Physiotherapy in the management of benign prostate hyperplasia (BPH)

Benign prostate hyperplasia (BPH) is a benign enlargement or hypertrophy of the prostate gland. In many men older than 50 years, the prostate gland enlarges, extending upwards into the bladder and obstructing the flow of urine by encroaching on the vesicle orifice. BPH is a noncancerous increase in the size of prostate gland and the most common urologic problem in male adults with about 50%, and 75% of men above 50 and 80 years of age respectively.
BPH is a non-cancerous growth of the prostate that does not leave the prostate or spread to other areas of the body. BPH occurs when the prostate expands to the point where it restricts the flow of urine as it passes through the urethra, making it difficult for a man to pee and completely drain his bladder. This situation is often compounded by a frequent and urgent need to urinate. The good news is that BPH does not develop into prostate cancer, nor is it an indicator for future prostate cancer; unfortunately, however, it is a common reason for erectile dysfunction (ED).
CAUSES AND RISK FACTORS
Studies has shown that androgens (testosterone and related hormones) play a permissive role in the development of BPH. This means that androgens must be present for BPH to occur, but do not necessarily directly cause the condition. This is supported by evidence suggesting that castrated boys do not develop BPH when they age.
BPH is considered a normal condition of male aging, and many men older than 80 years have BPH symptoms. Although the exact cause is unknown, changes in male sex hormones that come with aging may be a factor. Any family history of prostate problems or any abnormalities with the testicles may raise the risk of BPH.
1. Aging: BPH rarely cause signs and symptoms in men younger 40 years. Benign prostatic hyperplasia is an age-related disease. Mis-repair accumulation aging theory suggests that development of benign prostatic hyperplasia is a consequence of fibrosis and weakening of the muscular tissue in the prostate.
2. Family history: Having a blood relative (father or brother) with BPH
3. Ethnic background: This is more common in Asian men than in white and black men.
4. Diabetes, heart diseases and use of beta blockers might increase the risk of BPH.

SIGNS AND SYMPTOMS
The symptoms of BPH are often very mild at first, but they become more serious if they aren’t treated. Common symptoms include:
• Incomplete bladder emptying
• Nocturia, which is the need to urinate two or more times per night
• Dribbling at the end of your urinary stream
• Incontinence, or leakage of urine
• Weak urinary stream
• Sudden urge to urinate
• Slowed or delayed urinary stream
• Painful urination
• Blood in the urine
• Hesitancy in starting urination
• Fatigue
• Recurrent UTIs
• Pelvic floor dysfunction and pain

Pelvic floor dysfunction is a great Imitator of BPH. Basically, when it comes to restricting the flow of urine, a big prostate isn’t always to blame. For example, the urinary symptoms are the same for a man with an enlarged prostate, chronically tight pelvic floor muscles, or a narrowing of the urethra (called a “urinary stricture”). All three obstructions make it difficult to pee.

BPH PREVENTION
• Diet
• Exercises designed to strengthen your torso: Pilates, yoga, and advanced core exercises
• Herbal remedies
• Supplements
DIAGNOSTIC TOOLS FOR BPH
• Medical history
• Physical exam (with digital rectal exam)
• PSA screen (rule out prostate cancer)
• Urodynamic flow study
• Post void residual (PVR) testing
• Ultrasound
• Cystoscopy
COMPLICATIONS OF BPH
Many men ignore their symptoms of BPH. However, early treatment can help avoid potentially dangerous complications. Men who have a long-standing history of BPH may develop the following complications:
• urinary tract infections
• urinary stones
• kidney damage
• bleeding in the urinary tract
• a sudden inability to urinate
Sometimes urinary obstruction from BPH is so severe that no urine can leave the bladder at all. This is called bladder outlet obstruction. It can be dangerous because urine trapped in the bladder can cause urinary tract infections and damage the kidneys.
TREATMENT OPTIONS FOR BPH
Following the medical and sometimes surgical intervention for BPH, physiotherapy plays a major role in the management. Various types of exercises and lifestyle modifications can be helpful for men with prostate problems or overactive bladder.
• Pelvic floor exercises
• Aerobic exercises etc.
For more information on the type of exercises and appointment with a well-trained physiotherapist, contact PCA.