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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.

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:

  • 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.


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 the symptoms associated with 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.

What is prostatitis?

Prostatitis is swelling of the prostate gland, a gland about the size of a walnut just below a man’s bladder. The prostate contributes to the liquid portion of semen (ejaculate). Prostatitis has a number of causes, but the primary signs are pain and difficult urination. Prostatitis can be acute or chronic.

What are the symptoms of prostatitis?

Prostatitis is when the prostate gland becomes inflamed or swollen. Prostatitis symptoms may include:

  • Abnormal urination: painful, burning, difficult, dribbling/hesitant, or frequent

  • Pain: back, groin, abdominal, perineum (area between the scrotum and the rectum), penis, testicles, during orgasm

  • Flu-like symptoms


What causes prostatitis?

Chronic and acute bacterial prostatitis are caused by bacterial infections. The exact causes of non-bacterial prostatitis — chronic pelvic pain or chronic abacterial prostatitis — are unknown. Other causes of prostatitis may include:

  • Immune or nervous system problems

  • Direct injury to the prostate

  • Defective nerve and/or muscle function

  • Blockage of the urinary tract

  • Build-up of toxic chemicals in the urine


How is prostatitis diagnosed by my doctor?

A diagnosis of an inflamed prostate can be made based on the medical history and physical exam of a patient. These tests can identify several possible risk factors of prostatitis, including:

  • Being young or middle aged

  • Not drinking enough liquids

  • Being under a lot of stress

  • Genetic predisposition

  • Nerve problems

  • Stroke

  • Parkinson’s disease

  • Multiple sclerosis

  • Diabetes

  • Radiation from cancer treatments

Your doctor will perform a digital rectal exam, which can detect inflammation and tenderness of the prostate. Further tests are required to identify the specific type of prostatitis: urine, blood, and semen tests can detect an acute or chronic bacterial infection. These medical tests for an inflammation of the prostate gland can also rule out conditions that cause similar symptoms:

  • Overactive bladder

  • Benign prostatic hyperplasia (BPH)

  • Post-bladder cancer

  • Urethral stricture

  • Narrowing of the penis meatus


How does an acupuncturist diagnose prostatitis?

An acupuncturist’s main mode of diagnosis is inquiry.  Basically, we ask a lot of questions to figure out what’s going on. I never perform digital rectal exams in my clinic.  Men who seek treatment will either already have a diagnosis by a doctor, or will have symptoms that fit the bill.  If symptoms persist, and a patient has not been to a doctor, I will refer to a urologist to make a diagnosis and rule-out other problems.  More recently, urologists have begun to refer their patients out for acupuncture to help treat the symptoms of prostate inflammation, like problems with urination.

As part of an intake interview with an acupuncturist, we will discuss not only the symptoms you are having related to inflammation of prostate, but also about your health in general, lifestyle and diet, so I can get a better understanding of the whole you.  I treat people, not diseases.


How is prostatitis treated by a doctor?

Treatment of prostatitis depends on the underlying cause. Treatments may target the cause or the symptoms of an inflamed prostate (like problems with urination) and may include:

  • Antibiotics—oral or intravenous—to treat prostatitis caused by a bacterial infection

  • Drugs called alpha blockers relax the area where the prostate and bladder meet and help alleviate painful urination

  • Over-the-counter pain relievers also help with pain

  • Prostatectomy is surgery to remove all or part of the prostate


How does acupuncture treat prostatitis?

By piecing together the signs and symptoms, I identify a pattern of disharmony.  Patterns are how Chinese medicine quantifies and qualifies illness.  The names of patterns often have words we recognize from high school biology class about internal organs.  This isn’t a direct correlation, so don’t get caught up in the name or what it might mean.

Acupuncturists use the pattern diagnosis to dictate the treatment plan.  The treatment will involve acupuncture and herbs to unwind the disharmony of the pattern to restore balance to the body.  I also use dietary therapy and tui na massage to support these modalities.  I often give patients a bit of homework in the form of self-massage to be used as a treatment between acupuncture appointments.

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