Our Greatest Wealth Is Health

Andrew Siegel MD  1/12/2019

The prostate is one of the few organs that gets bigger over time.  Meanwhile, there is  shrinkage, loss of tissue mass and recession going on elsewhere, e.g., bones, muscles, gums, hairlines, etc. 

Attribution of image above: Akcmdu9 [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)%5D, from Wikimedia Commons

The following paragraph from Gabriel Garcia Marquez’s Love in the Time of Cholera (an awesome read) colorfully sums up the aging prostate:

“He was the first man that Fermina Daza heard urinate. She heard him on their wedding night, while she lay prostrate with seasickness
in the stateroom on the ship that was carrying them to France, and the sound of his stallion’s stream seemed so potent, so replete with authority, that it increased her terror of the devastation to come. That memory often returned to her as the years weakened the stream, for she never could resign herself to his wetting the rim of the toilet bowl each time he used it. Dr. Urbino tried to convince her, with arguments readily understandable to anyone who wished to understand them, that the mishap was not repeated every day through carelessness on his part, as she insisted, but because of organic reasons: as a young man his stream was so defined and so direct that when he was at school he won contests for marksmanship in filling bottles, but with the ravages of age it was not only decreasing, it was also becoming oblique and scattered, and had at last turned into a fantastic fountain, impossible to control despite his many efforts to direct it. He would say: ‘The toilet must have been invented by someone who knew nothing about men.’ He contributed to domestic peace with a quotidian act that was more humiliating than humble: he wiped the rim of the bowl with toilet paper each time he used it. She knew, but never said anything as long as the ammoniac fumes were not too strong in the bathroom, and then she proclaimed, as if she had uncovered a crime: ‘This stinks like a rabbit hutch.’ On the eve of old age this physical difficulty inspired Dr. Urbino with the ultimate solution: he urinated sitting down, as she did, which kept the bowl clean and him in a state of grace.”

The prostate is a mysterious-to-many, deep-in-the-pelvis male reproductive organ that can be the source of trouble and angst.  It functions to produce a milky liquid that is a nutrient and energy vehicle for sperm. Similar to the breast in many respects, the prostate consists of numerous glands that produce this fluid and ducts that convey the fluid into the urethra (urinary channel that runs from the bladder to the tip of the penis). At the time of sexual climax, the muscle within the prostate squeezes the glandular fluid into the prostate ducts and then into the urethra, where it mixes with secretions from the other male reproductive organs to form semen.

The prostate completely envelops the urethra, enabling its many ducts to drain into the urethra. However, this necessary anatomical relationship between prostate and urethra can potentially be the source of many issues for the aging male. In young men the prostate gland is the size of a walnut.  Under the influence of three factors—aging, genetics, and the male hormone testosterone—the prostate gradually and insidiously enlarges.

Prostate enlargement is highly variable from man to man, depending upon the aforementioned factors.  As the prostate gland enlarges, it often—but not always—squeezes the section of the urethra that runs through it, making urination difficult and resulting in a number of annoying symptoms and disturbed sleep.  The effect of the enlarging prostate on urinary flow is similar to that of stepping on a garden hose, obstructing the flow. The resultant situation can be anything from a tolerable nuisance to one that has a huge impact on one’s daily activities and quality of life.

The condition of prostate enlargement is known as BPH—benign prostate hyperplasia—one of the most common plagues of aging men. Other processes that can mimic the symptoms of BPH include urinary infections, prostate cancer, urethral stricture (scar tissue causing obstruction), and impaired bladder contractility (a weak bladder muscle that does not squeeze adequately to empty the bladder).

Although larger prostates tend to cause more crimping of urine flow than smaller prostates, the relationship is imprecise and a small prostate can, in fact, cause more symptoms than a large prostate, much as a small hand squeezing a garden hose tightly may affect flow more than a larger hand squeezing gently. The factors of concern are the precise anatomical location of the prostate enlargement and the extent of the compression on the urethra. In other words, prostate enlargement in a location immediately adjacent to the urethra will cause more symptoms 
than prostate enlargement in a more peripheral location. Also, the prostate gland and the urethra contain a generous supply of muscle and, depending upon the muscle tone, variable symptoms may result.

Symptoms that develop as a result of BPH are commonly “obstructive” as the prostate becomes, in the words of one of my patients: “welded shut like a lug nut.”  These symptoms include a weak stream that is slow to start, a stopping and starting quality stream, prolonged time required to empty, and at times, a stream that is virtually a gravity drip with no force.  Another patient described the urinary intermittency as “peeing in chapters.”  Many men have to urinate a second or third time to try to empty completely, a task that is often impossible. Not only may the stream be slow to start, but also may continue after urination is thought to be completed, a condition known as post-void dribbling.  At times, one cannot urinate at all and ends up in the emergency room for relief of the problem by the placement of a catheter, a tube that goes in the penis to drain the bladder and bypass the blockage. BPH can be responsible for bleeding, infections, stone formation in the bladder, and on occasion, kidney failure.

The other type of symptoms that can develop with BPH are “irritative” as opposed to “obstructive” and may include the following: an urgency to urinate requiring hurrying to the bathroom, frequent daytime and nighttime urinating, and at times, urinary leakage before arriving to the bathroom.  As a result of these “irritative” symptoms, some men have to plan their routine based upon the availability of bathrooms, sit on an aisle seat on airplanes and avoid engaging in activities that provide no bathroom access.  One symptom in particular, sleep-time urination—a.k.a. nocturia—is particularly irksome because it is sleep-disruptive and the resultant fatigue can make for a very unpleasant existence.

Not all men with BPH need to be treated; in fact, many can be observed if the symptoms are tolerable. There are effective medications for BPH, and surgery is used when appropriate. There are three types of medications used to manage BPH: those that relax the prostate muscle tone; others that shrink the enlarged prostate; and Cialis that has been FDA approved to be used on a daily basis to treat both erectile dysfunction as well as BPH.  There are numerous surgical means of alleviating obstruction and currently the most popular procedure uses laser energy to vaporize a channel through the obstructed prostate gland.

In terms of the three factors that drive prostate growth: aging, genetics and testosterone– There is nothing much we can do about aging, which is quite a desirable state!  We cannot do a thing about inherited genes.  Having adequate levels of testosterone is a positive in terms of general health.

So what can be done to maintain prostate health? The short answer is that a healthy lifestyle can lessen one’s risk of BPH.  Regular exercising and maintaining a physically active existence results in increased blood flow to the pelvis, which is prostate-healthy as it reduces inflammation. Sympathetic nervous system tone tends to increase prostate smooth muscle tone, worsening the symptoms of BPH; this sympathetic tone can be reduced by exercise.  Maintaining a healthy weight and avoiding abdominal obesity, will minimize inflammatory chemicals that can worsen BPH.  Vegetables are highly anti-inflammatory and consumption of those that are high in lutein, including kale, spinach, broccoli and peas as well as those that are high in beta-carotene, including carrots, sweet potatoes and spinach, can lower the risk of BPH.

Bottom Line: BPH is a common problem as one ages, oftentimes negatively impacting quality of life.  There are medications as well as surgery that can help with this issue; however, a healthy lifestyle that includes exercise, avoidance of obesity, and a diet rich in vegetables can actually help lower the risk for developing bothersome prostate symptoms.

Tags: Andrew Siegel MD, benign prostate enlargement, benign prostate hyperplasia, enlarged prostate, lower urinary tract symptoms, prostate gland

This entry was posted on January 12, 2019 at 7:32 AM and is filed under health and wellness. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.