Prostatic Hypertrophy Rehabilitation

It is known that benign prostatic hyperplasia or BPH is caused by an overgrowth of prostate cells. This enlargement constricts the urethra so the flow of urine is reduced, making it increasingly difficult to empty the bladder.

BPH is very common, affecting about one third of men over 50. Although it is not prostate cancer, the symptoms of BPH are similar to those of prostate cancer so you should see your doctor if you start to experience problems in passing urine. 

Treatment

The mainstays of treatment for BPH are drugs and surgery. However, as any treatment can have unwanted effects, some men with mild symptoms opt for "watchful waiting", where no treatment is undertaken. Instead the situation is monitored closely with routine check-ups. If symptoms deteriorate, it is then possible to opt for treatment.

Drug treatment

There are two main classes of drugs that are prescribed for BPH: alpha-blockers and 5-alpha-reductase inhibitors.

Alpha-blockers

Work by relaxing the muscles at the neck of the bladder and in the prostate, so to reduce the pressure on the urethra and so help 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 with an alpha-blocker. There are several different alpha blockers. Currently, the alpha blockers used include doxazosin (Cardura), terazosin (Hytrin), tamsulosin (Flomax), alfuzosin (Xatral) and prazosin (Hypovase). The most common side-effects of alpha-blockers are tiredness, dizziness and headaches.

5-alpha-reductase inhibitors

These drugs work by inhibiting the production of a hormone called DHT, which contributes to prostate enlargement. Finasteride (Proscar) is the most commonly used drug of this type for BPH. Unlike alpha blockers, 5-alpha- reductase inhibitors are able to reverse BPH to some extent and so may delay your need for surgery. Potential side-effects of finasteride include a reduced sex drive and difficulty in maintaining an erection. Several months of treatment may be needed before the benefit is noticed.

Plant extracts

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.  

Surgery

There are three main surgical options for BPH:

Transurethral resection of the prostate (TURP) which is an effective procedure with over 90% of men reporting an improvement after the operation. However, a common side-effect of this procedure is retrograde ejaculation - where semen passes into the bladder during orgasm instead of out of the penis. This is sometimes called a "dry orgasm". Retrograde ejaculation is usually not a problem, although it 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). As with a TURP an instrument is passed up through the penis, but instead of removing a portion of the prostate, small cuts are made in the neck of the bladder and the prostate. This reduces the obstruction of the flow of urine.

Open prostatectomy

Open prostatectomy 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.

Other treatments

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. The problem with these technique might be irritative symptoms, post operative infection, urethral stenosis and retrograde ejaculation.

Alternative treatment – Traditional Chinese Medicine (TCM)

Traditional and Current Chinese Medicine believes that, prostatic hypertrophy is caused by Kidney deficiency and Spleen deficiency, which again results in accumulation of heat and damp in urinary bladder. Therefore the principle in the treatment of prostatic hypertrophy in TCM is to support the functions of Kidney and Spleen systems, and expel the accumulated damp and fire in urinary bladder. 

The major therapies used in TCM for this disease include herbal therapy and acupuncture. The herbs are applied as oral intake or as enema (infusion into colon through anus),

 (Note, the liver, kidney, spleen and heart systems, as well as the term of phlegm used in this brochure are the concepts in Traditional Chinese Medicine, not the ones in Western Medicine.)

Acupuncture

In one study, fifty patients with benign prostatic hypertrophy were treated with acupuncture. Seventy two per cent of them experienced dramatic improvement in their symptoms and only four per cent of them failed to have any healing effect.

In another study, the combination of acupuncture, moxibustion and far infrared therapy yielded a cure rate of 41% in total 32 patients. (Index for cure in this study: clinic symptoms disappeared, night urine reduces to less than once, the size of prostate apparently decreases and no residue urine in urinary bladder).

Herbal therapy

In a study, seventy per cent of total sixty patients with prostatic hypertrophy were cured after administration of herbal therapy. The degree of prostate hypertrophy in these patients: degree I, 8 cases, degree II, 47 cases and degree III, 5 cases. Index for cure: clinic symptoms and signs disappear, size of prostate return normal under ultra sound B measurement. 

Qigong therapy

Qigong is unique in the treatment of any disease in that it doesn’t need any clear diagnosis or gives any medicine. It is a special energy work to improve bio-energy flow in the body, so said. In one study involving 46 patients with prostatic hypertrophy, the total effective rate of Qigong therapy is 100%. Here we should point out that the healing effect of the Qigong therapy is very much affected by the level of the Qigong master. The healing ability is very much variable among Qigong masters.

Suggestions for those who suffer from the prostatic enlargement:

(1). Always consult with your TCM doctor if he/she can help you with no-harm acupuncture or Chinese herbal therapy. Currently, the healing effect by TCM is much better than the conventional medicine.

(2). If one acupuncturist cannot help you, try another one who can practice both acupuncture and herbal therapy. The healing ability among acupuncturist is largely variable. Don’t feel disappointed if one acupuncturist failed to help you.

(3). You need to change your life style: restrict sexual activity (including not to dream your loved one emotionally), but if you feel want to have sex, do it to complete whole course, do not restrict your activity on the half way. If you have masturbation, you should tell your doctor to stop it as soon as possible.

(4). Eat less spice food. Drink less alcohol-containing beverage.