Occam's Razor

Friend, do you suffer from BPH? If you are female, I can definitely say no. For you have to be born male to get BPH. Men generally discover by the time they are forty or so one inconvenient truths about middle age men, specifically they cannot get through the night without shuffling a couple times to the bathroom to go Number One. If this sounds like you, congratulations, you are a normal middle-aged male. You also have Benign Prostatic Hypersplasia. With a name like that, you can see why urologists prefer to say you have BPH.

If you have BPH, your prostate is swelling to an inconvenient size. This is good news in a way because it means you are still producing testosterone. It also probably means you do not need to reach for Viagra in order to be intimate with someone. Your prostate is swelling because testosterone is causing your prostate to create something very similar, DHT or Dihydrotestosterone. Your prostate has been producing DHT since puberty, but over time, it has the side effect of making your prostate swell. Your prostate is a gland that provides most of the fluid when you ejaculate. Your prostate is also inconveniently located just below your kidneys. When it swells, it tends to constrict the urethra, making it harder to go and also harder to fully empty your bladder. So your bladder rarely fully empties, which means you tend to go more often and when you go it can take a while. This condition can also contribute to urinary tract infections.

I, like most men my age, feel part zombie because my bladder inconveniently wakes me up throughout the night. On a good night, I will only shuffle to the bathroom once. On a bad night, it can be up four or five times. I must have developed BPH at an early age because this has been a problem of mine for at least twenty years, and I am 52. It generally arrives in men by age forty, although it may develop so gradually that it seems normal, which in fact it is.

The good news is that if you suffer from BPH you probably do not have prostate cancer. That’s why it’s called benign. If you are a smart man, you will have regular physicals. Your doctor will place his fingers into your colon and feel your prostate. It can be enlarged, and if it feels smooth like a balloon that is good. If when he presses on it he detects nothing hard, it suggests there is no cancer. That won’t solve your frequent urination problem, however.

I learned all these things this week because my employer invited a urologist over to talk to us about BPH. She came with all sorts of very clinical illustrations and actual pictures taken at Reston Hospital by special cameras that slide up your urethra. The lecture was actually interesting. Just as interesting as the lecture was listening to my fellow middle-aged men in my room. It is nice to know I do not suffer alone. This is not the sort of thing guys tend to share with other guys, or even their significant others. I am sharing it here in part to spread enlightenment.

Moreover, at least the men who attended the lecture are not morons. Many men avoid physicals simply because they want to avoid the prostate examinations, which can be embarrassing and uncomfortable. Sensible men, like those of us at the lecture, realize we have a condition. We also know that prostate cancer affects most men in life, although many die unaware that they have it, as in most cases the cancer grows very slowly. We do not consider ignorance in this area a virtue.

These same men thirty years earlier might have been bragging about their bedroom conquests. Now we come with bags under our chins and eyes and receding hairlines (well, not me, at least not yet). It was remarkable how straightforward and clinical we could be in a group setting when given the opportunity to question a urologist at length. Will surgery cause impotence? Will drugs to treat it cause impotence? Can BPH be cured? Do some men not get BPH? (Answer: yes, those who die young and who stop producing testosterone at an early age.) Our main concerns were “Are we likely to get prostate cancer?” and “Will we ever be able to sleep through the night again?”

On the latter question, there is hope. There are drugs to treat BPH of a class called Alpha-blockers. They relax the smooth muscle of the prostate and widen the urethra channel. (Flomax is probably the best known, but ask about Hytrin or Cardura because they are available as generics.) However, they might cause ejaculatory dysfunction. Another class of drugs, the 5-alpha-reductase inhibitors will also shrink the prostate, but not very much, and can cause a diminished sex drive if not outright impotence. For many men, fear of the latter makes us think that getting a good night’s sleep is highly overrated. (On the other hand, our wives may secretly be relieved.)

There are also surgical alternatives, including a microwave procedure and vaporization of part of the prostate with a laser (Greenlight Laser). Some of these can be done on an outpatient basis.

You may also want to embrace a prostate-healthy diet. Unsurprisingly, it is probably not a diet you will like, as it emphasizes lower amounts fats and eating soy. The diet will probably do nothing for your BPH, but it does reduce the risk of acquiring prostate cancer, which for men is something akin to breast cancer in women: to be dreaded and prevented if possible.

If you have BPH, and most men of a certain age do (but may not be aware of it), it’s good news in a way. It means that you are a survivor. A few generations ago, you were likely dead from something else by the time it became a problem. Today, you likely have a few decades of life ahead of you. You just have to decide whether to treat it or not. The condition can become so chronic that you end can up in an emergency room because you are unable to void your bladder. You probably do not want to reach that stage, so at some point you will want to have a deeper conversation with your doctor about BPH and perhaps see a urologist for a better diagnosis. You should also want your doctor to regularly give you a PSA (Prostate Specific Antigen) test. If you are developing prostate cancer, it will probably detect it, plus it can be used to help determine the severity of your BPH.

I know I will be talking with my doctor about drugs for BPH during my next physical. I hope that any side effects will be mild on me. I know I sure would relish a night of uninterrupted sleep again.