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Unwelcome Obstruction

Measures to control the urinary symptoms due to a benign enlargement of the prostate
THE prostate is a gland of the male reproductive system. It produces some of the fluid for semen, which helps to lubricate the urethra to increase sperm motility.

Normally, the prostate is quite small - about the same size as a chestnut. It is located just below the bladder, and wraps around the urethra, the tube that carries urine from the bladder to the outside of your body.

Many people feel uncomfortable talking about the prostate, since the gland plays a role in both sex and urination. Still, prostate enlargement with ageing is as common as gray hair.

For some fortunate men, the size of their prostate does not change. Unfortunately, about 75% of men over 50 years of age have measurable enlargement of the prostate. This prostate condition is called benign prostatic hyperplasia (BPH).

As the prostate enlarges, the layer of tissue surrounding it stops it from expanding, causing the gland to press against the urethra, like a clamp on a garden hose. The bladder wall becomes thicker and irritable. The bladder begins to contract even when it contains small amounts of urine, causing frequent urination.

Eventually, the bladder weakens and loses the ability to empty itself. Urine remains in the bladder. The narrowing of the urethra and partial emptying of the bladder cause many of the problems associated with BPH.

Symptoms
These include obstructive and irritative symptoms:

Obstructive (storage symptoms)

  • Weak (slow) urine stream
  • Having to strain to start urination
  • Straining to urinate
  • Dribbling after urination
  • Incomplete emptying of the bladder

  • Irritative (voiding symptoms)

  • Urgent need to urinate
  • Frequent need to urinate
  • Increased frequency of urination at night
  • Urge incontinence

  • BPH appears to be caused by an accumulation of the male sex hormone, testosterone, in the prostate. Once in the prostate, testosterone is converted into a more potent compound called dihydrotestosterone. This is the compound that causes the prostate cells to multiply excessively, causing the prostate to enlarge.

    BPH does not cause prostate cancer. However, prostate cancer may cause symptoms similar to those of an enlarged prostate. It is important to have your symptoms checked by a health professional to be certain they are not caused by prostate cancer.

    Treatment Options
    Prescription medication

    Medications are sometimes used to help relieve bothersome, moderate to severe urination problems caused by BPH. If you stop using medication, the symptoms will usually return. Prescription medications used to treat BPH include finasteride, terazosin, and tamsulosin. Though these drugs can reduce urinary symptoms in men with BPH, it is not clear whether they slow the progression of the disease.

    Natural herbal supplements

    There are some herbal extracts which have a long history of usage to support optimal prostate health.

  • Saw palmetto (Serenoa repens)
  •    The fat-soluble extract of the saw palmetto berry has become the leading natural treatment for BPH.

       This extract, when used regularly, has been shown to help keep the symptoms at bay. Saw palmetto appears to inhibit 5-alpha-reductase, the enzyme that converts
       testosterone to its more active form, dihydrotestosterone (DHT). Saw palmetto also blocks DHT from binding in the prostate.

       Saw palmetto is the best researched herbal remedy for treatment of BPH. A three-year preliminary study in Germany found that 160mg of Saw Palmetto Extracts taken
       twice daily reduced nighttime urination in 73% of patients and improved urinary flow rates significantly.

       Most recent studies have shown that to achieve the optimal benefits with saw palmetto, it is essential that the fat-soluble extracts are standardised to contain 85%-95%
       fatty acids. (Note: Most of the older preparations in the market use the crude extract of the saw palmetto berries. The problem with the crude extract is that the quality
       of the powder may not be consistent. Hence, the potency may not be consistent.)

  • Tomato (Lycoparsion esculentum)
  •    One of the most studied natural nutrient in the area of prostate cancer prevention includes lycopene, which contains phytosterols (a plant chemical), responsible for
       giving tomatoes their bright red colour.

      Lycopene gets high marks from researches for its apparently potent antioxidant properties. Antioxidants can neutralise harmful substances in the body called free
      radicals which can contribute to cancer and cardiovascular diseases.

      Research studies show that high levels of lycopene consumption have been associated with long-term protection of prostate health. When looking for lycopene in a
      prostate formula, do ensure it comes from tomato extract standardised to contain minimum 5% lycopene.

  • Pygeum (Pygeum africanum)
  •    Pygeum is the second most popular herb for correcting enlarged prostate. Pygeum extract contains phytosterols, which can inhibit prostaglandins synthesis, thereby
       reducing the abnormal high levels of prostaglandin normally found in BPH.

       Pygeum has been approved in Germany, France, and Italy as a remedy for BPH. Controlled studies published over the past 25 years have shown that pygeum is safe and
       effective for men with BPH of mild or moderate severity.

  • Stinging nettle (Urtica dioca)
  •    The stinging nettle root contains high lignan content, which is responsible for the root's ability to bind to sex hormone binding globulin (SHBG), key to its use for prostate
       problems. As men age, their SHBG level increases, which makes them more susceptible to abnormal cell proliferation. Stinging nettle has a strong affinity for SHBG
       thereby limiting the amount of testosterone and oestrogen than can bind to it and influence cell proliferation.

       This extract may increase urinary volume and the maximum flow rate of urine in men with early-stage BPH. It has been successfully combined with both saw palmetto
       and pygeum to treat BPH in double-blind trials.

  • Pumpkin seed (Curcubita pepo)
  •     Pumpkin seed extract contains phytosterols, curcubitin, and selenium. The extract inhibits 5-alpha-reductase, preventing the conversion of testosterone to
       dihydrotestosterone. It also has an inhibitory effect on aromatase preventing androgens like testosterone from converting to oestrogen.

       Clinical studies have shown that a remarkable reduction in urinary frequency during the day and night-time can be achieved. Urinary flow rate is also increased and
       residual urine is reduced.

       There are many products for prostate in the market. Some are as a single herb while others can be found in various combinations. Since Saw palmetto, lycopene (from
       tomato standardized extract), pygeum, stinging nettle and pumpkin seed extract have been demonstrated through scientific studies to support prostate health, one
       should look for a supplement which combines these five natural extract to help regulate and improve urination in men.

    References:
    1. Bach D, Ebeling L. Long-term drug treatment of benign prostatic hyperplasia-results of a prospective 3-year multicenter study using Sabal
      extract IDS 89. Phytomedicine 1996;3:105-11.
    2. Carraro JC, Raynaud JP, Koch G, et al. Comparison of phytotherapy (Permixon®) with finasteride in the treatment of benign prostate
      hyperplasia: a randomized international study of 1,098 patients. Prostate 1996; 29:231-40.



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