Benign Prostatic Hypertrohy

Nov 1, 2017

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

I yelled at my kid to stop eating salad. Just when I thought I was winning this round of parents vs kids, I'm on the ropes again. Eric doesn't love vegetables. Getting him to eat veggies has always been a challenge. On the day in question, he packed the entire thin plastic bucket of broccoli sunflower crunch salad from Safeway for his lunch. I calmly suggested that maybe he should put half the salad in a sturdy tupperware container and leave the rest in the fridge for someone else. I quietly queried whether he should add a protein. Maybe Eric would like the left over ginger beef? Eric's voice got a little louder when he insisted that he hated ginger beef. My voice increased in intensity as I reminded Eric, patiently, that just yesterday he threw a minor hissy fit in Safeway saying he'd only eat ginger beef, or maybe a meat ball, but I shouldn't buy the broccoli sunflower crunch salad because he would never eat that stuff. I then gave him some other parental nutritional advice and explained how the thin plastic bucket from Safeway would get crushed in his back pack. I'm sure I was still speaking in a very calm voice. Or maybe I was yelling by that point, who is to say. At about this time, a little voice in the back of my head pointed out, "Hey, you are yelling at Eric telling him NOT to take a salad to school. The kid who won't eat veggies. Is this wise ?" I sent Eric to see his mother and left the kitchen, angry and defeated.

Middle school kids are said to be full of piss and vinegar. I don't know what that means, really, but if you are an older guy who is full of urine and havinge trouble releasing it, that can be a problem. One of the common reasons why older guys have trouble urinating is called BPH.

Let's do a quick anatomy review. The urethra is the canal through which urine passes. It starts at the bladder and goes out of the body. The prostate is a walnut sized gland that surrounds the urethra in males. Benign prostatic hypertrophy (BPH) is a condition where a male's prostate becomes enlarged to the point that it starts to push against the urethra, much like clamping a garden hose. This causes the bladder wall to thicken and become irritable. The bladder starts to contract even when it contains only a small amount of urine. Eventually the bladder weakens and becomes incapable of empty itself completely, leaving behind urine.

Symptoms of BPH rarely show up before age 40. However, as men age the chance of BPH symptoms go up. About 50 percent of men in their 60s have BPH and over 80 percent of men in their 80s have symptoms. Common symptoms of BPH include needing to urinate often, feeling like you really need to go now, straining to start urinating, a stream that starts and stops several times, feeling like you haven't completely emptied your bladder, and more frequent nighttime urination.

What should you do if you have trouble urinating? Visit the doctor. They can determine if your symptoms are related to BPH and discuss your treatment options. What treatment options are available for BPH? There is surgery and medication. The gold standard for surgery is called TURP or trans-urethral resection of the prostate. It is usually reserved for more severe cases of BPH. BPH treatment will usually start with medication. And don't panic about a BPH diagnosis. Despite what you made have heard, although BPH and prostate cancer share similar symptoms, having BPH does not increase your chances of developing prostate cancer.

Just because you go to the doctor and complain about trouble peeing, don't be disappointed if they don't immediately offer you surgery or medication. If your symptoms don't bother you that much or if your prostate is still considered small, watching and waiting is a very reasonable strategy. Treatment of BPH is only recommended when it poses a health risk for the patient or when it becomes very bothersome.

There are two main types of medications used to treat BPH. They are alpha blockers and 5-alpha-reductase inhibitors. Alpha blockers include alfuzosin, doxazosin and tamsulosin. Alpha blockers relax the smooth muscle in the prostate and the bladder neck. They work quite quickly, and gentlemen say they can pee more easily in two weeks to a month. As good as alpha blockers are their benefits don't last a long time. Their effects usually only last 6 months to a year and then symptoms often return. And alpha blockers don't shrink the prostate. 5-alpha-reductase inhibitors like dutasteride and finasteride stop the conversion of testosterone to dihydrotestosterone (DHT). DHT causes the prostate to grow. 5-alpha-reductase inhibitors help BPH symptoms and also reduce the size of the prostate. Unfortunately, these medications work slowly. It takes 6 months to a year for a 5-alpha-reductase inhibitor to help a guy's symptoms.

One obvious solution to the problem of quick acting but no staying power alpha blockers and slow acting but good in the long haul 5-alpha-reductase inhibitors is to use them together. So, doctors often put guys on both an alpha blocker and a 5-alpha-reductase inhibitor. That way the alpha blocker can get the guy to urinate more easily within two weeks while the 5-alpha-reductase inhibitor is slowly starting to shrink the gland. Studies like the Combination of Avodart and Tamsulosin (CombAT) Study have showed that the combination of these two types of drugs works.

This morning Eric didn't want to pack a lunch at all. He hated all the food in the house. He just wanted to watch Stranger Things on his phone. I may have yelled a bit, but it was all a lot of sound and fury signifying nothing. Doris stepped in and told him to make a sandwich. Eric complied. Five or six years from now, when Eric has moved out, I'm gonna miss mornings like this right?

As always if you have any questions or concerns about these or other products, ask your pharmacist.

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The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.


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