Benign prostatic hyperplasia: Discover how to shrink an enlarged prostate

If you are a man over 40 and your waterworks dont seem to function as they did in your youth, the problem could be your prostate gland. Difficulty in starting urination, a weak urine stream, embarrassing dribbling and a need to get up and go to the loo several times a night could mean that you have an enlarged prostate.

As a man gets older, this normally walnut-sized gland which is located just below the bladder may get bigger a condition called benign prostatic hyperplasia (BPH), which affects around 60 per cent of men between the ages of 40 and 60.

Conventional drugs for this problem can cause difficulties with sexual performance, but recent research has shown that safe herbal alternatives, which dont have this distressing side effect, are just as effective in combating BPH symptoms.

Your prostate gland has just one job, to secrete fluid containing substances needed for reproduction. This requires an extremely high concentration of testosterone in the tissues of your prostate gland and, the older you get, the more readily this hormone becomes converted to a form called 5-alpha-dihydrotestosterone (DHT). It is DHT that causes your prostate to grow bigger than normal.

An enlarged prostate constricts the urethra (the tube carrying urine from your bladder to your penis), which reduces urine flow. It also presses against your bladder, causing feelings of urgency, and interferes with the normal contraction of your bladder muscles, so that it does not empty properly.

Drug treatments or surgery for BPH can seriously affect your sex life

If you suspect that you have BPH, see your doctor to confirm the diagnosis and rule out other possible problems such as a bacterial infection of the bladder or prostate cancer.

You are likely to be prescribed drugs for BPH, such as finasteride (Proscar), which blocks the conversion of testosterone into DHT, or one of the newer alpha-blockers (e.g. tamsulosin) that relax the urethra and bladder, so improving urine flow. However, taking finasteride can result in reduced libido and erection difficulties and, according to the findings of one scientific study, it may even increase your risk of prostate cancer (Br J Cancer 1998; 78(3): 413-418). Alpha-blockers can cause dizziness, headaches and palpitations, in addition to preventing ejaculation.

For serious cases of BPH, surgery to remove part of your prostate gland may be considered. This carries the risk of post-operative infection, sexual problems (in nearly a third of cases) and the formation of scar tissue that can itself interfere with urine flow. Because some of the prostate gland always remains, this can grow and become enlarged again, so surgery is not a once-and-for-all solution.

Saw palmetto works faster than the leading prescription drug but without the side effects

Herbal medicine offers some extremely effective alternatives to conventional BPH treatments, and recent research has shown that some of these tried-and-tested natural remedies are equally as good, if not better, than prescription drugs.

Best known is the extract from the berries of a small palm tree called saw palmetto (Serenoa repens), which has outshone conventional drugs in clinical trials. In a randomised international study of more than 1,000 patients, both saw palmetto extract and the drug finasteride relieved BPH symptoms significantly in two thirds of cases, but saw palmetto worked faster and resulted in far less problems of sexual function, decreased libido and impotence (Prostate 29: 231-40, 1996).
In another year-long trial in the Netherlands, involving 811 men, saw palmetto was found to be just as effective as the alpha-blocker drug tamsulosin in reducing symptoms, but in the tamsulosin group seven times as many patients complained of ejaculation disorders (Eur Urol 2002; 41(5): 497-506).

The active ingredients in saw palmetto are natural plant chemicals called sterols, which block the enzyme 5-alpha reductase, which is responsible for converting testosterone into DHT (Prostate 2004; 61(1): 73-80). Saw palmetto acts in a similar way to finasteride, but in addition it appears to have anti-inflammatory properties that enhance its effectiveness. The treatment dose is 160mg to 240mg of standardised extract, taken twice a day.  80mg to 160mg a day would be an appropriate preventive dose.

Stinging nettle root helps over 80 per cent of men with BPH

Most people steer well clear of stinging nettles, but this vicious weed is also the source of a powerful BPH remedy. Nettle root (Urtica dioica) extract was the subject of a randomised, double-blind crossover trial carried out recently in Iran. A total of 620 men took part in this six-month study, at the end of which an impressive 81 per cent of the nettle root group reported an improvement in their symptoms, compared with just 16 per cent of the placebo group.

Whats more, men taking nettle root  had improved urine flow rates, more efficient bladder emptying and measurable reductions in prostate size, while those taking placebo showed little or no change (J Herb Pharmacother 2005; 5(4): 1-11). Take 600mg to 1,200mg a day of dried nettle root extract, or as advised by the manufacturer since the strength of extracts can vary.

Pygeum and red clover both reduce night-time visits to the loo

Another herb that has proved its effectiveness in treating BPH is Pygeum africanum, the African plum tree, whose bark is used to prepare a herbal extract widely used in Central and Eastern Europe.
In a multi-centre clinical trial, pygeum reduced BPH symptoms by 40 per cent on average and decreased night-time visits to the loo by a third. The researchers also reported that pygeum was extremely safe.

The patients were monitored after the end of the trial for an additional month without any treatment and the beneficial results continued, showing a long-lasting therapeutic effect (Curr Med Res Opin 1998;14(3):127-39). The recommended dose of pygeum is 100mg to 200mg daily.

Red clover, a herb best known for helping women through the menopause, may also be of benefit to BPH sufferers. A paper presented at the Annual Meeting of the Endocrine Society, in June 2000 in Toronto, Canada, reported a preliminary study involving 35 men with BPH who took 40mg or 80mg per day of red clover isoflavones for 3 months. Their symptoms improved significantly and frequency of night-time urination fell by 28 per cent. Try taking 600mg to 1,200mg of standardised (8% isoflavones) extract a day.