Posts Tagged ‘lower urinary tract symptoms’

Why Is My Prostate Growing When Everything Else Is Shrinking?

January 12, 2019

Andrew Siegel MD  1/12/2019

The prostate is one of the few organs that gets bigger over time.  Meanwhile, there is  shrinkage, loss of tissue mass and recession going on elsewhere, e.g., bones, muscles, gums, hairlines, etc. 

Normal-vs-enlarged-prostate

Attribution of image above: Akcmdu9 [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)%5D, from Wikimedia Commons

The following paragraph from Gabriel Garcia Marquez’s Love in the Time of Cholera (an awesome read) colorfully sums up the aging prostate:

“He was the first man that Fermina Daza heard urinate. She heard him on their wedding night, while she lay prostrate with seasicknessin the stateroom on the ship that was carrying them to France, and the sound of his stallion’s stream seemed so potent, so replete with authority, that it increased her terror of the devastation to come. That memory often returned to her as the years weakened the stream, for she never could resign herself to his wetting the rim of the toilet bowl each time he used it. Dr. Urbino tried to convince her, with arguments readily understandable to anyone who wished to understand them, that the mishap was not repeated every day through carelessness on his part, as she insisted, but because of organic reasons: as a young man his stream was so defined and so direct that when he was at school he won contests for marksmanship in filling bottles, but with the ravages of age it was not only decreasing, it was also becoming oblique and scattered, and had at last turned into a fantastic fountain, impossible to control despite his many efforts to direct it. He would say: ‘The toilet must have been invented by someone who knew nothing about men.’ He contributed to domestic peace with a quotidian act that was more humiliating than humble: he wiped the rim of the bowl with toilet paper each time he used it. She knew, but never said anything as long as the ammoniac fumes were not too strong in the bathroom, and then she proclaimed, as if she had uncovered a crime: ‘This stinks like a rabbit hutch.’ On the eve of old age this physical difficulty inspired Dr. Urbino with the ultimate solution: he urinated sitting down, as she did, which kept the bowl clean and him in a state of grace.”

The prostate is a mysterious-to-many, deep-in-the-pelvis male reproductive organ that can be the source of trouble and angst.  It functions to produce a milky liquid that is a nutrient and energy vehicle for sperm. Similar to the breast in many respects, the prostate consists of numerous glands that produce this fluid and ducts that convey the fluid into the urethra (urinary channel that runs from the bladder to the tip of the penis). At the time of sexual climax, the muscle within the prostate squeezes the glandular fluid into the prostate ducts and then into the urethra, where it mixes with secretions from the other male reproductive organs to form semen.

The prostate completely envelops the urethra, enabling its many ducts to drain into the urethra. However, this necessary anatomical relationship between prostate and urethra can potentially be the source of many issues for the aging male. In young men the prostate gland is the size of a walnut.  Under the influence of three factors—aging, genetics, and the male hormone testosterone—the prostate gradually and insidiously enlarges.

Prostate enlargement is highly variable from man to man, depending upon the aforementioned factors.  As the prostate gland enlarges, it often—but not always—squeezes the section of the urethra that runs through it, making urination difficult and resulting in a number of annoying symptoms and disturbed sleep.  The effect of the enlarging prostate on urinary flow is similar to that of stepping on a garden hose, obstructing the flow. The resultant situation can be anything from a tolerable nuisance to one that has a huge impact on one’s daily activities and quality of life.

The condition of prostate enlargement is known as BPH—benign prostate hyperplasia—one of the most common plagues of aging men. Other processes that can mimic the symptoms of BPH include urinary infections, prostate cancer, urethral stricture (scar tissue causing obstruction), and impaired bladder contractility (a weak bladder muscle that does not squeeze adequately to empty the bladder).

Although larger prostates tend to cause more crimping of urine flow than smaller prostates, the relationship is imprecise and a small prostate can, in fact, cause more symptoms than a large prostate, much as a small hand squeezing a garden hose tightly may affect flow more than a larger hand squeezing gently. The factors of concern are the precise anatomical location of the prostate enlargement and the extent of the compression on the urethra. In other words, prostate enlargement in a location immediately adjacent to the urethra will cause more symptoms 
than prostate enlargement in a more peripheral location. Also, the prostate gland and the urethra contain a generous supply of muscle and, depending upon the muscle tone, variable symptoms may result.

Symptoms that develop as a result of BPH are commonly “obstructive” as the prostate becomes, in the words of one of my patients: “welded shut like a lug nut.”  These symptoms include a weak stream that is slow to start, a stopping and starting quality stream, prolonged time required to empty, and at times, a stream that is virtually a gravity drip with no force.  Another patient described the urinary intermittency as “peeing in chapters.”  Many men have to urinate a second or third time to try to empty completely, a task that is often impossible. Not only may the stream be slow to start, but also may continue after urination is thought to be completed, a condition known as post-void dribbling.  At times, one cannot urinate at all and ends up in the emergency room for relief of the problem by the placement of a catheter, a tube that goes in the penis to drain the bladder and bypass the blockage. BPH can be responsible for bleeding, infections, stone formation in the bladder, and on occasion, kidney failure.

The other type of symptoms that can develop with BPH are “irritative” as opposed to “obstructive” and may include the following: an urgency to urinate requiring hurrying to the bathroom, frequent daytime and nighttime urinating, and at times, urinary leakage before arriving to the bathroom.  As a result of these “irritative” symptoms, some men have to plan their routine based upon the availability of bathrooms, sit on an aisle seat on airplanes and avoid engaging in activities that provide no bathroom access.  One symptom in particular, sleep-time urination—a.k.a. nocturia—is particularly irksome because it is sleep-disruptive and the resultant fatigue can make for a very unpleasant existence.

Not all men with BPH need to be treated; in fact, many can be observed if the symptoms are tolerable. There are effective medications for BPH, and surgery is used when appropriate. There are three types of medications used to manage BPH: those that relax the prostate muscle tone; others that shrink the enlarged prostate; and Cialis that has been FDA approved to be used on a daily basis to treat both erectile dysfunction as well as BPH.  There are numerous surgical means of alleviating obstruction and currently the most popular procedure uses laser energy to vaporize a channel through the obstructed prostate gland.

In terms of the three factors that drive prostate growth: aging, genetics and testosterone– There is nothing much we can do about aging, which is quite a desirable state!  We cannot do a thing about inherited genes.  Having adequate levels of testosterone is a positive in terms of general health.

So what can be done to maintain prostate health? The short answer is that a healthy lifestyle can lessen one’s risk of BPH.  Regular exercising and maintaining a physically active existence results in increased blood flow to the pelvis, which is prostate-healthy as it reduces inflammation. Sympathetic nervous system tone tends to increase prostate smooth muscle tone, worsening the symptoms of BPH; this sympathetic tone can be reduced by exercise.  Maintaining a healthy weight and avoiding abdominal obesity, will minimize inflammatory chemicals that can worsen BPH.  Vegetables are highly anti-inflammatory and consumption of those that are high in lutein, including kale, spinach, broccoli and peas as well as those that are high in beta-carotene, including carrots, sweet potatoes and spinach, can lower the risk of BPH.

Bottom Line: BPH is a common problem as one ages, oftentimes negatively impacting quality of life.  There are medications as well as surgery that can help with this issue; however, a healthy lifestyle that includes exercise, avoidance of obesity, and a diet rich in vegetables can actually help lower the risk for developing bothersome prostate symptoms.

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

MPF cover 9.54.08 AM

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

New video on female pelvic floor exercises:  Learn about your pelvic floor

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Prostate Arterial Embolization To Treat Prostate Enlargement

February 18, 2017

Andrew Siegel MD  2/18/17

Note: Today’s entry was supposed to be on the topic of female stress incontinence, but this very interesting prostate topic presented itself to me, so the female incontinence entries will be continued next week.

Benign prostate enlargement (BPH) is a common condition of the middle-aged and older male in which the enlarging prostate gland obstructs urinary flow. It causes a number of annoying lower urinary tract symptoms, including a hesitant, weak and intermittent stream, prolonged emptying time, incomplete emptying, frequent urinating, urgency, nighttime urinating, and at times, urinary leakage. 

There are numerous treatment options available and one of the newest minimally invasive options is “super-selective prostate artery embolization”—a.k.a. “PAE”—a  procedure that is done by an interventional radiologist (a specialist x-ray doctor who does internal procedures without using conventional surgical techniques).  The blood supply to the prostate is purposely blocked (embolized) using micro-particles that are injected into one or more of the arteries to the prostate.  As a result of this embolization of the prostate artery, the part of the prostate served by the artery shrinks, opening up the obstructed urinary channel and improving the lower urinary tract symptoms.

Urinary difficulties attributable to BPH are commonly quantified using the International Prostatic Symptom Score (IPSS), a questionnaire consisting of seven symptom categories, with a range of increasingly severe symptom scores from 0 through 35. The score is based on the severity of each of the following lower urinary symptoms: hesitancy, decreased urinary stream, intermittency, sensation of incomplete emptying, nighttime urination, frequency, and urgency. The questionnaire responses are graded, with each of the seven symptom categories contributing a maximum of 5 points, for a total possible score of 35. Symptoms can be ranked as mild (0–7), moderate (8–19), and severe (20–35).  This IPSS is a useful metric both before and after a procedure like PAE, in order to document clinical symptomatic improvement.

Before pursuing PAE, a CT angiogram of the prostate is performed to determine prostate arterial anatomy, to help plan the PAE and to exclude patients with severe arterial disease or anatomic variations that will not allow PAE to be a consideration. Prior to pursuing a PAE procedure, it is vital to check PSA, perform a digital rectal examination and rule out prostate cancer.

 Technique of PAE

The PAE procedure takes place in the radiology department of the hospital under the supervision of the interventional radiologist. The femoral artery (thigh artery) is cannulated and by using an injection of contrast, the arterial supply to the prostate gland is identified. The prostate artery most commonly branches off the internal pudendal artery. Embolization of the anterolateral prostate artery, the main blood supply to the benign prostate growth, is attempted on both sides. The most challenging aspect is to identify and catheterize the tiny prostate arteries that are often only 1-2 mm in diameter.  Micro-particles (polyvinyl alcohol, trisacryl gelatin microspheres or other synthetic biocompatible materials) are injected into the prostate arteries to purposely compromise blood flow and cause partial necrosis (death of prostate cells) and shrinkage. After the embolization on one side, an angiogram (x-ray of pelvic arterial anatomy) is done before the sequence is repeated on the other side.

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Because of variation in prostate arterial anatomy and the types of micro-particles used, the extent of necrosis and shrinkage of the prostate is quite variable. Furthermore, prostate volume reduction does not precisely correlate with symptom improvement.  Although ideally performed on both sides, when done only on one side (left or right prostate artery) it still results in improvement of symptoms without as significant a reduction in prostate volume.

Although clinical improvement in urinary symptoms is less predictable after PAE as compared to standard treatments including surgical removal or laser treatment of the obstructing part of the prostate, the PAE has numerous points in its favor. Advantages of this new procedure are avoidance of general anesthesia and surgery an preservation of ejaculation, as opposed to surgical treatments of BPH, which commonly cause retrograde ejaculation (ejaculating backwards into the bladder with semen following the path of least resistance).  The PAE procedure is ideal for the older male with symptomatic BPH and significant prostate enlargement who for one of a variety of reasons is not a good candidate for conventional surgery.

Side effects of the PAE include urethral burning, fever, nausea and vomiting and perineal pain from prostate ischemia (damage to the blood supply), short-term inability to urinate as well as the radiation exposure necessary to perform the procedure.

Bottom Line:  Growing evidence supports the use of prostate arterial embolization to treat benign prostate enlargement.  Selectively occluding the prostate arterial supply results in damage to the prostate blood supply and ischemic necrosis (prostate tissue death) with reduction in the volume of the prostate gland with improvement in symptoms.  Safe and effective, it is a promising minimally invasive option that is an attractive alternative to surgery for symptomatic patients with large prostates and concomitant medical problems who have failed to respond well to pharmacological treatments.

 Dr. John DeMeritt is an interventional radiologist at Hackensack University Medical Center in Hackensack, New Jersey, who has particular expertise and experience in PAE.  He reported the first case study of PAE in the USA, has conducted numerous studies on the topic as well as written several medical journal articles and has been interviewed on the subject by Dr. Max Gomez on CBS news: https://www.youtube.com/watch?v=SdV8ZxtLqZU

Thank you to Dr. DeMeritt for provided me with information on the subject matter, both verbally and in the form of several excellent articles, including his original case report.  He also provided me with the PAE image.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in such dire need of bridging.

Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health http://www.MalePelvicFitness.com

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health  http://www.TheKegelFix.com

 

5 Things Every Woman Should Know About Her Man’s Pelvic Health

November 28, 2015

Andrew Siegel MD   11/28/15

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(Attribution: Pier-Luc Bergeron, A happy couple and a happy photographer; no changes made, https://www.flickr.com/photos/burgtender/4910841630)

Since this is Thanksgiving weekend and a broadly celebrated family holiday, I cannot think of a better time to blog about how wives/girlfriends/partners can help empower their men’s pelvic health.

  1. His Erections
  2. Prostate Cancer
  3. Bleeding
  4. Testes Lumps/Bumps
  5. Urinary Woes

 

Erectile Dysfunction: A “Canary in the Trousers”

If his erections are absent or lacking in rigidity or sustainability, it may just be the “tip of the iceberg,” indicative of more serious underlying medical problems. The quality of his erections can be a barometer of his cardiovascular health. Since penile arteries are tiny (diameter of 1-2 millimeters) and heart arteries larger (4 millimeters), it stands to reason that if vascular disease is affecting the penile arteries, it may affect the coronary arteries as well—if not now, then perhaps soon in the future. Since fatty plaque deposits in arteries compromise blood flow to smaller blood vessels before they do so to larger arteries, erectile dysfunction may be considered a genital “stress test.”

Bottom Line: If your man is not functioning well in the bedroom, think strongly about getting him checked for cardiovascular disease. His limp penis just may be the clue to an underlying more pervasive and serious problem.

Prostate Cancer

One in seven American men will develop prostate cancer in their lifetimes and most have no symptoms whatsoever, the diagnosis made via a biopsy because of an elevated or accelerated PSA (Prostate Specific Antigen) blood test and/or an abnormal rectal exam that reveals an asymmetry or lump. Similar to high blood pressure and glaucoma, prostate cancer causes no symptoms in its earliest phases and needs to be actively sought after.

With annual PSA testing, he can expect a small increase each year correlating with prostate growth. A PSA acceleration by more than a small increment is a “red flag.” The digital exam is simply the placement of a gloved, lubricated finger in the rectum to feel the size, contour and consistency of the prostate gland, seeking hardness, lumps or asymmetry that can be a clue to prostate cancer. It is not unlike the female  pelvic exam.

Bottom Line:  As breast cancer is actively screened for with physical examination and mammography, so prostate cancer should be screened for with PSA and digital rectal exam. In the event that prostate cancer is diagnosed, it is a treatable and curable cancer. Not all prostate cancers demand treatment as those with favorable features can be followed carefully, but for other men, treatment can be lifesaving.

Bleeding

Blood in the urine can be visible or only show up on dipstick or microscopic exam of the urine. Blood in the urine should also be thought of as a “red flag” that mandates an evaluation to rule out serious causes including cancers of the kidney and bladder. However, there are many causes of blood in the urine not indicative of a serious problem, including stones, urinary infections and prostate enlargement.

Blood in the semen is not uncommonly encountered in men and usually results from a benign inflammatory process that is usually self-limited, resolving within several weeks. It is rarely indicative of a serious underlying disorder, as frightening as it is to see blood in the ejaculate. Nonetheless, it should be checked out, particularly if it does not resolve.

Bottom Line: If blood is present when there should be none—including visible blood in the urine, blood stains on his undershorts or blood apparent under the microscope—it should not be ignored, but should be evaluated. If after having sex with your partner you notice a bloody vaginal discharge and you are not menstruating, consider that it might be his issue and make sure that he gets followed up.

Testes Lumps and Bumps

Most lumps and bumps of the testes are benign and not problematic. Although rare, testicular cancer is the most common solid malignancy in young men, with the greatest incidence being in the late 20s, striking men at the peak of life. The excellent news is that it is very treatable, especially so when picked up in its earliest stages, when it is commonly curable.

A testicular exam is a simple task that can be lifesaving. One of the great advantages of having his gonads located in such an accessible locale—conveniently “gift wrapped” in the scrotal satchel—is that it makes them so easy to examine. This is as opposed to your ovaries, which are internal and not amenable to ready inspection. This explains why early testes cancer diagnosis is a cinch as opposed to ovarian cancer, which most often presents at an advanced stage. In its earliest phases, testes cancer will cause a lump, irregularity, asymmetry, enlargement or heaviness of the testicle. It most often does not cause pain, so his absence of pain should not dissuade him from getting an abnormality looked into.

Your guy should be doing a careful exam of his testes every few weeks or so in the shower, with the warm and soapy conditions beneficial to an exam. If your man is a stoic kind of guy who is not likely to examine himself, consider taking matters into your own hands—literally: At a passionate moment, pursue a subtle, not-too-clinical exam under the guise of intimacy—it may just end up saving his life.

Bottom Line: Have the “cajones” to check his cajones. Because sperm production requires that his testes are kept cooler than core temperature, nature has conveniently designed mankind with his testicles dangling from his mid-section. There are no organs in the body—save your breasts—that are more external and easily accessible. If your man is not willing to do self-exams, at a moment of intimacy do a “stealth” exam under the guise of affection—it just might be lifesaving.

Urinary Woes

Most organs shrink with the aging process. However, his nose, ears, scrotum and prostate are the exceptions, enlarging as he ages. Unfortunately, the prostate is wrapped precariously around the urinary channel and as it enlarges it can constrict the flow of urine and can cause a host of symptoms. These include a weaker stream that hesitates to start, takes longer to empty, starts and stops and gives him the feeling that he has not emptied completely. He might notice that he urinates more often, gets up several times at night to empty his bladder and when he has to urinate it comes on with much greater urgency than it used to. He might be waking you up at night because of his frequent trips to the bathroom. Almost universal with aging is post-void dribbling, an annoying after-dribble.

Bottom Line: It is normal for him to experience some of these urinary symptoms as he ages. However, if he is getting up frequently at night, dribbling on the floor by the toilet, or has symptoms that annoy him and interfere with his quality of life, it is time to consider having him looked at by your friendly urologist to ensure that the symptoms are due to benign prostate enlargement and not other causes, to make sure that no harm has been done to the urinary tract and to offer treatment options.

Wishing you the best of health and a wonderful Thanksgiving weekend,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”: www.HealthDoc13.WordPress.com

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback: www.MalePelvicFitness.com. In the works is The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.

Co-creator of Private Gym, a comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training program. Built upon the foundational work of Dr. Arnold Kegel, Private Gym empowers men to increase pelvic floor muscle strength, tone, power, and endurance: www.PrivateGym.com or Amazon.

“Welcome To The Club”

June 20, 2015

Andrew Siegel MD 6/20/15

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(Thank you Pixabay for above image)

“Welcome to the club.” These four words have become my favorite response to a variety of the presenting complaints of my middle-age patients. As a fifty-something year-old male, I am a member of this club, the one in which things are not necessarily bad or problematic, but certainly different from the way they used to be.

I find that this sentence—gently stated in a heartening manner with a smile on my face—is calming and reassuring to my patients who are uncertain if they have a genuine medical issue that they might need to be concerned about. By being told that they are “members of the club,” they immediately understand that their complaint is not only common and shared by many of their peers, but also is to be expected and is not a major concern.

“Things fall apart, the center cannot hold.” –Chinua Achebe

Things change. We get older and we look and function differently…again, not necessarily badly, but differently. Unfortunately, humans do not come with a “user manual” that explains what to expect as we age, which could help us make the distinction between the normal expectations of aging as opposed to problems that demand medical attention. On my bucket list is to write such a “Manual of Man,” at least from a urology perspective, discussing the urinary, genital and sexual changes to be expected with the aging process. The challenge is to recognize the difference between “normal aging” and “pathological aging.”

On Becoming A Slack In The Sack

Sex Drive

After age 40, you are still interested in sex, but not nearly with the all-consuming passion you had decades before. Testosterone levels fall ever so gradually, resulting in this decrease in sexual appetite. That stated, libido seems to be the element of male sexuality that survives the longest, intact to some extent long after the penis functions only to allow you to stand to urinate. However, what was once a raging “fire” may now be mere “embers.”  It can be a source of great frustration to have functioning software but poorly functioning hardware!

Erections

You still may be able to get a respectable erection, but now it probably requires a bit more effort—often demanding touch for full arousal, whereas at one time it took only a smidgeon of erotic stimulation. Although the penis may be capable of getting hard enough for penetration, it has probably lost some of the rock-star majestic rigidity of yesteryear. Although the erection still can defy gravity, it might not have quite the angle it used to. On occasion the erection may soften before the sex act is completed. Nighttime and morning erections are fewer and farther between. Getting a second erection after climax is difficult, and you probably have more interest in going to sleep rather than pursuing a sexual encore.

Ejaculation and Orgasm

Ejaculation becomes noticeably different. The volume of semen is diminished and you question why you are “drying up.” Climax happens with less force and arc, sometimes just a mere dribble; your once “high-caliber rifle” is now a “blunt-nosed handgun.” Orgasms are unquestionably different with loss of some kick and intensity. At times, it may feel like nothing much happened—more “firecracker” than “fireworks.” Sperm quality also tends to go by the wayside with aging, but who really cares since procreation is for the next generation!

The penis often becomes less sensitive, not only making it more difficult to achieve and maintain an erection, but also at times giving rise to difficulty achieving climax, with delayed ejaculation. Perhaps this is an improvement over the premature ejaculation that may have been an issue when you were younger.

Changes In Genital Anatomy

Shrinkage

Not a day goes by in my urology practice when I don’t hear the words: “Doc, my penis is shrinking.” The truth of the matter is that the penis can shrink from a variety of circumstances, but most of the time it is a mere illusion—a sleight of penis. Weight gain causes a generous pubic fat pad—the male equivalent of the female mons pubis—making the penis appear shorter. However, penile length is usually intact, with the penis merely hiding behind the fat pad, what I call the “turtle effect.”

There are genuine reasons for penile shrinkage such as treatments for prostate cancer including radical prostatectomy and testosterone deprivation as well as “disuse atrophy,” penile “wasting” resulting from not using the penis as nature intended. Additionally, with aging there is often a fatty plaque buildup within the penile arteries, loss of erection chamber smooth muscle and elastic tissue (replaced with scar tissue) and weakening of the pelvic floor muscles. This results in less elastic and expansive erection chambers that do not fill up and trap blood properly.  It also causes a loss in penile length, girth and the ability to maintain the high penile blood pressures that cause bone-hard rigidity. If scar tissue forms on the sheath of the erectile chambers, it can cause penile curvature and pain with erections, a.k.a. Peyronie’s disease.

On Becoming Slack In The Sac

While the penis may shrink, the scrotal sac expands, time and gravity being cruel conspirators. This smaller penis and larger and looser scrotum–appearing like the genitals of an old hound dog snoozing on the veranda–is not a particularly appealing sight! While the sac expands, the testicles often shrink in size. One of the complaints voiced not infrequently by middle-aged and older men is that their testicles hang down loosely, similar to pendulous breasts in older women. At times, men complain that when they sit on the toilet, their scrotum touches the toilet water. Ouch! The scrotum may hang so low that when you pass wind, your testicles may become airborne like a kite flying erratically in a sudden gust.

Urinary Woes

The only male organs that get bigger with age are our noses, ears, scrotums and prostate glands. Unfortunately, the prostate is wrapped precariously around the urethral channel and as the prostate enlarges it can constrict the flow of urine. You may observe a weaker stream that hesitates to start, takes more time to get going and longer to empty, starts and stops and the sensation that you have not emptied completely. You might notice that you urinate more often, get up one or more times at night to empty your bladder and when you have to go, it comes on with much greater urgency than it used to. Almost universal with aging is post-void dribbling, that annoying dribble that occurs after emptying your bladder.

Bottom Line: If you are a middle-aged male and are experiencing some of these symptoms, “Welcome to the club.” If these symptoms become annoying and interfere with your quality of life, it is time to check in with your friendly urologist!

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”: www.HealthDoc13.WordPress.com

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Kindle, iBooks, Nook, Kobo) and paperback: http://www.MalePelvicFitness.com

Co-founder of Private Gym: http://www.PrivateGym.com

available on Amazon and Private Gym website

The Private Gym is a comprehensive, interactive, follow-along exercise program that provides the resources to properly strengthen the pelvic floor muscles that are vital to sexual and urinary health. The program builds upon the foundational work of Dr. Arnold Kegel, who popularized exercises for women to increase pelvic strength and tone. This FDA registered program is effective, safe and easy-to-use: The “Basic Training” program strengthens the pelvic floor muscles with a series of progressive “Kegel” exercises and the “Complete Program” provides maximum opportunity for gains through its patented resistance equipment.