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NON PHARMACOLOGICAL TREATMENT OF BPH (BENIGN PROSTATIC HYPERTROPHY)
OP Kapoor
Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.
People usually develop early symptoms of enlarged prostate after the age of 50 and most of the men have markedly enlarged prostate by the age of 80 (often with associated cancer).
Most of the above patients develop symptoms of prostatism, now known as ‘Lower Urinary Tract Symptoms’ (LUTS). These are due to irritability of the bladder (now labelled as ‘storage’ symptoms), the symptoms being frequency of urine, nocturia, urgency and urge incontinence. If the prostate is moderately enlarged, then patients could have obstructive (now known as ‘voiding’) symptoms like hesitancy (starting trouble), poor stream, straining to void, intermittency of flow, dysuria, post-micturition dribbling or incomplete evacuation.
In my opinion (consistent with the modern world literature) diagnosing prostatism should be handled like detecting hypertension which is so common in normal population. Most of the GPs will be eager to prescribe some drug. All hypertensive patients should be immediately treated with non-pharmacological (DASH) line of treatment first. It should be tried for a few months or even longer before prescribing any drug.
In private practice, the doctors should manage prostatism problem in the same manner. There will be some part of the population which is not bothered by these symptoms and can be left alone. For the rest of them, ‘non-pharmacological treatment’ should always be advised first, before putting the patients on alpha blockers permanently (the cost of which is about Rs. 300-500 per month at least and that too for a lifetime).
Non-pharmacological treatment for prostatism is as follows:-
1.Advise the patient about double evacuation of the bladder. This means that after finishing to pass urine, the patient should wait for 30-60 seconds and then again pass urine. Although, this should be done throughout the day, it is specially important to do so before retiring to bed, otherwise slight residual urine adds to nocturia.
2.Bladder training should be introduced if available in the physiotherapy department, otherwise the patients should be taught to empty the bladder regularly at 2-3 hours’ interval.
3.Pelvic floor exercises : The patient should be taught to contract the pelvic floor muscles to strengthen them. These muscles are ultimately responsible for the urine to pass out. This can be done as frequently as possible, even hourly and also while working or even talking, without any waste of time.
4.Finally, ‘urethral milking’ should be taught to reduce as well as to hasten the post micturition dribbling. The patient should not feel shy to do this even in public toilets, where other people in the queue may be observing the unusual handling of the penis.
Remember that alpha blockers do not stop future prostate hypertrophy but only give relief as far as symptoms of prostatism are concerned. ‘Finasteride’ is the only drug which can stop further enlargement of the prostate. However, this drug is not within the reach of the normal people since it is very costly and is to be taken lifelong. It also has many side effects especially on the sexual life of the patient and therefore in practice, it should be prescribed only to patients whose prostate is enlarged to 40 Gms or more and that too after doing a PSA (Prostate Specific Antigen) blood level to exclude malignancy. This drug can reduce the levels of PSA and you can miss a cancer of the prostate.
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