 years.

What is benign prostatic hyperplasia?

Benign prostatic hyperplasia is non-malignant (non-cancerous) enlargement of the prostate gland, a common occurrence in older men. It is also known as benign prostatic hypertrophy and abbreviated as BPH and as nodular hyperplasia of the prostate.
Enlarged Prostate Causes
The prostate gland, which is normally about the size and shape of a walnut, wraps around the urethra between the pubic bone and the rectum, below the bladder. In the early stage of prostate enlargement, the bladder muscle forces urine through the narrowed urethra by contracting more powerfully. As a result, the bladder muscle becomes thicker and more sensitive, causing a need to urinate more often.

As the prostate grows larger and the urethra is squeezed more tightly, the bladder might not be able to fully compensate for the problem and completely empty. Very rarely, a blockage from prostate enlargement may cause repeated urinary tract infections and gradually result in bladder or kidney damage. It may also cause a sudden inability to urinate (acute urinary retention)—a medical emergency.

Enlarged Prostate Symptoms

Many men with an enlarged prostate have no symptoms. Common symptoms may include the following:

  • A weak stream of urine when stopping and starting of the stream

  • Difficulty starting urination

  • Dribbling of urine, especially after urinating

  • A sense of not emptying the bladder

  • Leaking of urine

  • More frequent urination and a strong and sudden desire to urinate, especially at night

  • Blood in the urine

  • Weight loss helps

If you have a beer belly, losing it may reduce the odds of developing aggressive prostate cancer or prostate enlargement. M. D. Anderson Cancer Center study of 526 prostate cancer survivors found that men who were obese at age 40 and at the time of diagnosis (20 years later, on average) were twice as likely as their leaner peers to see their PSA (prostate specific antigen) levels rise after treatment--a sign of cancer recurrence. Weight gain over time alters hormones and may create an environment that breeds aggressive changes in the prostate gland. Researcher Sara Strom, PhD. Losing weight, especially with a low-fat diet and exercise, may help reduce the risk, she adds.

Can herbs help

Scientific research can be a slow process. It starts with simple observation, followed by the collection of scientific data. A few years ago, an Austrian herbalist named Maria Treben wrote a bestselling book that was translated into English as Health Through God's Pharmacy (Ennsthaler, 1998). In it, she recommended a tea prepared from the small-flowered willow herb (Epilobium parviflorum) as an effective treatment for benign prostatic hyperplasia (BPH), or prostate enlargement. The herb became very popular in Europe, but there was no evidence to support its value.

Scientists have now isolated compounds known as oenotheins from the Epilobium species and, in test-tube experiments, have shown them to inhibit the enzymes aromatase and 5-alpha-reductase, both of which are involved in prostate enlargement. Clinical studies have not yet been carried out, but the signs are hopeful that the traditional use of this herb will be validated. Willow herb is not yet widely available in the US

Herbal alternatives for treatment

Naturopaths and herbalists have used both nettle and Saw Palmetto to ease frequent urination and bladder irritation in men, which are symptoms of the enlargement of the prostate known as benign prostatic hyperplasia (BPH).

What We Know

A review of 18 saw palmetto studies published in the Journal of the American Medical Association concluded that the herb alleviates urinary tract symptoms 28% better than placebos do. In a German study of 246 BPH sufferers, men taking nettle had 24% fewer symptoms, such as urinary infections, than placebo takers. The German government has approved both plants for BPH treatment.

Russian and German researchers asked 257 men with BPH to take two daily doses of either a supplement containing 160 mg of saw palmetto and 120 mg of nettle, or a placebo pill. After 6 months, the supplement group reported that symptoms such as sudden urges or frequent nighttime trips to the bathroom decreased by 35%, while the placebo group noted a 24% drop. Side effects, such as diarrhea and shortness of breath, were rare.

Others studies have suggested that both Saw palmetto and nettle can inhibit an enzyme that drives prostate enlargement. Saw palmetto is also used in the treatment of symptoms related to benign prostatic hyperplasia. The active component is found in the fruit of the American dwarf palm tree. Studies have demonstrated the effectiveness of saw palmetto in reducing symptoms associated with benign prostatic hyperplasia. Saw palmetto appears to have efficacy similar to that of medications like finasteride, but it is better tolerated and less expensive. There are no known drug interactions with saw palmetto, and reported side effects are minor and rare. No data on its long-term usage are available. The herbal product also has been used to treat chronic prostatitis, but currently there is no evidence of its efficacy. (Am Fam Physician 2003;67:1281-3.)

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