Enlarged Prostate (BPH)

What is an benign prostatic hypertrophy (BPH)?

The prostate gland is a reproductive gland just below the bladder of a man. It encircles the urethra, the tube in the penis through which urine and semen pass. The prostate contributes fluids and nutrients to the semen.

Comparison of normal and hyperplastic prostate

Benign prostatic hypertrophy, or more simply an enlarged prostate, is generally considered a normal part of the aging process. The prostate gland grows bigger, and can cause problems with urination when it begins to squeeze the urethra or press on the bladder.

The reason an enlarged prostate is called benign prostatic hypertrophy (that last ‘H’ sometimes stands for hyperplasia) is this condition is not cancer and does not contribute to cancer risk.

What are the symptoms of an enlarged prostate?

Less than half of all men with an enlarged prostate show symptoms. Those who do have symptoms of BPH, usually have one or more of the following symptoms:

  • Urinary dribbling following the end of urination
  • Inability to urinate (urinary retention)
  • Feeling of incomplete urination
  • Incontinence
  • Nocturia, or the need to urinate more than 2 times at night
  • Pain with urination or bloody urine (these may indicate infection)
  • Slowed or delayed start of the urinary stream (hesitancy)
  • Strong and sudden urge to urinate (urgency)
  • Weak urine stream

What causes BPH?

The cause of BPH is unknown, but the prostate does seem to become enlarged as part of the normal course of aging.

Additionally, doctors have noticed that men who have had their testicles removed at a young age do not develop BPH. If the testicles are removed after the onset of BPH, the prostate will return to its original size. So, it is suspected that some process happening in the testicles plays a roll in the development of an enlarged prostate.

According to the National Institutes of Health, here are some additional BPH facts (quote):

  • BPH is so common that it has been said all men will have an enlarged prostate if they live long enough.
  • A small amount of prostate enlargement is present in many men over age 40 and more than 90% of men over age 80.
  • No risk factors have been identified other than having normally functioning testicles.

How is an enlarged prostate diagnosed by my doctor?

Your doctor’s primary tools for diagnosis are taking a medical history and a digital rectal exam to feel your prostate gland for any inflammation. Additionally, your doctor might perform the following tests:

Digital Rectal Exam

How a digital rectal exam is performed

  • Urine flow rate
  • Post-void residual urine test (checks to see how much urine is left in your bladder after urination)
  • Urinalysis to check for any abnormalities in the urine (i.e., infection, blood)
  • Urine culture to check for bacteria
  • Prostate-specific antigen (PSA) blood test to rule out prostate cancer
  • Cystoscopy, a test that allows the doctor to see inside the urethra and bladder

Your doctor might also use a survey to evaluate the severity of your symptoms. A commonly used survey is this one:the American Urological Association BPH Symptom Score Index Questionnaire. Click here to view it. Feel free to bring this to share with me during your first visit.

How does acupuncture diagnose BPH?

Acupuncture and the theories behind it were developed thousands of years ago, and so do not rely on the same tests a doctor would perform. Rather, as an acupuncturist, I will ask you all about what your subjective experience of having an enlarged prostate is, like the frequency of urination or the sensations and discomfort you may be feeling. I will also collect some objective information – pulse, tongue and abdominal diagnosis – by looking at how you present to me in the clinic.

I then put all of this information to create a Chinese medicine diagnosis, or pattern of disharmony. This guides your treatments.

How will my doctor treat an enlarged prostate?

Since the prostate of most men becomes enlarged as they age, and because about half of men have no symptoms of this enlargement, doctors often take a wait-and-see approach. There are some self-care remedies a doctor might recommend during this waiting period. They are:

  • Don’t hold it, and urinate when you have the chance even if you don’t feel you have to
  • Don’t drink alcohol or caffeine after 5pm
  • Evenly space drinks throughout the day rather than drinking all of your fluids at once
  • Don’t drink anything within 2 hours of bedtime
  • Keep warm and get regular exercise (This is spot-on from an acupuncture perspective)
  • Do Kegel exercises
  • Reduce stress

More active interventions by a doctor might include:

  • Medications (Alpha-1 Blockers, like doxazosin, prazosin, or tamsulosin, to relax the neck of the bladder and prostate; Finasteride and dutasteride to lower levels of hormones produced by the prostate (but these also reduce sex drive/libido))
  • Surgery (Transurethral resection of the prostate (TURP), Transurethral incision of the prostate (TUIP) or Simple prostatectomy)
  • Prostatic stent

How will acupuncture treat an enlarged prostate?

I use a combination of acupuncture, herbal medicine, dietary therapy and nutritional supplements to decrease urinary urgency and night urination, stop discomfort and decrease hesitancy. This is done by using the pattern diagnosis mentioned above to treat the symptoms I see before me. There is no one-size-fits-all treatment. It’s about treating You the Individual, and the whole you, too. Every treatment is fully customized for your specific constellation of symptoms. And relief awaits.

To make an appointment with me for treatment, please contact me here.

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