Prostate Problems

Prostate Problems

Forget about those yearnings for red convertibles and shapely young blondes. The real midlife crisis occurs in a man's prostate, the gland that adds fluid to semen so that he can ejaculate. Four of every five men over age 50 develop an enlarged prostate--or, more specifically, a condition called benign prostatic hyperplasia (BPH). One-fourth to one-third of them will experience BPH's uncomfortable and potentially dangerous symptoms.

"BPH causes no pain, but it does make urination more difficult," says Stephen Rous, M.D., professor of surgery at Dartmouth Medical School and a urologist at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire. Because the prostate surrounds the urethra, the tube that carries urine from the bladder, when it enlarges it restricts urine flow. This results in a need to urinate more frequently, often with increased difficulty getting started.

With prostate problems, you may also experience dribbling, because the prostate isn't as strong as it used to be and you can't urinate with the same force. Some men with this problem are unable to sleep through the night without waking to urinate, while others are completely unable to urinate--an emergency condition.

Surgery to remove the prostate is one alternative, and there are several medications--some of which take months to work--that can reduce an enlarged prostate and improve urination. But for tried-and-true home treatments, here's what the experts recommend.

Cut the caffeine. "Caffeine in any form--coffee, tea, chocolate or soft drinks--tends to tighten the bladder neck and make it more difficult to pass urine," says urologist Durwood Neal, Jr., M.D., associate professor of surgery, urology, microbiology and internal medicine at the University of Texas Medical Branch at Galveston. "Some of the prostate is made up of smooth muscle, and anything that causes that muscle to constrict will make urination more difficult. Caffeine does this quite a bit."

Don't serve yourself. Alcohol also tightens the bladder neck to hamper urination. And since it's a diuretic, it increases the amount of urine that builds up inside the bladder, adds Dr. Neal. "Drinking alcohol also makes the bladder operate a lot less efficiently. And the more you drink, the more problems you'll likely have."

Give a cold shoulder to cold medicines. Antihistamines and decongestants can cause even more harm to some men. In fact, taking large doses of cold medications occasionally leads to urinary retention--a potentially life-threatening condition in which you completely stop urinating. "Decongestants cause the muscle at the bladder neck to constrict, restricting the flow of urine," says Peter Nieh, M.D., a urologist at the Lahey Clinic Medical Center in Burlington, Massachusetts. "And antihistamines simply paralyze the bladder."

If you have allergies as well as prostate problems, Dr. Nieh suggests you speak to your doctor about prescribing asternizole (Hismanal) or terfenadine (Seldane), two medications that have no antihistamines. If you must buy over-the-counter medication, take half of the suggested dose. If no problem ensues, move to the full recommended dosage.

Be wary of spicy foods. Spicy and acidic foods bother some men with enlarged prostates, says Dr. Neal. "If you notice more problems after eating salsa, chili or other spicy or acidic foods, then you're among those men--and you should avoid that cuisine."

Manage your stress. Perhaps the most underrated trigger is unmanaged stress. "Stress plays a major role in prostate-related discomfort, because the bladder neck and prostate are both very rich with nerves that respond to adrenal hormones," says Dr. Neal. "When you're under stress, there are more of those hormones floating around--causing more difficulty in urinating."

Stress also triggers the release of adrenaline in your body, prompting a fight-or-flight response. "Just as it's impossible to get an erection during the fight-or-flight response, it can make urination difficult, too," Dr. Neal adds.

Get more amour. One way urologists help ease urination problems is to massage the prostate. For men with mild to moderate voiding difficulties, an alternative may simply be to have more sex. "Many men notice that the more they ejaculate, the easier it is to urinate," says Dr. Rous. That's because ejaculation helps empty the prostate of secretions that may hamper urination.

Empty your bladder before you go to bed. "Many men get the urge to urinate in the middle of the night, and it can be a real problem," says Dr. Neal. "But if you limit your intake of beverages after 6:00 P.M. and make sure you urinate before going to sleep, you can eliminate much of this problem."

Flee south in the winter. If at all possible, spend winters somewhere in the Sunbelt. "In the urology trade, we usually say that summer is the season to pass kidney stones and winter is the time for urinary problems. I'm not exactly sure why, but people have more trouble urinating and are most likely to go into urinary retention during cold weather. Perhaps this is due to an increase in upper respiratory infections, which many men treat with over-the-counter antihistamines and decongestants. These further aggravate BPH," says Harold Fuselier, M.D., chairman of urology at Ochsner Medical Institutions in New Orleans. "Since an enlarged prostate already makes urinating more difficult, you'll do much better in a warm climate during cold weather."