Leaking, Dribbling, Start-Stop Stream.. Fellas, I’m Not Talking About Your Facets

Sometimes, you’ve just got to get the awkward stuff out in the open. I’m more of a “rip-the-bandaid-off” sort of gal, so let’s get right to it. As men get older, sometimes you have less control of things in your nether regions than you want to, and maybe you pee your pants sometimes. Let me start off by saying this is VERY common, and nothing to be ashamed of. If this is the right comparison (which it definitely isn’t), women have periods and menopause, men have erectile dysfunction and a prostate. It’s a fact of life – let’s accept it, and move on.

While doing research for my previous article on tomatoes being a men’s health superfood, I came across a study that basically said men have no idea what a prostate is. So, let’s start there.

Prostate cancer only affects men, because women don’t have a prostate! It’s a little “nub”-like thing that sits between the bladder and penis, in front of the rectum (talk about weird imagery). Digital rectal exams (DRE) are done through the rectum in order to assess the prostate, because that is the closest that we can get to it (without further imaging/equipment). I’ll be writing an article soon about male screening exams, so stay tuned! Alrighty, now that we’ve got that out of the way, let’s get to the good stuff.

Take a look at these symptoms and see if any (or all) apply to you:

• when voiding urine, you have poor flow, an intermittent stream (that starts and stops), a bit of dribbling, and/or poor/incomplete bladder emptying
• during your day to day, you have trouble holding in your urine (which may cause you to stain your underwear from time to time), you have to pee a lot, and/or you wake up to pee often during the night
• sometimes it’s hard to pass urine and/or you have a dull, achy pain just above your pubic region

This could be a sign of benign prostatic hyperplasia (BPH), meaning non-cancerous growth of your prostate, a common condition among aging males. About one third of men experience this by the age of 60, and half of men by the age of 80. Note that this is a growth in the number of cells, not the increase in size of the cells (hyperplasia, NOT hypertrophy like when you’re building your bicep muscle). And it is benign, meaning non-cancerous.

So, what are the risk factors, and what causes this? I would have this on my radar if there’s a family history of BPH, and conditions such as diabetes, heart disease (especially with the use of beta blockers), and obesity. It rarely happens in men under the age of 40 (although it absolutely can). The cause is multi-factorial, and has to deal with hormone imbalances and lifestyle factors.

Interestingly enough, men who are castrated will never develop BPH. This is because testosterone is necessary for this process. Testosterone is converted to DHT (a hormone that is 10x stronger than testosterone) in the prostate from the action of an enzyme called 5-alpha-reductase. This is what causes the prostate to grow in size. There is also some local conversion of androgens to estrogen in the prostate tissue. With the naturally decreasing testosterone levels with age, there isn’t testosterone there to balance out the effects of DHT. High protein intake may also be a factor, along with elevated alcohol intake and metabolic syndrome (due to their effects on hormone balance).

A common test that doctors do for prostate health is prostate specific antigen (PSA). It is important to note that this test does NOT differentiate between symptomatic BPH and prostate cancer. You should also be doing a urinalysis and/or urine culture and sensitivity to rule out prostatitis.

Conventional treatments involve the following types of pharmaceuticals:

• alpha blockers – which don’t decrease the size of the prostate, but decrease symptoms of obstruction by relaxing the smooth muscle of the bladder neck, urethra and prostate

• 5-alpha-reductase inhibitors – which blocks the conversion of testosterone to DHT and can reduce the size of the prostate

As far as naturopathic treatments go, botanicals medicine definitely wins!

• Serenoa repens – 5-alpha-reductase inhibitor and anti-inflammatory, with multiple studies supporting its efficacy for BPH alone or in combination with other treatments [1-4]
• Pygeum africanum – 5-alpha-reductase inhibitor, anti-androgenic effects, [5]
• Urtica dioica – comparable to Finasteride (a popular BPH pharmaceutical) when used in combination with serenoa repens [6]

The bad news about this is that it’s not something “curable”, but the good news is that it’s something that can be well managed to improve symptoms and overall quality of life. Like I said, the first step is just having that open conversation, so we can focus on getting you better. Let’s chat!

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References:

1. Debruyne F, et al. Comparison of a phytotherapeutic agent (Permixon) with an alpha-blocker (Tamsulosin) in the treatment of benign prostatic hyperplasia: a 1-year randomized international study. Eur Urol. 2002 May;41(5):497-506.
2. Ryu YW et al. Comparison of tamsulosin plus serenoa repens with tamsulosin in the treatment of benign prostatic hyperplasia in Korean men: 1-year randomized open label study. Urol Int. 2015;94(2):187-93.
3. Morgia G et al. Serenoa repens, lycopene and selenium versus tamsulosin for the treatment of LUTS/BPH. An Italian multicenter double-blinded randomized study between single or combination therapy (PROCOMB trial). Prostate. 2014;74(15):1471-80.
4. Minutoli L, et al. Serenoa Repens, lycopene and selenium: a triple therapeutic approach to manage benign prostatic hyperplasia. Curr Med Chem. 2013:20(10):1306-12.
5. Shenouda, N. S., Sakla, M. S., Newton, L. G., Besch-Williford, C., Greenberg, N. M., MacDonald, R. S., and Lubahn, D. B. Phytosterol Pygeum africanum regulates prostate cancer in vitro and in vivo. Endocrine. 2007;31(1):72-81.
6. Sokeland J. Combined sabal and urtica extract compared with finasteride in men with benign prostatic hyperplasia: analysis of prostate volume and therapeutic outcome. BJU Int 2000;86:439-42.