Benign Prostate Hypertrophy and Ayurveda

By Sajimon George BANS, AAA, ATMS

Benign prostatic hypertrophy (BPH), also known as benign prostatic hyperplasia is a non-cancerous growth of the prostate gland in men, which occurs with natural ageing.

The prostate gland is the male organ which is most commonly afflicted with either benign or malignant neoplasm. BPH is the most common benign tumor in men, and its incidence is age-related.

The peculiarity of the prostate gland is that in old age when most of the organs regress in size; it enlarges and causes trouble. By virtue of its position, where it guards the outlet of the urinary bladder; when it enlarges, it obstructs the urinary passage leading to a back pressure effect on the bladder. Later on, the ultimate renal damage is detrimental to life.

An enlarged prostate gland affects nearly 20% of men at the age of 40 years, 70% at age 60 and 90% by the age of 80 years old.

With an incidence so great, it has been even suggested that prostate enlargement (BPH) is a normal process of aging and it does not reflect a disease process.

However, approximately 25% of men will require surgery for enlarged prostate. It is important to note that the symptoms of BPH can also be present in other conditions like a urinary infection, prostate cancer or a bladder tumor. An accurate diagnosis of BPH is therefore very important before initiating any treatment.

As the condition of BPH is age related, Ayurveda looks at this modern problem in a different way. Ayurveda not only takes care of symptoms of BPH but also facilitates the shrinkage of the prostate hence improves quality of life of patient with Benign Prostatic Hyperplasia.

The advantage of using Ayurvedic herbal medicines in the treatment of benign prostatic hypertrophy is that these medicines can be used on a long-term basis even in the elderly population without any risk of serious adverse effects

Symptoms of Benign Prostrate Hypertrophy

In general, symptoms of BPH are due to the interference of urine flow through urethra which leads to urine retention in the bladder. The severity of symptoms of BPH doesn’t directly depend on the size of prostate, sometimes it is seen that men with greatly enlarged prostate don’t have that severe symptoms and vice versa.

Obstructive symptoms:

1. Hesitancy or a delay in initiating micturition
2. A poor or intermittent stream
3. Straining to void
4. Terminal dribbling (The flow of urine continues after the main stream has finished, sometimes in spurts or dribbles. Occasionally a second large volume of urine is passed)
5. Post-micturition dribbles
6. A sensation of incomplete bladder emptying

Irritative symptoms: These are the symptoms attributed to bladder irritability:

1. Dysuria (painful urination)
2. Urinary frequency
3. Urgency
4. Urge incontinence
5. Nocturnal urinary frequency
6. Nocturnal enuresis (involuntary urination occurring at night)

Several problems may occur if an enlarged prostate is left untreated:

• There may be sudden, complete blockage of urine requiring a tube to be passed to empty the urinary bladder.
• The urinary bladder may hold residual urine even after the person has evacuated. This pool of urine can get infected and stones may form in the bladder.
• With the passage of time, the back pressure due to the urinary obstruction can affect the kidney function and lead to renal failure.

Ayurvedic Approach to Benign Prostrate Hypertrophy

The anatomical position of the prostate gland is described in Ayurvedic classic Yogaratnakara as – Below umbilicus (naabhi), there is a hard gland which is little bit bulged and changes its place some times and sometimes stays stationary, this gland is like “ashteela” (a small stone used to sharpen swords).

This gland, when affected by vitiated Vatha, causes a disease called “Vathaashteela” this condition is comparable to Benign prostate hypertrophy.

The causes of vathaashteela or BPH are explained as follows- Vataashteela is caused by vitiated Vatha. “Apaana vatha” one of the five types of Vatha located in the testicles, urinary bladder, phallus, umbilicus, thighs, groin, anus and colon. Its functions include ejaculation of semen, voiding of urine, normal delivery and stools. From these functions it becomes clear that the prostate gland also is a functional site of Apana vaatha.

The vitiation of Vatha and Apaana vatha is caused by

• Controlling the urge of urination
• Controlling the urge of defecation
• Over indulgence in sex
• Consuming dry, very cold and less quantity of food
• Old age
• General weakness
• Indigestion
• Physical and mental overexertion.

Ayurvedic Treatment Principles for Benign Prostrate Hypertrophy

Ayurvedic management of BPH includes Ayurvedic treatment procedures and formulations. In addition to this, dietary changes, yoga and specific prostate care practices are also suggested. All men over fifty can benefit from the yoga and prostate care practices on a preventative basis.

Treatment needs to be specific for each patient, since not all patients respond to the same medicines. Depending upon the presenting symptoms and perceived enlargement of the prostate gland, treatment procedures and formulations for the pacification of Apaana vatha are used. After determining efficacy, minor changes if required will be made and it should be continued for a period of at least six months.

Ultimately, BPH must be considered as a Kapha predominant condition. Symptoms that specifically indicate enlargement of the prostate include nocturnal urination, sensation of incomplete emptying, frequency of urination, slow or interrupted stream, dribbling, and straining to pass urine. Pitha effect of inflammation and irritation of the bladder may also manifest.

Due to incomplete emptying of the bladder, additional symptoms of bladder infection may arise, including burning sensations and a greater increase in frequency. BPH with Vatha predominance will mainly show symptoms mainly intermittent urination, often associated with pain, frothy urine and foul smelling urination.

Ayurveda Treatment Procedures

All procedures for pacifying Vatha are useful here. Such as Snehana (Oral administration of suitable medicated ghee or Oil) and Vasthis (Introduction of medicine through anal route) are useful in BPH. Particularly Uthara vasthi or introduction of medicines through urethra is very useful in BPH.

Do’s and Don’ts

Do’s

• Urinate as soon as the urge arises
• Remain sexually active
• Take time to urinate when it is convenient even if there is no urge
• When you take long trips, make frequent stops to urinate
• Keep a container in the vehicle that you can urinate in when you cannot get to a bathroom in time
• Sit on a hard chair instead of a soft one whenever possible
• Drink eight or more glasses of water every day
• Reduce stress
• Pelvic floor muscle exercises are useful to prevent urine leakage

Don’ts

• Vatha gets vitiated when natural urges are controlled. Hence do not control the natural urge of passing urine
• Urinate when you first get the urge
• Alcohol and coffee increase Vatha and vitiate it. Hence avoid alcohol, tobacco and coffee, especially after dinner
• Mental exertion leads to increase of Vatha. Avoid mental exertion at work place and at home
• Avoid foods which cause constipation as constipation causes vitiation of Vatha
• Avoid dampness and cold temperatures
• Do not let the bladder get too full…
• Relax when you urinate
• Do not drink liquids too close to bedtime
• Do not smoke
• You should clarify usage of allopathic medications for cold and allergy that contain decongestants such as pseudoephedrine with your allopathic doctor
• Diuretics and alcoholic beverages can also make matters worse.

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