Benign prostatic hyperplasia in the actual sense is not yet a problem, as long as the men affected by it have no problems urinating. Only when the prostate, due to the benign cell proliferation, presents too great a drainage resistance for the urinary bladder and, as a result, there are problems with urination, can the pressure on the urinary bladder become a real source of suffering for patients.
What is benign prostatic hyperplasia?
Benign prostatic hyperplasia refers to the benign enlargement of the prostate gland as a result of cell proliferation in men, which is widespread and mainly affects older men. Statistically, it can be said that with advancing age, the probability of prostate enlargement also increases. In the group of men aged 65 and over, 65 percent have an enlarged prostate and in men aged 90 and over, the figure is as high as 90 percent. The biggest problem with an existing benign prostatic hyperplasia is usually the so-called micturition disorder, a problem with urination, which can even lead to urinary retention, a complete inability to empty the bladder, in the case of a severely enlarged prostate.
Causes
Today, it is still not clearly understood what exactly causes benign prostatic hyperplasia, but there is evidence to suggest that age-related changes in male hormone balance are causally responsible for the cell increase. Under discussion is the shift in the ratio of male and female hormones with increasing age. Due to the decrease in testosterone levels and a constant estrogen level, an excess of estrogen develops over the years, which could lead to a slowing down of the natural death of prostate cells. The proliferation of glandular tissue could be caused by an increased concentration of the steroid hormone dihydrotestosterone (DHT), which is synthesized from testosterone with the help of a certain enzyme, 5-alpha-reductase. Apart from DHT, however, numerous other growth factors can be considered as causes of benign prostatic hyperplasia.
Symptoms, complaints, and signs
Benign prostatic hyperplasia does not cause symptoms itself. These arise exclusively from the displacement processes due to the enlargement of the prostate. The extent to which the existing symptoms have medical significance depends on the current stage of the disease. In stage I, there is often an urge to urinate at night and difficult urination. During urination, there are voiding dysfunctions and irritable symptoms. The urinary stream is weakened. It takes longer for the bladder to empty again. The irritable symptoms are manifested by pain during urination and a frequent urge to urinate. However, no residual urine remains in the bladder at this stage. Although this is not yet a disease, the quality of life is often limited. In stage II, there is already residual urine formation with more than 50 milliliters of urine. Urination begins late and is constantly interrupted. In the third stage, the bladder overflows. Bladder stones can even cause urinary retention, which leads to congestive kidney disease. Urinary retention is a medical emergency that requires immediate treatment. If prolonged, the kidneys fail. Veins become congested in the bladder outlet area. They can rupture and cause macrohematuria (blood in the urine). Urinary tract infections are further favored. In case of prolonged urinary dysfunction, the so-called bar bladder develops due to strengthening of the bladder muscles. Since the bladder is no longer fully contractile, urinary incontinence then develops.
Diagnosis and course
To make the diagnosis of benign prostatic hyperplasia, a digital examination of the prostate is first indicated. “Digital” in this context stands for the Latin word “digitus,” which translates as “finger.” The palpation of the prostate is performed from the rectum using the finger. This is often followed by an ultrasound examination, with the ultrasound device also approaching the prostate via the rectum. The urinary tract and the constriction of the same are of particular interest in benign prostatic hyperplasia, because an excess of residual urine in the bladder can be the cause of infections of the urinary bladder and also of the kidneys.Uroflowmetry, a method in which the patient urinates into a special funnel with a measuring device, can be used to measure the urine outflow per unit of time during urination. If the value is too low, this indicates urinary flow obstruction, since the enlarged prostate constricts the urinary bladder on the one hand and represents an increased outflow resistance on the other. If there is evidence of an enlarged prostate, the tumor marker is determined by means of a blood test, in addition to several other markers, in order to rule out a malignant change in the prostate gland. However, if this is elevated, a tissue sample should be taken from the prostate, which is generally quite easy to obtain, similar to ultrasound examination of the organ. If the cell increase is benign in nature, surgery may still be indicated at a later stage if the organ does not respond to drug therapy or if the prostate mass threatens to cause urinary retention.
Complications
Benign prostatic hyperplasia can involve several complications. The enlarged prostate always leaves some residual urine in the bladder and urethra. This creates a high risk of inflammation and urinary tract infections. In the worst case, the pathogens can spread into the bloodstream and attack the entire body. Urosepsis occurs, which leads to death in over 50 percent of cases if left untreated. It also promotes the formation of urinary stones. This causes urine to back up to the kidney, which can also become inflamed as a result. This can lead to kidney failure (renal insufficiency), which severely impairs the quality of life. The kidney can no longer perform its functions and urinary substances are no longer excreted. This can lead to poisoning of the blood (uremia), which can result in a coma and ultimately death. The fluid and salt balance is also thrown into confusion. Edema develops and the affected person suffers from high blood pressure (hypertension). In addition, the hormones produced in the kidney are missing, the body suffers a disturbance of blood formation and thus anemia. Benign prostatic hyperplasia can also lead to a bar-like thickening (hypertrophy) of the urinary bladder wall, a bar bladder is the result. This again increases the risk for urinary tract infection and urinary retention with subsequent kidney failure.
When should you go to the doctor?
Benign prostatic hyperplasia is, as the name “benign” already indicates, an essentially benign disease, which, however, should result in a visit to the doctor in case of suspicion, in order to exclude cancerous tumors of the prostate. After that, visits to the doctor are often not necessary at first, since the hyperplasia usually progresses very slowly and the typical symptoms such as difficult bladder emptying due to narrowing of the urinary stream only slowly become more apparent. Even after a confirmed initial diagnosis, it is quite possible to let a longer period of time pass until the next visit to the doctor or a possible operation, if the symptoms are still within a reasonable range and the quality of life of the affected person is not noticeably restricted. However, a visit to the doctor should be scheduled if significant restrictions in urination occur. If the benign prostatic hyperplasia is at this stage, surgical treatment should be considered to avoid the risk that residual urine remaining in the urinary tract system can promote infections by bacteria. The family doctor or treating urologist should also be consulted in the event of new or severe symptoms. Such signs include pain or burning when urinating, blood in the urine, and a feeling of pressure or pain in the abdomen or back, and the combination with fever and a general feeling of illness should be taken particularly seriously. In addition, a visit to the doctor is advisable if a patient with benign prostatic hyperplasia suffers from impotence.
Treatment and therapy
From a medical point of view, an enlarged prostate alone is not yet a reason for therapy. Only when micturition disorders occur as a result of the enlargement, which limit the patient’s quality of life, are therapeutic measures indicated. Initially, an attempt can be made to improve the symptoms with the help of herbal preparations. Products with saw palmetto or pumpkin extract, as well as rye pollen and pine or spruce extracts are often used here.If the enlargement is already too advanced, so-called alpha receptor blockers can be used. These drugs cause the prostate to relax, which reduces outflow resistance and facilitates urine flow. On the one hand, this leaves less residual urine in the bladder, which reduces the risk factor of infections, and on the other hand, the improved urine output also leads to a decrease in the frequency of urination. Furthermore, 5-alpha-reductase inhibitors are available. These are able to shrink the organ by up to 30 percent. However, temporary erectile dysfunction must be expected while taking the drug. Of course, there is also the possibility of surgical intervention by means of a scalpel or even modern laser surgery, which is unavoidable if urinary retention is imminent, not only because of the risk of kidney failure.
Outlook and prognosis
The outlook for cure of benign prostatic hyperplasia is based on the severity of the disease. In many patients, no further health complaints are noted in everyday life, so there is no need for treatment or impairment of lifestyle. If the prostate continues to enlarge, there are disturbances in sexuality and urination. Patients are usually assisted with natural aids during this phase of the disease. Medicinal treatment can also be used. However, natural remedies have so far proven to be more effective. They have a good effect and are free of side effects. A cure of benign prostatic hyperplasia does not take place despite the therapy. The alleviation of the secondary symptoms is achieved to a considerable extent and is often sufficient. In severe cases, the growth of the prostate can no longer be stopped. Surgical intervention is necessary to prevent further damage to the organism or to endanger health. Through it, a reduction of the symptoms takes place. Older men are most often affected by the disease. The probability of suffering from other diseases is very high in people over 60 years of age. Despite the operation, this worsens the prospects of freedom from symptoms and increases the risk of possible complications.
Prevention
To prevent benign prostatic hyperplasia, due to the fact that the exact causes are not yet known, only general advice for a healthy lifestyle can be given. A healthy diet, low alcohol consumption and avoidance of tobacco products are just as important as sufficient exercise. From the age of 50, annual prostate screening is recommended. Although benign prostatic hyperplasia cannot be prevented, malignant changes in the organ can be detected at an early stage.
What you can do yourself
If the prostate has not yet enlarged very much and the symptoms are only mild, natural substances are offered on the market to support prostate function. However, a positive effect of pumpkin seeds and Co. on the prostate has not been proven so far. The only exception can be dried saw palmetto fruits, which are taken in the form of capsules. Important for the healthy function of the prostate is a sufficiently high testosterone level. For this purpose, a balanced diet rich in amino acids (especially contained in tuna, cottage cheese, eggs, oatmeal and nuts) and sufficient sleep is sufficient. Also, scientific studies have confirmed that frequent ejaculations improve prostate function. Enough exercise and a normal body weight also contribute to a healthy prostate. After prostate surgery, spicy foods, carbonation, cigarettes and alcohol should be avoided, as these make the urine more “acidic” and thus when flowing through the wound, can delay healing. Abstinence from alcohol improves the intensity of the urine stream, so that a negative effect of high alcohol consumption on the prostate can generally be assumed.