As men get older, many of them start to experience a change in their bodily rhythms. The need to pee more frequently especially at night is one that many of us recognise. Sometimes this can develop into other distressing symptoms; difficulty starting or stopping urination, never quite feeling that the bladder is empty, or even dribbling after you think you have finished. I always wondered why old men in public urinals took so long when they seemingly had finished peeing, now I know, they are just waiting for the last dribble, so they don’t have to manage that embarrassing small wet patch on their trousers. I still remember with shame, the disgust I felt when I saw my own father coming out of the loo with a small damp stain, and how I vowed that would never happen to me.
What? Why? How?
But why does this happen and what is the culprit? It turns out that this is all due to a gland that only men have. Its called the prostate, and in young men is about the size of a walnut. For reasons that are not entirely understood, it gets larger as we age, especially after about the age of 50. This condition is called benign prostatic hyperplasia or BPH, it affects millions of men, and whilst not life-threatening, it can definitely be lifestyle-threatening.
Despite the danger of too much detail, its important to understand why only us men have this gland. The prostate circles the urethra ( the tube the pee goes down ) and its main purpose is to produce the fluid that mixes with the sperm when we ejaculate. During ejaculation, the muscular part of the prostate contracts, squeezing the prostate fluid into the urethra where it mixes with sperm from the testicles and fluid from other glands to form semen. The fluid from the prostate contains enzymes, zinc, and citric acid, which not only nourish the sperm but also help in clotting semen after ejaculation to keep it within the female reproductive tract, increasing the chances of fertilization.
There, I think we got through the murky details OK. It also now makes more sense when some men with BPH experience a loss of libido and difficulty, ahem, er, getting it up!
Why Does It Enlarge?
As I mentioned, it is not entirely clear why the prostate gets bigger, it is thought to be a combination of factors, including; a change in the balance between testosterone and estrogen as we age and an increase in the number of cells in the prostate's transition zone (the area around the urethra) both of which could cause the increase in size. Simply put, aging itself might make tissues more susceptible to changes, including those in the prostate gland, but the affect is to squeeze the pee tube and therefore affecting our ability to pee. Think of putting pressure half way down a garden hose!
There is also some evidence to suggest a genetic component. Men with a family history of prostate enlargement are at a higher risk, indicating that genetics can play a role in how the prostate responds to aging, and of course there are lifestyle factors such as diets high in animal fats and lacking in fibre that might contribute although the evidence is mixed.
Other theories are exploring how various growth factors and signalling pathways in the body can influence how prostate cells behave, but the evidence is mixed so far.
What Can We Do?
The first and most important thing to do is to get a checkup, because of its association with significant health concerns, particularly prostate cancer. No one likes the thought of a stranger's finger up the bottom, but these check-ups can also be done with blood tests now, negating the need for that rather embarrassing procedure.
Aside from surgery, which requires detailed discussion with your medical practitioner and I would think is a last resort, there are other treatments such as Transurethral Microwave Thermotherapy or TUMT. This involves inserting a catheter equipped with a microwave antenna through the urethra into the prostate. The microwave energy heats the prostate tissue to temperatures that causes cell death, typically between 45°C to 60°C (113°F to 140°F), while sparing the surrounding tissues due to controlled heating. The goal is to reduce the size of the prostate gland, thereby alleviating the pressure on the urethra which improves urine flow and reduces BPH symptoms.
This procedure is described as "minimally invasive", but to me that sounds pretty invasive and would be low on my Christmas list. However the benefits are said to be that it can be done under a local anaesthetic, and has a lower risk of affecting sexual function. Might be worth considering if your BHP symptoms are really bad.
For the rest of us it is about management of BPH symptoms which involves hormonal, genetic, and lifestyle factors. This can be done through medication (like alpha-blockers or 5-alpha reductase inhibitors), talk to your doctor for details. Or for many of us it is to do with lifestyle changes.
The classic advice is to do more exercise, eat more roughage, cut down on foods that are high in sugar and red meat and follow these simple rules;
- Limit fluid intake before bedtime. - Avoid caffeine and alcohol, which can irritate the bladder. - Practice double voiding (urinating twice to empty the bladder completely). - Stay physically active to improve urinary function.
But the simple truth is that even with these precautions, constantly feeling the pressure to pee, or having problems in the bedroom do affect our lifestyle and can lead to stress and feelings of low esteem.
Alternative Solutions
Alternative and complementary therapies are starting to gain some attention, although their efficacy remains a subject of ongoing research and debate.
Common alternatives include the use of herbal supplements such as saw palmetto, beta-sitosterol, and Pygeum africanum. Although some studies suggest these supplements may offer relief, results are mixed, and rigorous clinical trials are needed to confirm their efficacy and safety . Recent research has also focused on other things such as pomegranate, green tea, and turmeric, but existing studies often have limitations, such as small sample sizes and short durations.
So until the medical community can come up with some definitive answers, the vast majority of us are left to manage as best we can. It goes without saying that we should all be trying to lead a healthier life, exercising more and eating a balanced diet rich in fruits, vegetables, etc. whilst avoiding bladder irritants like caffeine and alcohol. But lets face it, we are all human and a glass of wine and a steak make up some of the joys of life.
So I for one , will be hedging my bets, I'll make the lifestyle changes that I can, and then maybe experiment with some herbal supplements just to see what works. If I can find a combination that allows me to worry less and live more, then for me its worth the cost and effort.
Conclusions
So until the medical community can come up with some definitive answers, the vast majority of us are left to manage as best we can. It goes without saying that we should all be trying to lead a healthier life, exercising more and eating a balanced diet rich in fruits, vegetables, etc. whilst avoiding bladder irritants like caffeine and alcohol. But lets face it, we are all human and a glass of wine and a steak make up some of the joys of life.
So I for one , will be hedging my bets, I'll make the lifestyle changes that I can, and then maybe experiment with some herbal supplements just to see what works. If I can find a combination that allows me to worry less and live more, then for me its worth the cost and effort.
