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Prostate Enlargement

You used to sleep like a rock every night. Now your slumber is routinely interrupted by trips to the bathroom. You even stopped drinking liquids after dinner so that your bladder would be empty by the time you went to bed. But still you have to get up and go-sometimes two or three times a night.

Frequent nighttime urination is a trademark symptom of an enlarged prostate, says Phillipp a Kennealy, M.D., a family practitioner at the University of California, Los Angeles, Medical Center in Santa Monica. “Anyone can feel the urge to urinate at night,” she explains. “But many men have no idea that frequent wake-ups mean prostate enlargement.”

The prostate is a walnut-size, doughnut-shaped gland that sits directly below a man’s bladder. It’s responsible for producing most of the fluid in semen. It wraps around a tube called the urethra, which carries urine and semen out of a man’s body.

Unless it gets infected, your prostate maintains such a low profile that you probably don’t pay much attention to it. But once you reach age 30, the gland starts growing.

Sometimes this growth signals prostate cancer, a leading cause of cancer deaths among men, according to James Smolev, M.D., assistant professor in the department of urology at Johns Hopkins University School of Medicine in Baltimore. That’s why all men over age 45 should have annual prostate exams. But most midlife prostate growth is noncancerous. Doctors call it benign prostatic hypertrophy (BPH)-benign, meaning noncancerous, and hypertrophy, meaning enlargement.

As BPH progresses, your swelling prostate gland pinches your urethra. At the same time, muscle tissue around your urethra tightens, pinching it even more. This process is painless, but it causes urinary problems: difficulty getting started, decreased flow, difficulty finishing. You feel the urge to urinate more often, and-most annoying of all-you have to get up at night to go.

Researchers believe that the prostate balloons because of age-related hormonal changes that occur after age 40. Half of all men experience BPH symptoms in their fifties, and the percentage rises with age. BPH usually gets worse over time, but its course is unpredictable, says Richard J. Macchia, M.D., professor and chairperson of the department of urology at the State University of New York Health Science Center at Brooklyn. In some men, symptoms go from mild to severe in a half dozen years. In others, the process takes 15 years.

If you’ve been diagnosed with BPH, when should you seek medical treatment? “That’s an individual decision,” Dr. Smolev says. “When you feel persistently uncomfortable during the day, or when you get tired of waking up at night, then you may want to discuss treatment options with your doctor.”

In the meantime, you may be able to manage your symptoms without drugs or surgery. “BPH often responds to nutritional and herbal approaches,” says Joseph Pizzorno Jr., N.D.

Best Choices

Nutrition

Squelch symptoms with soy. Compared with American men, Japanese men have far fewer problems with BPH, according to Stephen Holt, M.D., professor of medicine at Seton Hall University in South Orange, New Jersey. Researchers attribute this lower rate of BPH to the Japanese diet, which features an abundance of tofu and other soy foods. Soy is rich in plant estrogens, or phytoestrogens. These compounds can help control BPH.

Supplements

Zap prostate growth with zinc. Dr. Pizzorno describes zinc as “paramount to effective BPH prevention and treatment:” He suggests taking 60 milligrams of zinc picolinate every day for up to 6 months. Since this is a high dose, you should be under a doctor’s supervision while taking it. Your nutrient status should be reviewed and tested by a doctor at the end of 6 months and before you resume any dosages.

Pamper your prostate with primrose. Evening primrose oil is rich in essential fatty acids. Dr. Pizzorno says that supplementation with essential fatty acids has given many men significant relief from BPH symptoms. He recommends taking 1 teaspoon of evening primrose oil a day. If you can’t find evening primrose oil, feel free to substitute sunflower, linseed, or walnut oil.

Herbal Medicine

Try a Native American herbal remedy. “I’m betting my own prostate gland that herbs work better than drugs or surgery in treating BPH;” says James A. Duke, Ph.D. High on Dr. Duke’s list of effective herbal remedies is saw palmetto, a dwarf palm tree native to the southeastern United States.

At least a dozen studies have shown that saw palmetto can help shrink an enlarged prostate and relieve BPH symptoms. But because saw palmetto’s effects are so powerful, you should use it only under a qualified practitioner’s guidance.

Get aid from Africa. South Mrican herbalists have long recommended the root of Mrican star grass for prostate enlargement. But consult a qualified practitioner before you begin taking this herb. The recommended dosage is 160 milligrams taken twice a day for 3 to 6 months, at which time your caregiver can assess your progress.

Get more aid from Africa. In Africa’s central and southern highlands grows an evergreen called pygeum, or Mrican prune. For centuries, Mricans have used a tea made from powdered pygeum bark to treat urinary problems. Dr. Duke recommends taking 50 milligrams of pygeum bark extract twice a day.

Treat your prostate with pollen. In 1959, a Swedish urologist found that rye flower pollen extract helps treat BPH. He developed a product called Cernilton, which became popular in Scandinavia. Cernilton found its way to England, where it was rechristened ProstaBrit. Scientists aren’t sure how the remedy works, but several studies show benefit after at least 6 months of treatment.

In the United States, you can buy Cernilton in some health food stores. Follow the instructions on the package for proper dosage. But don’t use this product if you have pollen allergies.

Nip nature’s call with nettle. Nettle root is an age-old European remedy for urinary problems. Modern research has shown that the herb contains a number of compounds, including phytosterols, that appear to provide some relief from BPH symptoms. According to naturopath Donald Brown, N.D., professor of herbal medicine at Bastyr University in Kenmore. Washington, nettle root works best in combination with saw palmetto. You can buy over-the-counter capsules containing a combination of the two herbs in doses effective enough to treat BPH. But check with your doctor before taking a combination formula, since saw palmetto should be taken only with medical supervision.

Pick a pumpkin prescription. In Thrkey, Bulgaria, and the Ukraine, the traditional treatment for BPH is a handful of pumpkin seeds a day. “In my experience, pumpkin seeds don’t do much by themselves,” says Alan P. Brauer, M.D. “But in combination with saw palmetto and pygeum, they help.” You can eat the seeds by the handful.

Home Remedies

Practice patience. As BPH develops, it takes longer to start urinating and even longer to finish, notes Herbert Lepor, M.D., professor of pharmacology at New York University School of Medicine in New York City. His advice: Don’t rush. Relax at the beginning, which helps start your stream flowing. And take time at the end, which helps you push out the last few squirts.

Ban beverages before bedtime. To minimize nighttime urination, don’t drink fluids after 7:00 P.M., Dr. Lepor suggests.

Cut out caffeine. Caffeine is a urinary irritant. Many men get some relief from their BPH symptoms when they limit their intakes of coffee, tea, colas, and chocolate, Dr. Lepor says.

Other Good Choices

Homeopathy

Defeat BPH with Chimaphilla. In rare cases, BPH results from the formation of an adenoma, a noncancerous mass of tissue, in the prostate gland. In one study, Russian homeopaths used homeopathic medicines to treat 37 men with adenomas. Of the 27 who had experienced weak urine streams and frequent nighttime urination, 23 reported improvement within 6 months.

Homeopath Dana Ullman says that the primary homeopathic treatment for BPH is Chimaphilla. But depending on a man’s symptoms, homeopaths may also prescribe Clematis or Selenium. To find out which remedy is appropriate for you, consult a homeopath.

Chinese Medicine

Be kind to your Kidney. Practitioners of Chinese medicine attribute BPH to an excess of damp Heat brought on by too much sex, alcohol, or spicy foods that impair urine flow. “The inflammation causes enlargement, which the Chinese consider Heat,” says Efrem Korngold, O.M.D., L.Ac. “The dampness comes from the fact that the prostate both holds fluid and secretes it.”

The Kidney organ network is also involved in BPH. In the Chinese view, the Kidney regulates the discharge of reproductive essence and is weakened by the factors that cause BPH, especially sexual excess.

To treat BPH, Dr. Korngold prescribes formulas containing diuretic, anti-inflammatory herbs that strengthen the Kidney. These herbs include dandelion root, astragalus root, and dioscorea root.

Pin hope on acupuncture. Dr. Korngold also prescribes acupuncture to help treat BPH. If you’re interested in trying acupuncture, you need to consult a trained acupuncturist. Among the points that an acupuncturist may stimulate is Spleen 6, located four finger-widths above your inner anklebone on the back inner border of your shinbone. You can try stimulating this point yourself, with acupressure. Simply apply steady, penetrating finger pressure to the point for 3 minutes.

Naturopathy

Consider the sitz solution. Naturopaths sometimes recommend hot sitz baths, or shallow baths, to relieve BPH symptoms. “A sitz bath can relax and open the urinary passageway,” Dr. Pizzorno explains. He recommends a 3- to 15-minute bath in tolerably hot water.

Medical Measures

Until recently, the only mainstream treatment for BPH was a surgical procedure called transurethral resection of the prostate, or TURF. Under general anesthesia, the surgeon threads a flexible tube through the urethra and snips away enough over­grown prostate tissue to relieve urethral pinching. TURP usually provides long-term relief of BPH symptoms, but the operation carries a small risk of infection, incontinence, and erection impairment.

These days, many men are able to avoid or at least postpone TURP, thanks to the prescription drugs terazosin (Hytrin) and finasteride (proscar). Terazosin relaxes the muscles around the urethra, widening it. Finasteride reverses the overgrowth of prostate tissue.

“Terazosin generally works best for men in their fifties whose prostates have not grown that large,” explains William A. Norcross, M.D., professor of clinical family medicine at the University of California, San Diego, School of Medicine. “Finasteride works best for men over age 60, whose prostates are larger.”

Several surgical procedures that are less invasive than TURP have begun gaining acceptance. One is transurethral needle ablation, or TUNA. Like TURP, TUNA involves inserting a flexible tube into the urethra. But instead of cutting away excess tissue, TUNA zaps it with radio waves. This eliminates prostate overgrowth without affecting nearby nerves or muscles, meaning fewer side effects.

Keep in mind, too, that certain medications can aggravate BPH symptoms. These include prescription drugs for ulcers, irritable bowel syndrome, high blood pressure, and depression as well as over-the-counter cold formulas. If you have BPH and you’re taking one of these medications, ask your doctor whether it may aggravate your symptoms.

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