Friday, 26 March 2010 12:20 Last Updated on Monday, 21 June 2010 08:31 Written by Deborah Grant BSc(Hons) Herb.Med

Benign Prostatic Hyperplasia (BPH) or enlarged prostate is a benign (non-cancerous) disease of the prostate gland, which, if left untreated, can lead to medical complications including kidney and bladder damage.

If BPH is diagnosed and treated early, there is a lower risk of developing these complications. Enlargement of the prostate typically affects men as they age and causes pressure on the urethra. This can lead to difficulty in passing urine, frequent trips to the bathroom at night and pain associated with sexual function. BPH is not a life-threatening disease but it is likely to negatively impact a man's quality of life.

What is the Orthodox Medical Treatment of BPH?

Drug treatment:

There are two main classes of drugs that are prescribed for BPH.

• Alpha-blockers relax the muscles at the neck of the bladder and in the prostate, thereby reducing the pressure on the urethra and so helping increase the flow of urine. They do not cure BPH but help to alleviate some of the symptoms. Around 60% of men find symptoms improve significantly within the first 2-3 weeks of treatment. The most common side-effects of alpha-blockers are tiredness, dizziness and headaches.

• 5-alpha-reductase inhibitors work by inhibiting the production of a hormone called DHT (dihydrotestosterone), which may contribute to prostate enlargement. The role of DHT is not yet fully understood. Finasteride is the most commonly used drug of this type for BPH. These drugs can slow down the progression of BPH by suppressing the production of DHT. They decrease prostate volume and in doing so they improve symptoms and urinary flow, and decrease the risks of urinary retention and delay the need for BPH related surgery. The most common side-effects of finasteride include a reduced sex drive, difficulty in maintaining an erection and ejaculatory dysfunction. Also, several months of treatment may be needed before the benefit is noticed

Surgery:

• Transurethral resection of the prostate (TURP) is the most common operation for BPH. A precisely controlled electric current, applied by a loop of wire at the end of the resectoscope, is used to shave off sections of the enlarged prostate. A common side-effect of this procedure is retrograde ejaculation - where semen passes into the bladder during orgasm instead of out of the penis, which may reduce fertility. Complications of the operation can include urinary incontinence or damage to the urethra, resulting in a "stricture" that can itself cause difficulty passing urine. Transurethral incision of the prostate (TUIP) may be appropriate for men who have a less enlarged prostate. It is a quicker operation than a TURP and involves removing less tissue.

• Open Prostatectomy: This is only recommended for men whose prostate is very large. It is a major operation and carried out under a general anaesthetic. An incision is made in the lower abdomen in order to remove the central part of the prostate. Laser therapy (using a laser probe to cut away prostate tissue) and transurethral microwave thermotherapy (using heat to remove some of the prostate tissue via a probe) are becoming more common in the treatment of BPH

What are the natural treatments for Enlarged Prostate?

Since widespread media coverage of the successful clinical trials of the herbal treatment of BPH, increasing numbers of men are turning to it for a safe and effective alternative to the pharmaceutical approach to medically diagnosed Benign Prostatic Hyperplasia (BPH).

Saw Palmetto (Serenoa repens) is the mainstay of the herbal treatment to support prostate health. This herb has been safely and effectively used for hundreds of years to maintain prostate health and tradition is now being underpinned by scientific research, which has been widely and favourably reported in the media. In fact, many men are now taking it as a preventive measure to help avoid prostate problems. Evidence supports Saw Palmetto’s use for BPH.

A recent updated review of the clinical trials concluded that Saw Palmetto improves urological symptoms and urinary flow measures compared with placebo, and that Saw Palmetto produces similar improvement in urinary symptoms and flow when compared to the drug finasteride but is associated with fewer adverse treatment events. Saw Palmetto is usually prescribed along with other medicinal plants to decrease the size of the prostate. This approach is proving to be very effective for men, who have either been diagnosed with BPH or who simply want to support prostate health.

It is worth noting that the NHS website states the following with regard to the treatment of BPH:

"A number of plant extracts are popularly used to alleviate BPH, although formal evidence that they are effective is often scanty. However, there is some scientific evidence that an extract of saw palmetto (called Serenoa repens) can be beneficial ..."

"Serenoa repens produced similar improvement in urinary symptoms and flow compared to finasteride and is associated with fewer adverse treatment events."

What are the side effects of Saw Palmetto?

Saw Palmetto is well tolerated by most patients and causes relatively few side-effects. Most side-effects are minor gastrointestinal problems, such as nausea, which are usually resolved when the herb is taken with meals.

What's the best kind of Saw Palmetto?

For the effective treatment of BPH, it is important to use an extract of Saw Palmetto, which states on the label exactly how much of the important active chemical constituents are in it. Many over the counter and online remedies and  are not of sufficient therapeutic strength or quality to aid prostate health. Without this verification, the herb will not provide the required therapeutic action. Saw palmetto works best in a formulation with other plant extracts, specifically for the urinary tract.

For the best treatment outcome, it is advisable to take high strength, prescription-only Saw Palmetto, which can be obtained after a consultation, which takes into consideration all aspects of the man’s health.

It is important for men aged 50 and over to see their GP annually for a PSA (prostate specific antigen) blood test and prostate examination to help monitor prostate health.

Written by: Deborah Grant BSc(Hons) Herb.Med.

You can find out more about Deborah at London Herbal Medicine