Ashtheela (B.P.H.)

Introduction

A condition in which a non-cancerous growth of the prostate gland makes urination frequent, difficult and uncomfortable is called benign prostatic hypertrophy (BPH). BPH rarely causes symptoms before age 40, but more than half of men in their sixties and 75% by age of 80 have some symptoms of BPH. It is a common part of ageing. Prevalence rates are 2-7% for men aged 45-49, increasing to 24% by the age of 80 years48. If left untreated, BPH can be a progressive disease. Incomplete voiding may result in urinary tract infections in these patients.Descriptions of BPH are closely resembles with the clinical featutes of Ashtheela. It is one of the 13 types of  Mutraghata (obstructive uropathies) described in Ayurveda. Ashtheela is a mobile and elevated swelling, which obstructs the passage of urine and faeces. Generally vata prakopaka Ahara (like dry, cold and light food in insufficient quantities) and vihara (like starvation, over exertion and suppression of urine) aggravate vata dosha which leads to Ashtheela (Paurusha granthi vrddhi - Prostate gland enlargement)

Aetiology

The exact aetiology of BPH is unknown; however, ageing process is an important causative factor for BPH. In addition, prostatic growth is directly related to presence of Dihydrotestosterone (DHT) also. Initially, prostate growth takes place at puberty and again around fifth decade of life, which continues for the rest of man's life. This process involves a heterogenous and glanular hyperplasia of the prostate.

Clinical features

The most common symptoms of BPH are

1. Frequent urination, especially at night

2. Urgency of urination

3. Hesitancy and intermittency

4. Leaking or dribbling of urine

5. Interrupted weak stream

6. Bladder pain/ dysuria

7. Urine incontinence

8. Prolonged emptying

9. Urine retention (in severe BPH)

10. Hematuria

Complications

1. Urinary tract infections

2. Urinary stones

3. Blood in the urine

4. HydronephrosisL

5. Urinary retention

Investigations/Examination

1. Digital rectal Examination

2. Urine analysis

3. Ultrasound : Kidney, Ureter, Bladder

4. Cystoscopy

5. Serum Prostate Specific Antigen (PSA) Blood test

6. Prostate Biopsy

7. Uroflowmetry

Management approaches

a. Prevention of complications of BPH

1. Usage of wheat, old rice, mudga (green gram) juice, kulattha (horse gram), yava (barley) water, rasona (garlic), haridra (turmeric), Ardraka (ginger), patola/Tikta patolika or chichinda (snakegourd )Trichosanthes Dioica/Trichosanthus cuccumerina), Shigru (drum stick), coconut, cucumber, watermelon, coriander, cumin seed,sugarcane, grapes, butter milk etc.

2. Consumption  of adequate liquids

3. Avoidance of pea, black gram, spinach, jamun, mustard, sesame and excess hot and spicy food

b. Medical management

Line of treatment

1. Samshamna Chikitsa - (Bio-cleansing therapies) /other therapeutic procedures followed by Samshamana chkitsa (Palliative therapy) should be advocated. But it should be decided by physician according to the condition of the patient whether Shodhana therapy (Biocleansing therapies) is beneficial or not.

i. Avapeeda  snehapana with Vastyamayantaka  ghrita, single dose of 200 - 300ml

ii. Avagaha sveda (Sitz bath) for 15 days with warm water or decoctions like Pancha valkala kvatha/Triphala kvatha/Dashamula kvatha

iii. Vasti

Uttara vasti with Varunadi ghrita/ Satavaryadi ghrita 30-50 ml for 3 days (Each

Uttara vasti is given with a gap of three days).

Matra vasti with Varunadi ghrita/ Shatavaryadi ghrita 30-50 ml for 14 days

The dosage (per dose) should be decided by physician according to severity of the disease and condition of the patient.

2. Drug therapy

SIMPLE SINGLE MEDICINAL PLANT  

 FORMULATIONS

Formulations may be taken  Initially 2 times in a day after meal for 15 days followed by the condition of patient and physician's direction.

NOTE: Out of the drugs mentioned above any one of the drug or in the combination may be prescribed by the physician.The duration of the treatment may vary from patient to patient. Physician should decide the dosage (per dose) and duration of the therapy based on the clinical findings and response to therapy.

c. Yogic Practices - The following yogic practices are beneficial in BPH; however,these should be performed only under the guidance of qualified Yoga therapist. Duration of each yogic practicesshould be decided by the Yoga therapist.

1. Vajrasana, Siddhasana, Gomukhasana, Padnggushthasana, Guptasana,Paschimottanasana, Sarvangasana, Pavanamuktasana etc.

2. Ashvini mudra, Mula bandha, Nadi Shodhana, sheetali  pranayama

Counselling - Advice the patient to

1.  Urinate when ever the urge and at regular intervals

2.  Take plenty of fluids, but in divided quantities at regular intervals

3.  Try to evacuate bladder completely

4.  Practice of kegel exercise:  simply tighten and relax the pubo-coccygeus muscles for 3 seconds about 20-30 times a day for strengthening the pelvic floor

5.  Practice yoga to reduce stress

6.   Restrict high caloric and high fat diet

7.   Avoid drinking large amounts of fluid at one time and especially at night

8.   Avoid alcohol and caffee, especially after dinner.

9.    Avoid drinking water within 2 hours before going to bed

10.  Try to avoid decongestants and antihistamines, which can worsen BPH symptoms

Indications for referral

1. Incontinence of urine

2. Recurrent urinary infection

3. Recurrent blood in the urine

4. Urinary retention

Reference

AYURVEDIC MANAGEMENT OF SELECT GERIATRIC DISEASE CONDITIONS A CCRAS -WHO COUNTRY OFFICE, INDIA COLLOBORATIVE PROJECT CENTRAL COUNCIL FOR RESEARCH IN AYURVEDA AND SIDDHA

Department of AYUSH, Ministry of Health & Family Welfare Government of India, New Delhi - 110 058 Central Council for Research in Ayurveda and Siddha, New Delhi 2011