Benign prostatic hyperplasia (BPH), also known as benign prostatic enlargement, is a common condition among older men. Starting at age 40, men experience varying degrees of prostate enlargement, though symptoms generally do not appear until after age 50. The timing of symptom onset is related to the location and extent of the glandular enlargement. The advanced stages of this condition can be extremely painful, so its prevention and treatment must be taken seriously.
I. Causes of Benign Prostatic Hyperplasia
The exact causes of this condition are not yet fully understood, but the prevailing consensus is that it is caused by a combination of factors, including endocrine hormonal imbalances. Since the normal development of the prostate depends on male hormones—and the prostate fails to develop in adolescents who have had their testicles removed—it is believed that benign prostatic hyperplasia may be related to hormonal imbalances in older men.
Traditional Chinese Medicine (TCM) holds that the pathogenesis of benign prostatic hyperplasia is related to the qi transformation functions of the Sanjiao. When the Lung fails to perform its descending function, it cannot regulate the flow of body fluids to the bladder; when the Spleen fails to perform its transporting and transforming functions, it cannot separate the clear from the turbid, allowing damp-heat to descend into the bladder; and when Kidney Yang is deficient, the qi transformation of the Lower Jiao is disrupted, leading to impaired opening and closing of the urinary tract. Therefore, benign prostatic hyperplasia is caused by the disruption of qi transformation in the Lung, Spleen, and Kidney (the Sanjiao).
II. Clinical Manifestations in Patients with Benign Prostatic Hyperplasia
Symptoms arise due to the enlargement of the prostate gland, which causes the prostatic segment of the urethra to become curved, elongated, flattened, and narrowed, and elevates the bladder outlet.
Frequent urination: This is the earliest symptom to appear in patients with this condition. The frequency gradually increases, particularly at night. In mild cases, patients urinate 4–5 times per night; in severe cases, this can exceed 10 times per night.
Difficulty Urinating: Progressive difficulty urinating is the most important symptom of benign prostatic hyperplasia. The onset is gradual; initially, patients must wait a moment before urine begins to flow. Later, as the gland enlarges and obstruction worsens, urination becomes laborious with a weak urine stream. The distance the urine travels gradually shortens, the stream becomes thinner and may be interrupted, urination takes longer, or urine is passed in a trickle.
Urinary Retention in the Late Stages: Factors such as constipation, exposure to cold, alcohol consumption, and fatigue can cause bladder congestion and edema, leading to complete obstruction and acute urinary retention.
Pseudo-Incontinence: When the bladder is extremely full and the intravesical pressure exceeds the resistance of the urethral sphincter, urine may leak continuously; this is known as pseudo-incontinence.
Hematuria: Patients with benign prostatic hyperplasia may experience painless hematuria, which is caused by congestion of the bladder neck.
Benign prostatic hyperplasia can lead to numerous complications: due to prolonged urinary tract obstruction, secondary urinary tract infections may develop, bladder stones may form, and renal function may decline or even fail, resulting in loss of appetite, fatigue, followed by nausea, vomiting, elevated blood pressure, and anemia. At the same time, prolonged difficulty urinating increases abdominal pressure, leading to inguinal hernias, hemorrhoids, rectal prolapse, and varicose veins in the lower extremities.
Rectal Examination: A digital rectal examination (DRE) performed after bladder emptying may reveal an enlarged prostate with a smooth, nodule-free surface, well-defined borders, and elasticity; the central groove may be shallow or absent.
Other Examinations: Cystoscopy, cystography, and B-mode ultrasound may all reveal prostate enlargement or protrusion into the bladder.
III. Treatment of Benign Prostatic Hyperplasia
Non-surgical Treatment
(1) Traditional Chinese Medicine (TCM) Differential Diagnosis and Treatment
① Damp-Heat Pattern: Manifestations include dribbling urination, frequent urination, a burning sensation, and painful urination; scant, yellow urine; lower abdominal distension; dry mouth; and constipation. The tongue is red with a thick, yellow coating, and the pulse is string-like and rapid. Treatment should focus on clearing heat, draining dampness, resolving blood stasis, and unblocking the orifices. A decoction may be prepared using ingredients such as Phragmites rhizome, Anemarrhena rhizome, Lycopodium, Polygonum aviculare, Phellodendron bark, Sargassum, Talc, Plantain seed, Akebia stem, Rhubarb, and White Flower Snake Tongue Grass.
② Kidney Deficiency Type: Manifestations include urinary retention or dribbling with discomfort, a pale complexion, lower back soreness and aversion to cold, fatigue and weakness, a pale tongue with a thin white coating, and a deep, fine pulse. Treatment should focus on warming and tonifying kidney yang, transforming qi, and promoting diuresis. A decoction of Chinese yam (Shanyao), Chinese cornel fruit (Shanyuyou), Codonopsis (Dangshen), prepared rehmannia root (Shudi), aconite (Fuzi), cinnamon bark (Rougui), Alisma (Zexie), Achyranthes root (Niuxi), and plantain seed (Cheqianzi) may be administered (dosage based on the patient’s specific condition). Alternatives include Kidney Qi Pills (Shenqi Wan) or the Bu Zhong Yi Qi Decoction.
(2) Hormone therapy for women: This is somewhat effective for patients in the early stages and can reduce the size of hyperplastic glands. Ethinyl estradiol is commonly used at a dose of 2–5 milligrams daily, with a treatment course lasting 3–4 weeks. Estradiol or ethinyl estradiol may also be used; these are more potent than ethinyl estradiol and offer better therapeutic effects, but they carry side effects and contraindications.
(3) Other medications: Drugs such as phenylbenzamine and prostaglandins can help alleviate symptoms.
Surgical Treatment: Indicated for patients in the advanced stages with urinary retention or for those whose symptoms have worsened despite treatment with the above methods.
(1) Prostatectomy: This is a curative procedure, but it carries contraindications and life-threatening risks. Since these patients are typically elderly, the surgical risk is even greater for those with impaired cardiac, pulmonary, or renal function.
(2) Bilateral orchiectomy: Some advocate for the removal of both testicles; this yields good results in most patients and is suitable for those who cannot tolerate prostatectomy.
IV. Prevention of Benign Prostatic Hyperplasia
Since the causes of benign prostatic hyperplasia are currently believed to be related to an imbalance in sex hormones, Traditional Chinese Medicine (TCM) attributes it to a dysfunction of the Triple Burner’s qi transformation. Therefore, prevention of benign prostatic hyperplasia can be approached from the following aspects:
Maintain a calm and cheerful state of mind, and avoid fear, anxiety, and excessive worry. Traditional Chinese Medicine holds that “all diseases arise from qi,” and the “seven emotions” (joy, anger, worry, overthinking, sadness, fear, and shock) can also lead to various illnesses. Under normal circumstances, these emotions are part of normal mental activity and do not cause disease. However, if emotional fluctuations are severe or prolonged, or if the mind is subjected to excessive stimulation, they can disrupt the body’s physiological functions, leading to imbalances in yin, yang, qi, and blood, as well as dysfunction of the internal organs, thereby causing disease. Excessive thinking damages the spleen, worry damages the lungs, and fear damages the kidneys, causing the triple burner’s transformative functions to malfunction and leading to illness.
Avoid excessive fatigue: Excessive fatigue damages spleen qi, while excessive sexual activity and lack of moderation in sexual life easily deplete kidney essence, leading to symptoms such as lower back pain, weak knees, dizziness, and tinnitus, which disrupt the physiological functions of the internal organs and result in illness.
Reduce or abstain from alcohol and limit consumption of spicy and stimulating foods.
Maintain regular bowel movements: Daily bowel movements are crucial for preventing this condition and other colorectal diseases.
Avoid pelvic venous stasis: For those who sit for extended periods at work, be sure to stand up and move around for a few moments at regular intervals to promote blood circulation in the pelvic area.
Elderly men experiencing frequent urination should consult a doctor as soon as possible to obtain a clear diagnosis and timely treatment, to prevent the condition from worsening due to delay.