BENGIN PROSTATIC

HYPERPLASIA

"MANAGING BPH: A GUIDE TO

UNDERSTANDING SYMPTOMS, TREATMENT,
AND LIFESTYLE MODIFICATIONS
Dr Ali Raza

Benign prostatic hyperplasia (BPH) affects millions of men worldwide. It is a

common medical condition affecting men as they age. It occurs when the
prostate gland, which is located below the bladder and surrounds the
urethra, begins to enlarge. As the prostate grows, it can compress the urethra
and cause urinary symptoms.
BPH is a non-cancerous condition, but it can significantly impact a man’s
quality of life.

The impact of the condition can go far beyond the bathroom. In this article,
we’ll explore how BPH can impact men’s overall health and wellbeing, and
what men can do to manage the condition and stay healthy.

Definition of B.P.H According to (NICE) guidelines,

According to the National Institute for Health and Care Excellence (NICE)
guidelines, benign prostatic hyperplasia (BPH) is a common condition in men
where the prostate gland grows in size, causing urinary symptoms such as
frequency, urgency, hesitancy, weak stream, and nocturia.

The guidelines define BPH as “a non-cancerous enlargement of the

prostate gland, which is caused by the proliferation of prostatic
epithelial and stromal cells”.

The condition is typically diagnosed in men over the age of 50, and the
prevalence increases with age. The NICE guidelines recommend a holistic
approach to BPH management, taking into account the patient’s individual
preferences and comorbidities.

Enlist the main causes of BPH?

The exact cause of benign prostatic hyperplasia (BPH) is unknown, but
several factors are thought to contribute to its development. The primary
cause of BPH is age-related changes in hormone levels, specifically an
increase in dihydrotestosterone (DHT), a hormone derived from
testosterone, which is responsible for the growth and development of the
prostate gland. Other factors that may contribute to the development of BPH
include:

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 1. Family history: Men with a family history of BPH are more likely to
develop the condition themselves.
2. Obesity: Studies have shown a correlation between obesity and BPH,
possibly due to increased levels of estrogen and insulin-like growth
factor-1 (IGF-1).
3. Chronic inflammation: Chronic inflammation in the prostate gland may
contribute to the development of BPH.
4. Erectile dysfunction: Men with erectile dysfunction may be at an
increased risk of developing BPH due to shared risk factors.
5. Lifestyle factors: Sedentary lifestyle, high intake of red meat and fat,
and low intake of fruits and vegetables may increase the risk of
developing BPH.

While the exact cause of BPH remains unknown, understanding the

contributing factors can help men take proactive steps to reduce their risk
and manage symptoms.

Enlist both irritative and obstructive Symptoms of BPH

Benign prostatic hyperplasia (BPH) can cause both irritative and obstructive
symptoms. Irritative symptoms are related to the bladder’s overactivity,
while obstructive symptoms are related to the obstruction of urine flow
through the prostate. Some common irritative and obstructive symptoms of
BPH include:

Irritative symptoms:

1. Increased frequency of urination

2. Urgency to urinate
3. Nocturia (waking up at night to urinate)
4. Urge incontinence (inability to hold urine)
5. Painful urination (dysuria)
6. Bladder pain or discomfort

Obstructive symptoms:

1. Weak urine stream

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 2. Hesitant or delayed urination
3. Intermittent urine stream
4. Straining to urinate
5. Feeling of incomplete bladder emptying
6. Post-void dribbling (urine leaking after urination)
7. Urinary retention (inability to urinate)

It’s important to note that not all individuals with BPH will experience the
same symptoms, and the severity of symptoms can vary. If you experience
any of the above symptoms, it’s important to speak with your healthcare
provider for an accurate diagnosis and appropriate treatment.

Enlist the main investigations for the BPH diagnosis

There are several investigations that may be used to diagnose benign
prostatic hyperplasia (BPH) and rule out other conditions with similar
symptoms. Some of the main investigations used for BPH diagnosis include:

 Digital rectal exam (DRE): During a DRE, a healthcare provider inserts

a lubricated, gloved finger into the rectum to feel the prostate gland.
An enlarged prostate gland can indicate BPH.

 Prostate-specific antigen (PSA) blood test: PSA is a protein produced

by the prostate gland. A high PSA level may indicate BPH or other
prostate conditions, such as prostate cancer.
 Urinalysis: Urinalysis can help rule out urinary tract infections or
other conditions that may cause similar symptoms.
 Uroflowmetry: Uroflowmetry is a test that measures the rate and
volume of urine flow. A reduced urine flow rate may indicate BPH.
 Transrectal ultrasound (TRUS): TRUS is a non-invasive imaging test
that uses high-frequency sound waves to produce images of the
prostate gland. It can help determine the size of the prostate gland and
rule out other conditions, such as prostate cancer.

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  Cystoscopy: Cystoscopy is a test that uses a thin, flexible tube with a
camera to examine the inside of the bladder and urethra. It can help
identify any abnormalities that may be causing urinary symptoms.
 Pressure-flow studies: Pressure-flow studies measure the pressure
and flow rate of urine during urination. This test can help determine
the severity of obstruction in the urinary tract.

The specific investigations used for BPH diagnosis may vary depending on
the individual case and healthcare provider’s preference. It’s important to
discuss any concerns or questions about BPH diagnosis with your healthcare
provider.

Prenatal Vitamins and Anemia: What You Need to Know

Prenatal vitamins can be an important part of the prevention and treatment
of anemia in pregnancy. Prenatal vitamins typically contain iron, folate, and
other essential nutrients for fetal development. Adequate intake of these
nutrients can help prevent anemia and other complications of pregnancy.

However, it’s important to note that prenatal vitamins are not a substitute for
a healthy diet. Pregnant women should aim to eat a balanced diet rich in iron,
folate, and other essential nutrients. Good dietary sources of iron include
lean red meat, poultry, fish, beans, lentils, and fortified cereals. Good dietary
sources of folate include leafy green vegetables, citrus fruits, and fortified
cereals.

Why Level of Erythropoietin Increases During Gestation?

Erythropoietin is a hormone that stimulates the production of red blood cells.

During pregnancy, the level of erythropoietin increases to support the
increased blood volume and oxygen demand of the growing fetus and
placenta.

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The kidneys produce erythropoietin in response to low oxygen levels in the
blood. During pregnancy, the oxygen-carrying capacity of the blood
decreases due to the increase in blood volume, which dilutes the
concentration of red blood cells. This triggers the kidneys to produce more
erythropoietin, which stimulates the bone marrow to produce more red
blood cells.

While the increase in erythropoietin is a normal physiological response to

pregnancy, it can lead to anemia if the body is unable to produce enough red
blood cells to meet the increased demand. This is why adequate intake of
iron, folate, and other essential nutrients is crucial during pregnancy to
support the body’s increased demand for red blood cell production.

In Which Trimester Folic Acid Should be Given and

What is its Role in Fetal Development?
Folic acid is a B-vitamin that plays a crucial role in fetal development,
particularly in the development of the neural tube, which eventually forms
the brain and spinal cord. Folate deficiency during pregnancy has been linked
to an increased risk of neural tube defects, such as spina bifida.

The American College of Obstetricians and Gynecologists (ACOG)

recommends that all women of childbearing age consume 400-800
micrograms of folic acid daily, ideally beginning at least one month before
conception and continuing throughout pregnancy.

During pregnancy, folic acid supplementation is particularly important in the

first trimester when the neural tube is developing. Adequate intake of folic
acid can help reduce the risk of neural tube defects and other birth defects,
such as cleft palate and congenital heart defects.

In addition to supplementation, good dietary sources of folate include leafy

green vegetables, citrus fruits, beans, and fortified cereals.

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Conclusion
Anemia in pregnancy is a common condition that can lead to a variety of
complications for both mother and baby. Understanding the causes,
symptoms, and treatment of anemia in pregnancy is important for the health
of both. Adequate intake of essential nutrients, such as iron, folate, and
vitamin B12, is crucial during pregnancy to support red blood cell production
and fetal development. Prenatal vitamins and a balanced diet can help
prevent anemia and other complications of pregnancy.