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.

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