Male Health: Dribbling Into Middle Age
Men! Are your nights interrupted by frequent trips to the bathroom? Do you
groan in agony when you see a "next rest stop, 69 miles" sign on the road? Have
you given up basketball games because you’re doing more dribbling than the
players?
If so, you’ve truly entered middle age and are experiencing the
one problem that nearly all men share: Prostate problems, especially
benign prostatic hyperplasia.
The prostate is a donut-shaped,
chestnut-sized gland located below the bladder. More important is that
it surrounds the urethra, the tube through which urine flows from the
bladder. If the prostate is inflamed or enlarged, as is often the case
with prostate problems, it can push against the urethra, pinching it and
causing it to narrow. The result is the same as when you pinch your
garden hose; the water dribbles out.
To compensate for the
narrowing of the urethra, the muscular wall of the bladder contracts
more strongly to expel urine. This increased "exercise" leads to the
thickening of the bladder wall and a decrease in its urine capacity. The
bladder will hold less and less urine, resulting in having to urinate
more and more.
Basically, there is nothing you can do to keep the
prostate from enlarging as you age. When in your 20s, 30s, and 40s, the
prostate remains much the same size, but when you hit the big five-zero
it starts growing. By age 85 just about every male has some prostate
growth.
This growth is generally known as benign prostatic
hyperplasia (BPH). Known traditionally as "old man’s disease" because so
many elderly men develop it, various reports state that 50 percent to 60
percent of men over 50 years of age and some 85 percent of men over 80
years of age have some indication of BPH. Common symptoms include
- An urgent feeling that you need to urinate;
- An increased frequency of urination, waking multiple times during the
night to urinate;
- Some difficulty when beginning to urinate;
- A urine stream that is weak and thin;
- Difficulty stopping urinating; often followed by dribbles; and
- A feeling that your bladder has not completely emptied, urinary retention.
If left untreated, BPH results in stagnant urinary residue, which can
lead to infection and blockage of the bladder outlet.
Not all men
experience symptoms. Only about half of all men will have noticeable
symptoms, and only half of those will experience enough discomfort to go
to a doctor. The symptoms often come and go.
Although researchers
do not know exactly why BPH develops, it appears to be related to age
and increased levels of 5-alpha-dihydrotestosterone (DHT), a hormone.
DHT binds to the prostate, which results in continued prostate growth.
This can eventually cause the overproduction (hyperplasia) of prostate
cells, which causes the prostate gland to enlarge more than it should.
Helping Out
For BPH, you can help yourself.
Drink water: Although the
natural reaction to frequent and urgent urination is to cut back on
fluid intake, this is a mistake. You risk dehydration and the likelihood
of developing a bladder infection increases because your urine becomes
stronger. Drinking lots of fluid keeps the retained urine in the bladder
fairly diluted and reduces the risk of bladder infection and
dehydration.
Dietary
changes: Caffeine, alcohol, spicy foods and/or acidic foods may
irritate the prostate, and most doctors recommend either eliminating
them or consuming very little of them. Diets with an emphasis on soy are
helpful, as this helps eliminate DHT. Sunflower and pumpkin seeds may
also be helpful. Cut back on beer, as this stimulates hormones that may
contribute to prostate growth.
Watch your weight: At least
one study (
American Journal of Epidemiology; Dec. 1994) has shown
that men with larger than a 43-inch (109 cm) waist are more than twice
as likely to have enlarged prostates. It pays, then, to eat right and
exercise so that your gut doesn’t hang over your belt.
Avoid decongestants and antihistamines: Sudafed, Tavist-D, Contact,
etc., all carry warnings in fine print not to use them if you have an
enlarged prostate or BPH. These medications appear to cause the prostate
to contract, which decreases urine flow. There is also some evidence
that these tend to make the prostatic secretion thicker and more prone
to forming clogs.
Stay
in love: Making love can also help forestall prostate problems.
Exercise: Walking will often help relieve prostate symptoms.
Use supplements: Dietary supplements can help general prostate
health. Make sure you get sufficient amounts of zinc and B vitamins.
These nutrients regulate the enzyme that converts testosterone to DHT.
Essential fatty acids may be helpful, as these influence hormones that
control inflammation.
There have been a number of animal and
clinical trials on the use of pollen extract for BPH, nonbacterial
prostatitis, and prostadynia. Herbs used to maintain prostate health
include saw palmetto and pygeum africanum.
The American Urological Association BPH Symptom Index
Circle the
number in the appropriate column:
| |
Never |
Less than 1 time in 5 |
Less than half the time |
About half the time |
More than half the time |
Almost always |
| 1. How often have you had a sensation of not emptying the
bladder completely after you finished urinating? |
0 |
1 |
2 |
3 |
4 |
5 |
| 2. How often have you had to urinate again less than two
hours after you finished urinating? |
0 |
1 |
2 |
3 |
4 |
5 |
3. How often have you found you stopped
and started again several times when you urinated? |
0 |
1 |
2 |
3 |
4 |
5 |
| 4. How often have you found it difficult to postpone
urination? |
0 |
1 |
2 |
3 |
4 |
5 |
| 5. How often have you had a weak urinary stream? |
0 |
1 |
2 |
3 |
4 |
5 |
| 6. How often have you had to push or strain to begin
urination? |
0 |
1 |
2 |
3 |
4 |
5 |
| 7. How many times did you most typically get up to urinate
from the time you went to bed at night until the time you got up in the
morning? |
None
0 |
1 |
2 |
3 |
4 |
5 or more |
Total all circled numbers. 1 - 7: mild; 8 - 19: moderate; 20- 35:
severe. Generally, no treatment is needed for mild symptoms. For
moderate and severe symptoms, consult a health practitioner.
| Other prostate
disorders Prostatitis is the general term for inflammation of
the prostrate gland. As with BPH, the inflamed prostate pinches the
urethras, resulting in many of the same symptoms; frequent and urgent
urination, increased nighttime urinating, and a stop-and-start urine
stream. Other symptoms include pain between the rectum and the
back of the scrotum, in the lower back, above the pubic bone, in the lower
abdominals, or in and around the groin and testicles. Prostatitis
can also result in dysuria which is painful or difficult urination
Prostatitis - or have no known cause, which is known as nonbacterial
prostatitis.
Prostatodynia occurs if there are prostatitis - like symptoms that
appear to originate in the prostate (but probably do not) and no evidence of
inflammation or bacteria. This really has nothing to do with the
prostate. Pain appears to originate in the prostate, buy might
actually be coming from the pelvic area, genitals or rectum. The
prostate is generally normal or slightly tender, and you may have tension
headaches. |
