What's Nagging You?
If you’ve entered middle age and you’re noticing changes in the bathroom, in
the bedroom, and with your overall quality of life, your prostate may be
telling you something.
If you’ve turned on the television today, you’ve likely run across one of a whole host of commercials featuring a fiftysomething man talking to his friends, his wife, or his doctor about how often he’s rushing to the bathroom, especially at night. Relief is promised in the form of one pill or another, the man smiles, and harmony is seemingly restored to his life.
If you’re age 40 or older, you might be experiencing the same problem (or others). And if you are, the root the problem may be your prostate, a small, chestnut-size gland at the base of the bladder. “The prostate resembles a doughnut,” explains Kenneth S. Ring, MD, chief of Urology at Overlook Hospital. “When men get older, the prostate gland increases in size. But as the doughnut gets larger, the hole gets smaller. The prostate has essentially two periods of growth. The first occurs at puberty, probably in response to hormonal changes. Since it is a relatively minor growth spurt, it is clinically insignificant. The prostate then remains relatively quiescent until around age 40, when it starts the second growth spurt—one that continues for the rest of a man’s life.”
Benign prostate hyperplasia (BPH), more commonly referred to as enlarged prostate, can result in obstructive and irritating urinary problems that range from increased nighttime urination to a slow stream of urine or intermittent, staccato voiding. There may be a sense of urgency to go, or some discomfort during urination. Most symptomatic men experience a combination of these. Sometimes BPH is associated with erectile dysfunction. “It’s not uncommon for a patient to come to me because he’s having symptoms related to BPH, and on his way out the door he’ll say, ‘Oh, by the way, I’m also having trouble with erectile dysfunction,’ ” says Ring. “These are two conditions that affect the aging male population, often simultaneously.”
Treating BPH
Some men with BPH don’t experience any symptoms. For most, though, symptoms will escalate over time as the condition worsens. When urinary problems affect quality of life or if symptoms become more serious (over time, BPH can result in blood in the urine or incontinence), your doctor can help. “It’s important to diagnose BPH and treat it, if necessary. BPH symptoms can increase—and in some cases, if left untreated, can progress to urinary retention or the inability to urinate, which in turn can lead to kidney failure,” explains Ring.
He says that for men in the earliest stages of BPH, doctors often recommend a watch-and-wait approach or may suggest natural therapies like saw palmetto, which has long been used in Europe to reduce prostate-related symptoms.
Of course, as we know from watching television, there are also several pharmacological therapies for treating BPH. One class of drugs, alpha blockers, works by relaxing the prostate’s smooth muscle tissue and opening the bladder neck. Another class of drugs, Ring explains, works by blocking the conversion of the male hormone testosterone to its active metabolite (dihydrotestosterone), causing the prostate to shrink in the process.
Laser therapies are also available to open the channel to improve urinary flow. If there is a benign growth on the prostate and this is contributing to symptoms, endoscopic surgical procedures can remove the growth. Radical prostatectomy—complete removal of the prostate—is generally reserved these days only in the treatment of prostate cancer. “There has been a huge shift in the last 20 years,” says Ring. “Previously, virtually everyone was treated with surgery. Now, patients can be managed exceptionally well on medications.”
No matter the course of treatment, the important thing is that BPH be treated in some form if there is an impact on quality of life, Ring says. “If unchecked, BPH in some men will lead to recurrent urinary infections, bleeding, and bladder stones due to urinary stasis and poor emptying. Long-term obstruction can also lead to kidney failure,” he explains.
That’s why, for any man who is experiencing symptoms, Ring encourages open dialogue. “Ask your primary care doctor about this, or ask for a referral to a urologist,” he says. “Ask your friends, too. You’re not alone; these conditions affect all men. Ask them, ‘Is this normal? Are you having this? Who are you seeing for treatment?’
“There’s nothing to be embarrassed about,” he continues. “You can
be treated.”
For a referral to a urologist, call (866) 647-0470.
