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A Comprehensive Guide to Ayurvedic Prostate Enlargement Treatment

The Enlarged Prostate (EP) is also known as Benign Prostatic Hyperplasia (BPH). Benign Prostatic Hypertrophy (BPH), Benign Enlargement of the Prostate, Nodular Hyperplasia of the Prostate. It is a major geriatric problem affecting men usually after the age of 50 years, and the incidence peak between the age of 60 and 70 years. It is rare at an early age.

What is Prostate Enlargement?

Prostate enlargement, also known as benign prostatic hyperplasia (BPH), is a common condition that affects aging men. The prostate is a small gland that surrounds the urethra, the tube that carries urine from the bladder out of the body. As men age, the prostate gland can undergo non-cancerous growth, leading to an enlargement of the gland.

What causes Prostate Enlargement?

While the exact cause of prostate enlargement is not fully understood, several factors are believed to contribute to its development.

  1. Age: Prostate enlargement is strongly associated with aging. As men get older, the likelihood of developing BPH increases. It is estimated that by the age of 60, a significant percentage of men will have some degree of prostate enlargement.
  2. Hormonal Changes: Changes in hormonal levels, particularly the increase in dihydrotestosterone (DHT), a byproduct of testosterone, are thought to play a role in the development of BPH. DHT contributes to the growth of prostate cells, leading to an enlargement of the gland.
  3. Family History: There is evidence to suggest that a family history of prostate enlargement may increase the risk of developing the condition. If a close male relative, such as a father or brother, has had BPH, an individual may be more predisposed to experiencing it themselves.

Symptoms of prostate enlargement

Symptoms of prostate enlargement are related to the pressure exerted on the urethra by the enlarged prostate. These symptoms can vary in severity and may include:

  1. Urinary Frequency: Increased frequency of urination, especially during the night (nocturia), is a common symptom. This is due to the compression of the urethra by the enlarged prostate, leading to incomplete emptying of the bladder.
  2. Difficulty Initiating Urination: Men with an enlarged prostate may experience difficulty starting the urinary stream. This is often accompanied by a weak or intermittent flow of urine.
  3. Incomplete Emptying of the Bladder: The enlarged prostate can obstruct the urethra, preventing the complete emptying of the bladder. This can result in a sense of incomplete voiding and the need to urinate again shortly after finishing.
  4. Urinary Urgency: Some individuals with BPH may feel a strong and urgent need to urinate, which can be challenging to control.
  5. Straining During Urination: Straining to push urine out is a common symptom of prostate enlargement. This can be accompanied by a feeling of bladder fullness.
  6. Urinary Retention: In severe cases, BPH can lead to urinary retention, where the individual is unable to empty the bladder at all. This requires prompt medical attention.
Prostate Enlargement Treatment

Tests for prostrate enlargement

Prostate enlargement, or benign prostatic hyperplasia (BPH), can be assessed through various tests and examinations. It’s important to note that the diagnostic process is typically carried out by a healthcare professional, and the specific tests may vary based on individual circumstances. Here are some common tests used to evaluate prostate enlargement:

  1. Digital Rectal Exam (DRE): A digital rectal exam is a physical examination in which a healthcare provider inserts a gloved, lubricated finger into the rectum to feel the size, shape, and consistency of the prostate gland. This allows the healthcare professional to detect any abnormalities, including enlargement, nodules, or irregularities.
  2. Prostate-Specific Antigen (PSA) Blood Test: The PSA blood test measures the level of a protein produced by the prostate gland in the bloodstream. Elevated PSA levels can be an indication of various prostate conditions, including BPH. However, it is important to note that an elevated PSA level does not conclusively diagnose BPH and can also be associated with other conditions, including prostate cancer.
  3. Urinalysis: A urinalysis may be performed to rule out other possible causes of urinary symptoms, such as urinary tract infections or bladder problems.
  4. Urodynamic Tests: Urodynamic tests assess how well the bladder and urethra are functioning. These tests can help determine the pressure and flow of urine and identify any issues related to voiding.
  5. Transrectal Ultrasound (TRUS): In a transrectal ultrasound, a small probe is inserted into the rectum to provide detailed images of the prostate. This imaging technique helps assess the size of the prostate and identify any abnormalities.
  6. Cystoscopy: Cystoscopy involves the insertion of a thin, flexible tube with a camera (cystoscope) into the urethra and bladder. This allows the healthcare provider to visually inspect the interior of the urethra and bladder, identifying any obstructions or abnormalities.
  7. Uroflowmetry: Uroflowmetry measures the speed and amount of urine expelled from the bladder. This test helps evaluate the flow of urine and can provide information about potential obstructions.
  8. Prostate Biopsy (Rarely): In certain cases where there is suspicion of prostate cancer, a prostate biopsy may be recommended. However, prostate biopsy is not a routine test for benign prostatic hyperplasia.

Prostate Enlargement Treatment

The treatment for prostate enlargement, or benign prostatic hyperplasia (BPH), depends on the severity of symptoms, the impact on the individual’s quality of life, and the presence of complications. Here are several treatment options commonly used for managing prostate enlargement:

  1. Watchful Waiting/Active Surveillance: In cases where symptoms are mild and not significantly impacting quality of life, a healthcare provider may recommend a watchful waiting approach. This involves regular monitoring of symptoms without immediate intervention.
  2. Lifestyle Modifications: Making certain lifestyle changes can help alleviate mild symptoms of BPH. These may include:
    • Limiting the intake of caffeine and alcohol, especially in the evening.
    • Avoiding fluids close to bedtime.
    • Urinating when you first feel the urge to prevent the bladder from becoming overly full.
    • Regular exercise, which can promote overall health and help manage symptoms.
  3. Medications: Several medications can be prescribed to alleviate symptoms of prostate enlargement. These medications work by either relaxing the muscles of the prostate and bladder or by reducing the size of the prostate. Commonly prescribed drugs include:
    • Alpha-blockers (e.g., tamsulosin, alfuzosin)
    • 5-alpha reductase inhibitors (e.g., finasteride, dutasteride)
    • Phosphodiesterase-5 (PDE5) inhibitors (e.g., tadalafil) may be used in some cases.
  4. Minimally Invasive Procedures: For moderate to severe symptoms, minimally invasive procedures may be considered. These procedures aim to reduce the obstruction caused by the enlarged prostate. Some common minimally invasive treatments include:
    • Transurethral Microwave Thermotherapy (TUMT)
    • Transurethral Needle Ablation (TUNA)
    • Laser Therapy (e.g., Holmium laser enucleation of the prostate – HoLEP)
  5. Transurethral Resection of the Prostate (TURP): TURP is a surgical procedure in which excess prostate tissue is removed using a special instrument inserted through the urethra. It has been a standard treatment for BPH but may be reserved for more severe cases due to the associated risks and recovery time.
  6. Transurethral Incision of the Prostate (TUIP): TUIP involves making small incisions in the prostate to reduce pressure on the urethra. It is often used for smaller prostates and may result in a quicker recovery compared to TURP.
  7. Prostatic Urethral Lift (UroLift): UroLift is a relatively new procedure that involves the insertion of implants to lift and hold the enlarged prostate tissue away from the urethra. It is a minimally invasive option with a shorter recovery period.

The choice of treatment depends on various factors, including the size of the prostate, the severity of symptoms, the individual’s overall health, and personal preferences. It is crucial for individuals experiencing symptoms of prostate enlargement to consult with a healthcare professional to determine the most appropriate course of action based on their specific situation. Regular follow-up visits are important to monitor the effectiveness of the chosen treatment and make adjustments as needed.

Prostate Enlargement – An Ayurvedic View

The prostate gland is known as ‘Astheela’ in Ayurveda.

In Ayurveda, the symptoms of BPH closely resemble a condition called ‘Vatastheela’. This is a disease of Mutravaha Srotas (urinary system) and ‘Vatastheela’ is described as one among the twelve types of pathological conditions of Mutraghata (obstructive uropathy).   The pathological condition of Vatashtheela is also known by the name of Astheela.

Etiopathogenesis and symptoms 

The condition of Vatastheela occurs due to the Apana Vata. The food possessing properties like Ruksha (dry), Laghu (light), Sheeta (cold), Katu (pungent taste), Tikta (bitter taste), Kashaya (astringent taste), lifestyle factors like ativyayama (excess physical exercise), ativyavaya (excess indulgence in sexual activity), anashana (fasting for a long time), pramitashana (eating in less quantity), adhyashana (over-eating), vata sevana (exposure to heavy breeze or wind), prajagara (staying awake at night), chinta (worry), bhaya (fear or anxiety), shoka (grief), atipralapa (excess indulging in talks), suppression of urine, stools and the flatus, trauma to the urinary system or the suprapubic region, etc. cause the vitiation of vata dosha and in particular the Apana Vata.

The pathogenesis can be explained in two ways. One is the vitiation of vata dosha leads to obstruction of the outlet of the basti pradesha (urinary bladder) and guda (rectum). This causes adhmana (the distension of the abdomen) and further, a prominent growth that is immobile, hard like stone, and painful obstructing the expulsion of the urine, feces, and the flatus.

The other way of pathogenesis is the vitiation of Apana vata that resides in the space between the basti pradesha and shakrit marga producing an immobile, hard growth that obstructs the passing of the urine, stools, and flatus causing distension of the abdomen and pain over the supra-pubic area. In the pathogenesis Vata dosha also vitiates pitta and kapha dosha.

Thus, the clinical manifestations of Vatashtheela are difficulty in micturition, incomplete voiding of urine, increased frequency of micturition, dribbling of urine, and urine retention, etc. which are the symptoms closely related to an enlarged prostate.

Ayurvedic Prostate Enlargement Treatment

Since Vata Dosha is the main cause of Mutraghata roga, the major lines of treatment for the condition of Vatashtheela are Snehana (oleation therapy- both internal and external oleation), Swedana (sudation therapy), Sneha Virechana (purgation therapy specifically with the drugs possessing unctuous properties)and Basti (enema therapy).

As discussed above the vata dosha is increased and hence the qualities of vata dosha are also increased, Snehana karma helps pacify the vitiated vata dosha. Swedana karma in this condition must be focused on the lower parts of the body especially the organs like the urinary bladder and rectum and anal canal.

Avagaha swedana, is a sudation method in which a person is asked to immerse the lower body part or sit in a tub of decoction of medicines as it relieves the symptoms of Vatashtheela. Enema therapy is the main treatment of Vata Dosha in which both decoction and oil enema can be given depending on the dosha and the symptoms. In the above-mentioned condition, Uttara Basti (enema administered through the urethra) is the best form of enema therapy for any urological disease.

Research works have proved the efficacy of Basti therapy and Uttara basti therapy respectively in treating the condition of an enlarged prostate. A few to quote are ‘A clinical study of Basti therapy in the management of Vatashtheela w.r.t BPH’ by Meena et al., ‘Yavakshara Uttara Basti in the management of Mutraghata w.r.t BPH by Jaiswal et al. and Bind et al. studied on the effect of ‘Ushiradi taila Basti in the management of Vatashtheela w.r.t BPH’. The oral medications in the form of Kashaya (decoction), Kalka (paste form), Asava (fermented preparations), Avaleha (linctus), Kshara (caustic alkali preparations), Guggulu (tablets or pills) are to be advised. The drugs that act as Vatanulomana (that facilitate the easy expulsion of Vata dosha) should be emphasized.

Diet and lifestyle

The old variety of rice, barley, soup of black gram, milk, buttermilk, ash gourd, ridge gourd, toddy palm, plenty of water and other fluids like fruit juices of orange, pomegranate, lemon, etc. whole fruits, leafy vegetables, carrot, beetroot, cucumber, radish, etc. are the diet advised.

Brisk walking, physical exercise specifically focused on strengthening pelvic floor muscles, Yoga and Pranayama, meditation, avoiding heavy physical exercise, excess sexual activity, suppressing urges like micturition, defecation, and flatus, staying awake at night, etc. are some of the lifestyle modifications to be followed.

Conclusion

The enlarged prostate gland is a condition that can be correlated with disorders in Ayurveda like Mutraghata and its type called Vatashtheela. Benign Prostatic Hypertrophy commonly affects men of the age between 60 and 70 years. Apana vata dosha is the main factor responsible along with kapha and pitta doshas.

The causative factors that are primarily involved are the intake of ruksha, laghu, sheeta ahara, suppression of urges like micturition, feces, flatus, excess physical activity and indulgence of sex, increased anxiety, and stress. The Basti Pradesha (urinary bladder) and Shakrit Marga (rectum and anal canal) which are the main seats of Apana Vata are affected causing obstruction to urine, stools, and flatus.

Vatashtheela is a prominent growth that is hard like stone, painful, and immobile. The main symptoms of an enlarged prostate are the retention of urine, dribbling of urine, increased frequency, and incomplete voiding of urine, etc. Avagaha Sweda, Basti, and Uttara Basti, and oral medications like Kashaya, Kshara, Asava, etc. are the treatment modalities.

Drinking plenty of water, old variety of rice, black gram, barley, rich fiber diet, fruits, and vegetables rich in water content, pelvic muscle strengthening exercises, timely attending the urges like micturition, etc. are the diet and lifestyle changes for benign prostatic hypertrophy.  

NOTE: 
“This article does not provide medical advice. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on this WebSite. If you think you may have a medical emergency, immediately call or visit your doctor.” 

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References
  1. https://www.wjpmr.com/download/article/36062018/1530263431.pdf
  2. https://www.aiirjournal.com/uploads/Articles/2019/06/3897_27.Dr.%20Dipendra%20Hanumant%20Kokare%20%20&%20Dr.%20A%20B%20Pundpal.pdf
  3. https://www.ijsurgery.com/index.php/isj/article/view/8392
  4. https://jaims.in/jaims/article/view/892

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