Posts Tagged ‘prostate’

6 Ways To Reduce Your Risk Of Prostate Cancer

May 13, 2017

Andrew Siegel MD  5/13/17

Prostate cancer is incredibly common– one man in seven will be diagnosed with it in his lifetime–with average age at diagnosis mid 60s. In 2015, an estimated 221,000 American men were diagnosed and 28,000 men died of the disease.  Although many with low-risk prostate cancer can be managed with careful observation and monitoring, those with moderate-risk and high-risk disease need to be managed more aggressively. With proper evaluation and treatment, only 3% of men will die of the disease. There are over 2.5 million prostate cancer survivors who are alive today.

Factoid: The #1 cause of death in men with prostate cancer is heart disease, as it is in the rest of the population. 

finger 2

This is the index finger of yours truly; observe the narrow digit, a most desirable feature for a urologist who examines many prostates in any given day.  The digital rectal exam of the prostate is a 15-second exam that is at most a bit uncomfortable, but vital in the screening process and certainly nothing to fear.

Wouldn’t it be wonderful if prostate cancer could be prevented? Unfortunately, we are not there yet—but we do have an understanding of measures that can be pursued to help minimize your chances of developing prostate cancer.

Factoid: When Asian men–who have one of the lowest rates of prostate cancer– migrate to western countries, their risk of prostate cancer increases over time. Clearly, a coronary-clogging western diet high in animal fat and highly processed foods and low in fruits and vegetables is associated with a higher incidence of many preventable problems, including prostate cancer.

The presence of prostate cancer pre-cancerous lesions commonly seen on prostate biopsy—including high-grade prostate intraepithelial neoplasia (HGPIN) and atypical small acinar proliferation (ASAP)—many years before the onset of prostate cancer, coupled with the fact the prostate cancer increases in prevalence with aging, suggest that the process of developing prostate cancer takes place over a protracted period of time. It is estimated that it takes many years—often more than a decade—from the initial prostate cell mutation to the time when prostate cancer manifests with either a PSA elevation, an acceleration in PSA, or an abnormal digital rectal examination. In theory, this provides the opportunity for intervention before the establishment of a cancer.

Measures to Reduce Your Risk of Prostate Cancer

  1. Maintain a healthy weight since obesity has been correlated with an increased prostate cancer incidence.
  2. Consume a healthy diet with abundant fruits and vegetables (full of anti-oxidants, vitamins, minerals and fiber) and real food, as opposed to processed and refined foods. Eat plenty of red vegetables and fruits including tomato products (rich in lycopene). Consume isoflavones (chickpeas, tofu, lentils, alfalfa sprouts, peanuts). Eat animal fats and dairy in moderation. Consume fatty fish containing omega-3 fatty acids such as salmon, tuna, sardines, trout and mackerel.  Follow the advice of Michael Pollan: “Eat food. Not too much. Mostly plants.”
  3. Avoid tobacco and excessive alcohol intake.
  4. Stay active and exercise on a regular basis. If you do develop prostate cancer, you will be in tip-top physical shape and will heal that much better from any intervention necessary to treat the prostate cancer.
  5. Get checked out! Be proactive by seeing your doctor annually for a digital rectal exam of the prostate and a PSA blood test. Abnormal findings on these screening tests are what prompt prostate biopsies, the definitive means of diagnosing prostate cancer. The most common scenario that ultimately leads to a diagnosis of prostate cancer is a PSA acceleration, an elevation above the expected incremental annual PSA rise based upon the aging process.

Important Factoid: An isolated PSA (out of context) is not particularly helpful. What is meaningful is comparing PSA on a year-to-year basis and observing for any acceleration above and beyond the expected annual incremental change associated with aging and benign prostate growth. Many labs use a PSA of 4.0 as a cutoff for abnormal, so it is possible that you can be falsely lulled into the impression that your PSA is normal.  For example, if your PSA is 1.0 and a year later it is 3.0, it is still considered a “normal” PSA even though it has tripled (highly suspicious for a problem) and mandates further investigation. 

  1. Certain medications reduce the risk of prostate cancer by 25% or so and may be used for those at high risk, including men with a strong family history of prostate cancer or those with pre-cancerous biopsies. These medications include Finasteride and Dutasteride, which are commonly used to treat benign prostate enlargement as well as male pattern hair loss. These medications lower the PSA by 50%, so any man taking this class of medication will need to double their PSA in order to approximate the actual PSA. If the PSA does not drop, or if it goes up while on this class of medication, it is suspicious for undiagnosed prostate cancer. By shrinking benign prostate growth, these medications also increase the ability of the digital rectal exam to detect an abnormality.

Bottom Line: A healthy lifestyle, including a wholesome and nutritious diet, maintaining proper weight, participating in an exercise program and avoiding tobacco and excessive alcohol can lessen one’s risk of all chronic diseases, including prostate cancer.  Be proactive by getting a 15-second digital exam of the prostate and PSA blood test annually.  Prevention and early detection are the key elements to maintaining both quantity and quality of life. 

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

 

10 Reasons For Men To Kegel

June 4, 2016

Andrew Siegel, M.D. 6/4/16

The pelvic floor muscles—a.k.a. the Kegel muscles—are internal, hidden and behind-the-scenes muscles, yet they are vital to a healthy life. There are numerous advantages to keeping them fit and robust with pelvic floor exercises.  Last week’s entry detailed why this is the case for females and today’s will explain how and why are equally beneficial for males.  As the saying goes: “What’s good for the goose is good for the gander,” and when it comes to the pelvic floor, this is an absolute truth.  Kegel popularized these exercises for females and it is my intent to do the same for men!   If you would like more information on pelvic floor muscle training in men, visit AndrewSiegelMD.com, the opening page of which has the link to a review article I wrote for the Gold Journal of Urology on the topic. 

 

pixabay image

  10 REASONS FOR MEN TO DO KEGEL EXERCISES 

  1. To improve/prevent erectile dysfunction.
  1. To improve/prevent premature ejaculation.
  1. To improve/prevent ejaculatory dysfunction (skimpy ejaculation volumes, weak ejaculation force and arc, diminished ejaculatory sensation).
  1. To improve/prevent post-void dribbling (that annoying after-dribble of urine that occurs after finishing urinating).
  1. To improve/prevent stress urinary incontinence (leakage with coughing, sneezing, exercise, etc.) that may occur following prostate surgery.
  1. To improve/prevent urinary and bowel urgency (“gotta go”) and urinary and bowel urgency incontinence (inability to get to the bathroom on time to prevent an accident).
  1. To improve/prevent pelvic pain due to pelvic floor tension myalgia by learning how to relax your pelvic floor muscles.
  1. To help prevent pelvic impairments from high impact sports and saddle sports (e.g., cycling, motorcycling and horseback riding).
  1. To improve core strength, posture, lumbar stability, alignment and balance.
  1. To maintain good health and youthful vitality.

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

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health– and MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health available on Amazon Kindle, Apple iBooks, B&N Nook and Kobo; paperback edition available at TheKegelFix.com

Author page on Amazon: http://www.amazon.com/Andrew-Siegel/e/B004W7IM48

Apple iBook: https://itunes.apple.com/us/book/the-kegel-fix/id1105198755?mt=11

Trailer for The Kegel Fix: https://www.youtube.com/watch?v=uHZxoiQb1Cc  

Co-creator of Private Gym and PelvicRx: comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training programs. Built upon the foundational work of Dr. Kegel, these programs empower men to increase pelvic floor muscle strength, tone, power, and endurance: www.PrivateGym.com or Amazon.  In the works is the female PelvicRx pelvic floor muscle training DVD. 

Pelvic Rx can be obtained at http://www.UrologyHealthStore.com, an online store home to quality urology products for men and women. Use promo code “UROLOGY10” at checkout for 10% discount. 

Breast Lift, Face Lift…Prostate Lift

April 1, 2016

Andrew Siegel MD 4/2/16

“Prostate lift” a.k.a. “Urolift,” is a new rather clever means of improving a man’s ability to urinate when it is compromised by obstruction of the urinary channel because of enlarged lateral prostate lobes.

Prostate 101

The prostate is a male reproductive organ that produces prostate fluid, a milky liquid that serves as a nutrient vehicle for sperm. Similar to the breast, the prostate consists of glands that produce this milky fluid and ducts that convey the fluid into the urethra (urine and semen channel). The prostate completely surrounds the urethra, enabling its many ducts to drain into the urethra. However, this necessary anatomical relationship between the prostate and the urethra can potentially be the source of many troubles for the aging male.

The Enlarging Prostate

Benign prostatic hyperplasia (BPH) is one of the most common conditions of the aging male  often causing bothersome lower urinary tract symptoms (LUTS)—urinary frequency, urgency, nighttime urination, weak and intermittent stream and the sensation of incomplete bladder emptying—that affect quality of life by interfering with normal daily activities and sleep patterns. The relationship between BPH and LUTS is complex because not all men with BPH develop LUTS, and LUTS are neither specific to nor exclusive to BPH. Urinary tract infections, prostate cancer, urethral scar tissue, and impaired bladder contractility (underactive bladder) are other problems that can mimic BPH.

Why Does The Prostate Enlarge?

Aging, genetic, and hormonal factors cause the prostate gland to gradually enlarge, with the process typically starting at about 40 years of age. As the prostate grows (hypertrophies), it puts pressure on the urethra, much
 as a hand squeezing a garden hose can affect the flow through the hose. Although larger prostates tend to cause more of this “crimping” than smaller prostates, this relationship is not precise.

UroLift (Prostate Urethral Lift)

UroLift is a new, minimally invasive means of treating prostate obstruction using a cystoscope (a small telescope that is positioned in the urethra to view the urethra, prostate and bladder) to place implants within the prostate to compress the obstructing prostate tissue. It opens the urethra so that the prostate no longer blocks the outflow of urine. It does so while leaving the prostate intact, not requiring cutting, heating, lasering or removal of prostate tissue. It is advantageous because of reduced bleeding and the preservation of erectile and ejaculatory function. It is important to know that it is not applicable to all men with prostate enlargement as it is only appropriate for certain prostate anatomies and sizes.

The technique uses mechanical compression of the encroaching lateral lobes of the prostate, creating an open channel. The implants are similar in action to molly bolts, resulting in crimping and tufting of the prostate tissue. The implants are deployed under direct visual guidance at the 2 o’clock and 10 o’clock positions using a needle that houses the components of the implant. The needle is passed through the full thickness of the prostate and upon retraction of the needle, the prostate capsule is engaged by a nitinol tab that is attached to an adjustable suture. The suture is placed under tension and a stainless steel urethral end piece is attached to the suture, securing the compression. Between two and ten implants may be used, depending on the size of the prostate gland.

Urolift color with text 2

Because the procedure does not remove tissue and avoids thermal energy, it has minimal  — if any– adverse effects on erectile and ejaculatory function, a major advantage over many of the alternative treatments of BPH, both medical and surgical. Minor side effects include short-term urinary burning, urgency and blood in the urine. The procedure was pioneered in Australia in 2005, received FDA approval in 2013 and Medicare approval in 2016.

Bottom Line: The UroLift is a clever new procedure that is effective in alleviating the annoying symptoms of prostate obstruction in men with certain prostate anatomies and sizes.  It alleviates obstruction without removing tissue by compressing the obstructing lateral (side) prostate lobes and does so without adversely affecting sexual or ejaculation function. 

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

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 and PelvicRx: comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training programs. Built upon the foundational work of Dr. Arnold Kegel, these programs empower men to increase pelvic floor muscle strength, tone, power, and endurance: www.PrivateGym.com or Amazon.  

Pelvic Rx can be obtained at http://www.UrologyHealthStore.com, an online store that is home to quality urology products for men and women.  Use code UROLOGY10 at check out for 10% discount. 

 

Shy Bladder Syndrome

January 16, 2016

Andrew Siegel MD   1/16/16

charlie pink leaves

The image above is of Charley Morgan, my Springer spaniel, who is standing in a bed of cherry blossoms.  She has the very opposite of shy bladder syndrome, urinating involuntarily whenever people visit!

 

The following are quotes from patients of mine who suffer with shy bladder syndrome, the difficulty or inability to urinate in a public venue or in the presence of others:

“ I can’t urinate in front of other people.”

 “No way could I ever use a urinal.”

 “No beer for me at the sports arena.”

 “I would die before I ever attempted to urinate into one of those trough urinals they have at some stadiums and gyms.”

 “I need a private stall when in a public restroom.”

In medical speak, the condition “shy bladder syndrome” is known as “paruresis,” although I prefer the term “bashful bladder.” There are an estimated 20 million or so Americans suffering with this social phobia in which even the thought of having to urinate in public causes great distress, making the physical act of urinating impossible. However, those with bashful bladder have no such issues when in a private venue. In its most extreme form, a person with this phobia can only urinate at home when no other family members are present.

This problem occurs in both women and men and often manifests itself in adolescent years. It is a classic example of the mind-body connection in action. Anxiety brought on by the thought of having to pee in public causes the release of adrenaline and other stress chemicals, which cause a host of general effects such as  rapid pulse, shallow breathing, but also specific effects including the clenching of the muscles in the urethra (and male prostate gland). The inability to relax these sphincter muscles make the act of urinating difficult, if not impossible. It is little different than stage fright or the inability to speak in a public setting.

There are a variety of coping measures that people with shy bladder syndrome use, including restricting fluid and caffeine intake, deliberately holding in their urine and avoiding travel and other circumstances that would require the use of public restrooms.

Solutions to Bashful Bladder

The seemingly simple act of urination is actually a very complex event. Effective urination requires a contraction of the bladder muscle with coordinated relaxation of the sphincter muscles that pinch the urethra closed.  In order to improve bashful bladder, efforts need to be directed at general relaxation/anxiety management as well as at relaxing the urethra and sphincter muscles.

  • Relaxation techniques include deep breathing with exhalation to maximally relax the voluntary sphincter when in a public restroom; other methods include meditation and any of the many means of achieving a relaxed state including yoga, massage, tai chi, aromatherapy, hypnosis, etc.
  • Pelvic floor physical therapy to help relax tense pelvic muscles that can contribute to the problem, since they contribute in a major way to the voluntary sphincter muscle.
  • Cognitive behavioral therapy, which aims to retrain the mind to replace dysfunctional thoughts, perceptions and behavior with more realistic or helpful ones in order to modify fear of emptying one’s bladder in public.
  • Medications: Alpha blockers, “anti-adrenaline” agents used to relax the muscles of the urethra and prostate (Flomax, Rapaflo, Uroxatral, etc.);  Anti-anxiety medications can be helpful as well at times.

Bottom Line: Bashful bladder is a not uncommon social phobia that can severely impact one’s quality of life.  The good news is that this is a manageable problem.  For more information visit paruresis.org.

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

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.

Her Breasts and His Prostate…So Similar, So Mysterious

July 18, 2015

Andrew Siegel MD  7/18/15

prostate breast

(Thank you, Wikimedia, for above image)

The female breasts and the male prostate are both sources of fascination, curiosity, and fear. Hidden deep in the pelvis at the crossroads of the male urinary and reproductive systems, the prostate is arguably man’s center of gravity. On the other hand, the breasts—with an equal aura of mystery and power—are situated in the chest superficial to the pectorals, contributing to the alluring female form and allowing ready access for the hungry infant, curiously an erogenous zone as well as a feeding zone.

Interestingly enough, the breasts and prostate share much in common, both serving important “nutritional” roles. Each functions to manufacture a milky fluid; in the case of the breasts, the milk serving as nourishment for infants and in the case of the prostate, the “milk” serving as sustenance for sperm cells, which demand intense nutrition to support their arduous  marathon journey traversing the female reproductive tract.

Breasts are composed of glandular tissue that produces milk, and ducts that transport the milk to the nipple. The remainder of the breast consists of fatty tissue. The glandular tissue is sustained by the female sex hormone estrogen and after menopause when estrogen levels decline, the glandular tissue withers, with the fatty tissue predominating.

The prostate—on the other hand—is made up of glandular tissue that produces prostate “milk,” and ducts that empty this fluid into the urethra at the time of sexual climax. At ejaculation the prostate fluid combines with other reproductive secretions and sperm to form semen. The remainder of the prostate consists of fibro-muscular tissue. The glandular tissue is sustained by the male sex hormone testosterone and after age 40 there is a slow and gradual increase in the size of the prostate gland because of glandular and fibro-muscular cell growth.

Access to the breasts as mammary feeding zones is via stimulation of the erect nipples through the act of nursing. Access to the prostate fluid is via stimulation of the erect penis, with the release of semen and its prostate fluid component at the time of ejaculation.

Both the breasts and prostate can be considered to be reproductive organs since they are vital to nourishing infants and sperm, respectively. At the same time, they are sexual organs. The breasts can be thought of as accessories with a dual role that not only provide milk to infants, but also function as erogenous zones that attract the interest of the opposite sex and contribute positively to the sexual and thus, reproductive process. Similarly, the prostate is both a reproductive and sexual organ, since sexual stimulation resulting in climax is the means of accessing the prostate’s reproductive function.

Both the breasts and prostate are susceptible to similar disease processes including infection, inflammation and cancer. Congestion of the breast and prostate glands can result in a painful mastitis and prostatitis, respectively. Excluding skin cancer, prostate cancer is the most common cancer in men (accounting for 26% of newly diagnosed cancers with men having a 1 in 7 lifetime risk) and breast cancer is the most common cancer in women (accounting for 29% of newly diagnosed cancers with women having a 1 in 8 lifetime risk). Both breast and prostate tissue are dependent upon the sex hormones estrogen and testosterone, respectively, and one mode of treatment for both breast cancer and prostate cancer is suppression of these hormones with medication, e.g., Tamoxifen and Lupron, respectively. Both breast and prostate cancer incidence increase with aging. The median age of breast cancer at diagnosis is the early 60’s and there are 232,000 new cases per year, 40,000 deaths (the second most common form of cancer death, after lung cancer) and there about 3 million breast cancer survivors in the USA. The median age of prostate cancer at diagnosis is the mid 60’s and there are 221,000 new cases per year, 27,500 deaths (the second most common form of cancer death, after lung cancer) and there are about 2.5 million prostate cancer survivors in the USA.

Both breast and prostate cancer are often detected during a screening examination before symptoms have developed. Breast cancer is often picked up via mammography, whereas prostate cancer is often identified via an elevated or accelerated PSA (Prostate Specific Antigen) blood test. Alternatively, breast and prostate cancer are detected when an abnormal lump is found on breast exam or digital rectal exam of the prostate, respectively.

Both breast and prostate cells may develop a non-invasive form of cancer known as carcinoma in situ—ductal carcinoma-in-situ (DCIS) and high grade prostate intraepithelial neoplasia (HGPIN), respectively—non-invasive forms in which the abnormal cells have not grown beyond the layer of cells where they originated, often predating invasive cancer by years.

Family history is relevant with both breast and prostate cancer since there can be a genetic predisposition to both types and having a first degree relative with the disease will typically increase one’s risk. Imaging tests used in the diagnosis and evaluation of both breast and prostate cancers are similar with both ultrasonography and MRI being very useful. Treatment modalities for both breast and prostate cancer share much in common with important roles for surgery, radiation, chemotherapy and hormone therapy.

In a further twist to the relationship between breast and prostate cancer, a recent study showed that women with close male relatives with prostate cancer are more likely to be diagnosed with breast cancer. Compared to women with no family history of breast or prostate cancer, those with a family history of both were 80% more likely to develop breast cancer.

Breast and Prostate Cancer Myths and Facts

“Only old people get breast or prostate cancer.

Fact: 25% of women with breast cancer develop it before age 50, whereas less than 5% of men with prostate cancer develop it before age 50; however, many men in their 50s are diagnosed with the disease.

“Men can’t get breast cancer and women can’t get prostate cancer.”

Fact: 1700 men are diagnosed with breast cancer with 450 deaths on an annual basis.  Women have structures called the Skene’s glands, which are the female homologue of the male prostate gland. On very rare occasions, the female “prostate” can develop cancer. The Skene’s glands are thought to contribute to “female ejaculation” at the time of sexual climax. 

“All lumps in the breast or prostate are cancer.”

Fact: 80% of breast lumps are due to benign conditions as are 50-80% of prostate “nodules.”  If an abnormality is found, further evaluation is necessary.  

“It’s not worth getting screened for breast cancer because of the USPSTF (United States Preventive Services Task Force) recommendation against routine screening mammography in women aged 40 to 49 years and against clinicians teaching women how to perform breast self-examination.  It’s not worth getting screened for prostate cancer because the USPSTF also recommended against prostate-specific antigen (PSA)-based screening for prostate cancer.”

Fact: In my opinion, the USPSTF has done a great deal of harm to public health in the USA with their recommendations. The goal of screening is to pick up cancers in their earliest stages at times when treatment is likely to be most effective. Not all cancers need to be treated and the treatment can differ quite a bit based upon specifics, but screening populations at risk is a no-brainer.  For breast cancer and prostate cancer–the most common cancer in each gender–it is important to screen aggressively to obtain the necessary information to enable doctors and their patients make sensible decisions, which are individualized and nuanced, depending on a number of factors.

The reader is referred to a terrific recent article in the NY Times concerning screening for prostate cancer: http://www.nytimes.com/2015/07/06/opinion/bring-back-prostate-screening.html

Wishing you the best of health,

2014-04-23 20:16:29

AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in your email in box 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: http://www.MalePelvicFitness.com.  Work in progress is The Kegel Fix: Recharging Female Sexual, Urinary and Pelvic Health.

Co-creator of Private Gym pelvic floor muscle training program for men: http://www.privategym.com—also available on Amazon.

The Private Gym program is the go-to means of achieving pelvic floor muscle strength, tone, power, and endurance. It is a comprehensive, interactive, easy-to-use, medically sanctioned and FDA registered follow-along exercise program that builds upon the foundational work of Dr. Arnold Kegel. It is also the first program designed specifically to teach men how to perform the exercises and a clinical trial has demonstrated its effectiveness in fostering more rigid and durable erections, improved ejaculatory control and heightened orgasms.

How to Best Prepare For And Recover From Prostate Cancer Surgery: What You Need to Know

July 11, 2015

Andrew Siegel, MD  7/11/15

shutterstock_orange gu tract

Having your prostate removed is an effective means of curing prostate cancer. Unfortunately, because of the prostate’s “precarious” location – – at the crossroads of the urinary and genital tracts, connected to the bladder on one end, the urethra on the other, touching upon the rectum, and nestled behind the pubic bone in a well-protected nook of the body – – it’s removal has the potential for causing unwanted and undesirable side effects.

By strengthening the all-important pelvic floor muscles prior to and after surgery, patients can reduce the negative effects of the surgery with respect to urinary control and sexual function. 

Side Effects of Prostate Cancer Surgery

Trauma to nerves, blood vessels, and muscular tissue during surgery can compromise sexual function and urinary control. A small percentage of men will experience significant urinary incontinence, whereas most men will experience mild leakage initially, which will gradually improve over time. Many note a decline in their ability to obtain and maintain an erection after the surgery, particularly during the initial healing phase.

Additional sexual-related side effects that may occur include urinary leakage with foreplay and arousal; ejaculation of urine at the time of sexual climax; less intense orgasms and possibly pain with climax; a change in penile size with a decrease in length,  and girth; and possibly a penile deformity.

The Importance of Strengthening the Pelvic Floor Muscles

Numerous studies have shown the benefits of pelvic floor muscle training after prostate surgery in terms of a hastening the recovery of urinary control and significantly improving the severity of the incontinence.  Studies have also demonstrated the beneficial impact of such training on the recovery of erectile function with respect to how long the ED lasts and how severe it is.

Because of the potential urinary and sexual side effects of radical prostatectomy, it is prudent to commit to a program of Kegel pelvic floor exercises both before and after the prostate surgery. It makes sense to become proficient in these exercises proactively – – before the trauma of surgery – – so you go into the operation armed with precise knowledge and awareness of the pelvic floor muscles as well as with their strength, power and endurance optimized.

The Principles of Arnold Kegel

A quality pelvic floor muscle training program should adhere to the 4 principles promoted by Arnold Kegel, the namesake of pelvic floor muscle training:

  1. Muscle education
  2. Biofeedback
  3. Progressive intensity 
  4. Resistance

1. Muscle education is an understanding of your pelvic floor muscle anatomy and function.  Most men are clueless as to where their pelvic floor muscles are, what they do, how to exercise them, and what benefits they confer. In fact, many men don’t even know that they have pelvic floor muscles!  Muscle education will give you the wherewithal to develop muscle memory—the development of the nerve pathway from your brain to your pelvic floor muscles.

2. Feedback is a means of confirming that you are exercising the proper muscles.

3. Progressive intensity. Over the course of time, you gradually increase reps (number of repetitions), intensity of contraction and duration of contraction. Progression is the key to increasing your pelvic floor muscle strength and endurance. Additionally, it allows you to measure and monitor you progress and witness your increased capabilities over time.

4. Resistance adds a dimension that further challenges the growth of your pelvic floor muscles. Working your pelvic muscles against resistance rapidly escalates their strength and endurance, since muscle growth occurs in direct proportion to the demands and resistances placed upon them, a basic principle of muscle physiology.  It is similar to the difference between doing arm curls without weights versus with weights.

How To Strengthen the Pelvic Floor Muscles

D.I.Y.: One possibility is a D.I.Y. (Do It Yourself) program, but the problem lies in sticking with it and seeing it through in order to reap meaningful results.  D.I.Y. Kegels lack the foundational background and means of isolating and exercising the PFM in a progressively more challenging fashion. It is like handing someone a set of weights and expecting them to engage in a program without the essential knowledge and principles of anatomy and function, specific exercise routine and supervision to go along with the equipment, dooming them to most certain failure.

Physical Therapy: Pelvic floor physical therapy is the other extreme from D.I.Y.  This involves using the services of a physical therapist who specializes in the pelvic floor. I liken the pelvic floor physiotherapist to a “personal trainer” for the pelvic floor muscles. Pelvic floor physiotherapists have the training, tools and wherewithal to educate and instruct those in need. The down side is that physical therapy usually has to be done onsite at a physical therapy center and is both time-consuming and expensive with variable insurance coverage, depending on the carrier.

The “Private Gym” Pelvic Floor Muscle Training Program: This program gives one the advantages and benefits of pelvic floor physical therapy training, but in a D.I.Y. environment.  In many ways, it is like the highly successful P90X home training program, which I am a big fan of.  The Private Gym is the go-to means of gaining pelvic floor muscle proficiency for men who are scheduled for prostate cancer surgery and wish to train in a comfortable home environment with minimal expense.  It is a comprehensive, interactive, easy-to-use, medically sanctioned and FDA registered follow-along exercise program that builds upon the foundational work of Dr. Kegel. The Basic Training program strengthens the pelvic floor muscles with a series of progressive “Kegel” exercises, while the Complete Training program provides maximum opportunity for gains via resistance equipment.

It is recommended that the Complete Training program be used in preparation for prostate surgery because of the importance of using resistance to maximize the strength of the pelvic floor muscles. The Basic Training program can be started once sufficiently healed from surgery, with gradual progression to Complete Training at the appropriate time.

A clinical trial of the Private Gym program showed dramatic increases in the magnitude of pelvic floor muscle contractions, vastly exceeding measurements in the control group. The study demonstrated better quality erections, orgasms, ejaculatory control and sexual pleasure with a striking improvement in sexual confidence in virtually all participants. The study not only proved improved erectile function in men with mild ED, but it also showed enhanced erections and ejaculation in men without ED, with the resistance program expediting the results beyond the capacity of the non-resistance program. For more details about the results of the clinical trial please visit: http://www.privategym.com/how-it-works/clinical-trial-results/

Bottom Line:  “Failure to prepare is preparing to fail.”  Before embarking on prostate surgery, make every effort to get in the best general physical shape as well as achieve the best pelvic fitness possible. Yet another reason to exercise, eat properly, and maintain a healthy lifestyle are the advantages that accrue when you get ill and need surgery. A prepared pelvic floor will do wonders in helping to recover erections and urinary control.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

6922

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.  In the works is The Kegel Fix: Recharging Female Sexual, Urinary and Pelvic Health.

Private Gym: http://www.PrivateGym.com -available on Amazon as well as Private Gym website

“Un-Juiced”: When Ejaculation Goes South

March 27, 2015

Andrew Siegel MD   3/21/15

shutterstock_side view manjpeg

There is scarce medical literature on ejaculatory problems aside from those of ejaculatory timing issues (premature and delayed ejaculation) and hematospermia (blood in the semen). Despite being given short shrift in medical academia, not a day goes by in my clinical urology practice where I do not see at least several patients who complain of declining ejaculation function.

What Is The Origin Of The Word “Ejaculation”?

Ejaculation derives from ex, meaning “out”  and jaculari, meaning “to throw, shoot, hurl, cast.”

Trivia: You do not need an erection to ejaculate and achieve an orgasm. A limp penis cannot penetrate, but is eminently capable of ejaculation and orgasm.

If  “Semen” Or “Ejaculate” Is Too Medical For You:

The most popular slang is “cum.” It originates from the expression “come to climax” shortened to “come” and ultimately to “cum,” but not to be confused with the Latin “cum,” e.g., I graduated summa cum laude or the word meaning “along with being,” e.g., my basement-cum-gym! “Jizm,” “jism,” and “jizz” are also popular and are not to be confused with other         “–ism” words that mean a doctrine, e.g., socialism and capitalism! We cannot forget “splooge,” “spooge,” “spunk,” “wad,” “nut,” “load” and “man juice.”

What Happens To Ejaculation As We Age?

Ejaculation and orgasm often become less intense, with diminished force, trajectory and volume of semen. What was once an intense climax with a substantial volume of semen that could be forcefully ejaculated in an arc several feet in length gives way to a lackluster experience with a small volume of semen weakly dribbled out the penis.

Fact: I have never heard a patient complain that his penis is too large, nor have I ever heard anyone protest that his ejaculate volumes are too abundant.

Fact: The pervasive porn industry–where many male stars are hung like horses and whose penises seem capable of ejaculating flooding pools of semen– has given the average guy a bit of a complex.

So What’s The Big Deal?

Men don’t appreciate meager, lackadaisical-quality ejaculations and orgasms. Sex is important to many of us and getting a good quality rigid erection is foremost, but the culmination—ejaculation and orgasm—is equally vital. We may be 40 or 50 years old or older, but we still want to point and shoot like we did when we were 20. As the word origin indicates, we desire to be able to shoot out, hurl or cast like an Olympian Master Blaster and we yearn for that intensely pleasurable feeling of yesteryear.

Ejaculation Science 101

Sexual climax consists of three phases—emission, ejaculation, and orgasm. When the intensity and duration of sexual stimulation surpasses a threshold, emission occurs, in which secretions from the prostate gland, seminal vesicles, epididymis, and vas deferens are deposited into the urethra within the prostate gland. During ejaculation the pelvic floor muscles contract rhythmically, sending wave-like contractions rippling down the urethra to forcibly propel the semen in a pulsating and explosive eruption. Orgasm is the intense emotional excitement that accompanies the physical act of ejaculation.

Big Head Versus Little Head

Ejaculation is an event that takes place in the penis; orgasm occurs in the brain. The process of emission and ejaculation is actually a very complex and highly coordinated neurological event involving several specific centers in the brain (amygdala, thalamus and other areas), spinal cord and peripheral nervous system.

What’s Makes Up The Reproductive Juices?

Less than 5% of the volume of semen is actually sperm and the other 95+% is a cocktail of genital juices that provide nourishment, support and safekeeping for sperm. 70% of the volume comes from the seminal vesicles, which secrete a thick, viscous fluid and 25% from the prostate gland, which produces a milky-white fluid. A negligible amount is from the bulbo-urethral glands, which release a clear viscous fluid (pre-come) that has a lubrication function.

What’s Normal Volume?

The average ejaculate volume is 2-5 cc (one teaspoon is the equivalent of 5 cc). While a huge ejaculatory load sounds like a good thing, in reality it can cause infertility. The sperm can literally “drown” in the excessive seminal fluid.

Why Does The Seminal Tank Dry With Aging?

As we age, there are changes in the reproductive organs, particularly the prostate gland, one of the few organs in the body that enlarges as we get older. The aging prostate and seminal vesicles produce less fluid; additionally the ducts that drain the genital fluids can become blocked. In many ways, the changes in ejaculation parallel the changes in urination experienced by the aging male. Many medications that are used to treat prostate enlargement profoundly affect ejaculatory volume. Additionally, the pelvic floor muscles—which play a vital role in ejaculation—weaken with aging.

What About Those Pelvic Floor Muscles?

The pelvic floor muscles play a key role in ejaculation. The bulbocavernosus muscle (BC) is the motor of ejaculation, which supplies the “horsepower.” The BC surrounds the inner, deepest portion of the urinary channel. It is a compressor muscle that during sex engorges the spongy erection chamber that surrounds the urethra and also engorges the head of penis. At the time of climax, the BC expels semen by virtue of its strong rhythmic contractions, allowing ejaculation to occur and contributing to orgasm. A weakened BC muscle may result in semen dribbling with diminished force or trajectory, whereas a strong BC can generate powerful contractions that can forcibly ejaculate semen at the time of climax. 

How To Get The Juices Flowing Again?

Pelvic floor muscle training can be useful to improve the dynamics of ejaculation. The stronger the BC, the better the capacity for engorgement of the erection chamber that envelopes the urethra and the higher the ejaculatory horsepower, resulting in optimized urethral pressurization and ejaculation. The intensified ejaculation resulting from a robust BC can enhance the orgasm that accompanies the physical act of ejaculation.

Wishing you the best of health,

2014-04-23 20:16:29

AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in your email in box 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: http://www.MalePelvicFitness.com

Co-creator of Private Gym pelvic floor muscle training program for men: www.PrivateGym.com Gym—also available on Amazon

The Private Gym is a comprehensive, interactive, follow-along exercise program that provides the resources to 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 muscle 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 maximal opportunity for gains through its patented resistance equipment.

Prostate Cancer Screening: What’s New?

February 28, 2015

Andrew Siegel MD 2/28/15

The Dilemma

The downside of screening is over-detection of low-risk prostate cancer that may never prove to be problematic, but may result in unnecessary treatment with adverse consequences. The downside of not screening is the under-detection of aggressive prostate cancer, with adverse consequences from necessary treatment not being given.

The Buck Stops Here

Prostate biopsy (ultrasound guided) is the definitive and conclusive test for prostate cancer. An elevated PSA (Prostate Specific Antigen) blood test or an abnormal DRE (digital rectal exam) are the findings that typically lead to the recommendation for prostate biopsy.

What’s New In Prostate Cancer Screening?

The following are refinements in the screening process that can help make the decision about whether or not to proceed with a prostate biopsy, potentially sparing some from the need to undergo the biopsy and clearly indicating the need for biopsy in others.

  • Free PSA
  • PSA Velocity
  • PSA Density
  • PCA-3
  • Prostate MRI
  • 4K Score

Free PSA

PSA circulates in the blood in a “free” form, which it is unbound and a “complex” form, in which it is bound to a protein. The free/total PSA can enhance the specificity of PSA testing. The greater the free/total PSA, the greater the chances that benign enlargement of the prostate is the cause of the PSA elevation. In men with a PSA between 4-10, the probability of cancer is less than 10% if the ratio is greater than 25% whereas the probability of cancer is almost 60% if the ratio is less than 10%.

PSA Velocity

It is extremely useful to compare the PSA values from year to year. Under normal circumstances, PSA increases by only a small increment, reflecting age-related benign prostate growth. PSA acceleration at a rate greater than anticipated is a red flag that may be indicative of prostate cancer and is one of the most common prompts for undergoing biopsy.

PSA Density

There is a direct relationship between prostate size and PSA, with larger prostates producing higher PSA levels. PSA density (PSA/prostate volume) is the relationship of the PSA level to the size of the prostate. PSA density > 0.15 is a red flag that may be indicative of prostate cancer.

PCA-3 (Prostate Cancer Antigen-3)

PCA-3 is a specific type of RNA (Ribonucleic Acid) that is released in high levels by prostate cancer cells. Its expression is 60-100x greater in prostate cancer cells than benign prostate cells, which makes this test much more specific for prostate cancer than PSA.  PCA-3 is a urine test. The prostate is gently “massaged” via DRE to “milk” prostate fluid into the urethra. The first ounce of urine voided immediately after massage is rich in prostatic fluid and cells and is collected and tested for the quantity of PCA-3 genetic material present. Urinary levels of PCA-3 are not affected by prostate enlargement or inflammation, as opposed to PSA levels. PCA-3 > 25 is suspicious for prostate cancer.

Prostate MRI (Magnetic Resonance Imaging)

MRI is a high-resolution imaging test that does not require the use of radiation and is capable of showing the prostate and surrounding tissues in multiple planes of view, identifying suspicious areas. MRI uses a powerful Tesla magnet and sophisticated software that performs image-analysis, assisting radiologists in interpreting and scoring MRI results. A validated scoring system known as PI-RADS (Prostate Imaging Reporting and Data System) is used. This scoring system helps urologists make decisions about whether to biopsy the prostate and if so, how to optimize the biopsy.

PI-RADS classification Definition
I Most probably benign
II Probably benign
III Indeterminate
IV Probable cancer
V Most probably cancer

4Kscore Test

The 4Kscore Test measures the blood content of four different prostate-derived proteins: Total PSA, Free PSA, Intact PSA and Human Kallikrein 2. Levels of these biomarkers are combined with a patient’s age, DRE status (abnormal DRE vs. normal DRE), and history of prior biopsy status (prior prostate biopsy vs. no prior prostate biopsy). These factors are processed using an algorithm to calculate the risk of finding a Gleason score 7 or higher (aggressive) prostate cancer if a prostate biopsy were to be performed. The test can increase the accuracy of prostate cancer diagnosis, particularly in its most aggressive forms.

(It cannot be used if a patient has received a DRE in the previous 4 days, nor can it be used if one has been on Avodart or Proscar within the previous six months. Additionally, it cannot be used in patients that have within the previous six months undergone any procedure to treat symptomatic prostate enlargement or any invasive urologic procedure that may be associated with a PSA elevation.)

As of now, the test is not covered by insurance and costs $395 from the lab that performs it.

Bottom Line: Excluding skin cancer, prostate cancer is the most common cancer in men (accounting for 26% of newly diagnosed cancers with men having a 1 in 7 lifetime risk). The median age of prostate cancer at diagnosis is the mid 60’s and there are 221,000 new cases per year, 27,500 deaths (the second most common form of cancer death, after lung cancer) and there are currently about 2.5 million prostate cancer survivors in the USA.  It is important to diagnose prostate cancer as early as possible in order to decide on the most appropriate form of management–surgery, radiation, or observation/monitoring (the most common treatment pathways, although there are other options as well).  These refinements in the screening process can help urologists make the decision about whether or not to proceed with a prostate biopsy.  

 

Wishing you the best in health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the inbox 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, B & N Nook, Kobo) and paperback: http://www.MalePelvicFitness.com

Private Gym Male Pelvic Floor Muscle Training  Program: http://www.PrivateGym.com -available on Amazon as well as Private Gym website

 

5 Side Effects of Radical Prostatectomy You Don’t Hear Much About

December 27, 2014

Andrew Siegel MD  12/27/14

shutterstock_orange gu tract closeup

Having your prostate removed is a highly effective means of curing prostate cancer. Unfortunately, because of the prostate’s “precarious” location—smack in a busy area at the crossroads of the urinary and genital tracts, connected to the bladder on one end, the urethra on the other end, touching on the rectum, and nestled behind the pubic bone in a well-protected nook of the body—it’s removal has the potential for causing some unwanted and undesirable side effects.

Trauma to nerves, blood vessels, and muscular tissue during surgery can potentially compromise sexual function and urinary control. Generally, patients are informed about ED, urinary incontinence, the possibility of the surgery failing to cure the cancer and the risk of rectal injury. However, there are other possible complications that may affect your sexual quality of life that are often glossed over, perhaps because they are not considered that important in the grand scheme of cancer care.

Note that there are many men who undergo radical prostatectomy and experience absolutely no complications whatsoever, achieving “trifecta” status: a PSA (Prostate Specific Antigen) that is undetectable, full urinary control and intact erectile function. A small percentage of men experience significant urinary incontinence whereas many men will experience mild urinary incontinence. Many men note a decline in their ability to obtain and maintain an erection after the radical prostatectomy. What about the side effects that often go less mentioned?

Additional sexually related side effects that may occur including the following:

  • Ejaculation of urine at the time of sexual climax
  • Urinary leakage with sexual stimulation
  • Altered sensation of climax
  • Pain with climax
  • Penile shortening and deformity

 

Ejaculation of Urine at Sexual Climax

After radical prostatectomy, ejaculations are typically “dry” because of the removal of the structures that supply the contents of the ejaculate: prostate gland, seminal vesicles and the clipping of the sperm ducts. However, some men after radical prostatectomy may ejaculate urine at the time of sexual climax. This can be a nuisance and embarrassment to both the patient and his partner. This problem is most prevalent during the first year after prostatectomy and tends to improve with time.

Coping strategies are urinating before sex and/or using a condom or constrictive penile loop that pinches the urethra closed. Pelvic floor muscle training can strengthen the levator ani muscle, which contributes strongly to the voluntary urinary sphincter.

Urinary Incontinence at the Time of Sexual Stimulation

Urinary leakage is not always restricted to the moment of ejaculation as some patients can have it with foreplay. Once again, this is a potential bother and embarrassment to both patient and partner. Like ejaculation of urine, this issue is most commonly experienced during the first year after radical surgery and thereafter tends to improve.

Altered Sensation of Climax

Most men after radical prostatectomy will experience an altered perception of climax. Some will experience diminished pleasure, often with a feeling of diminished intensity of orgasm. Some are bothered by the dry climax. On occasion, one loses the ability to climax. In rare instances, a patient after radical prostatectomy will notice an increase in orgasm intensity.

Pain With Climax

Up to 20% of men after radical prostatectomy will experience discomfort or pain with climax, which is often perceived in the penis, testes or the rectum. With time both the intensity and frequency of pain usually decrease, although a small percentage of men will have persistent pain that persists beyond several years following the surgery.

Penile Shortening and Deformity

After radical prostatectomy, it is common to experience an alteration in penile size with a decrease in flaccid length, erectile length and erectile girth. The loss in penile length occurs during the first several months after the radical prostatectomy and whether the situation is reversible seems unlikely.

The shortening is likely based on factors including loss of urethral length, nerve and blood vessel damage and the presence of erectile dysfunction with its associated “disuse atrophy.” Lack of regular erections results in less oxygen delivered to the penile smooth muscle and elastic fibers with subsequent scarring and hence shortening.

The solution is to resume sexual activity as promptly as conceivable after surgery, pursuing “penile rehabilitation” to help avoid disuse atrophy. Pelvic floor exercises, oral medications of the Viagra class, the vacuum suction device, and penile injection therapy have proven to be helpful.

Up to 15% of men after radical prostatectomy will experience a penile deformity resulting in what appears to be a “waistband” or alternatively a penile curvature with erections.

Bottom Line: The potential sexual side effects from radical prostatectomy aside from ED may be bothersome and adversely affect one’s quality of life.

Reference: Frey AU, Sonksen J, Eode M: Neglected Side Effects After Radical Prostatectomy: A Systematic Review. J Sex Med 2014; 11:374-385

 

Wishing you the best of health and a peaceful upcoming 2015,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

6922

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

Private Gym: http://www.PrivateGym.com -available on Amazon as well as 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.

Getting Up At Night Gets Me Down: Nighttime Urinating

May 24, 2014

Blog #155

Getting up once to relieve your bladder during sleep hours is usually not particularly troublesome. However, when it happens two or more times, it can negatively impact one’s quality of life because of sleep disruption, daytime fatigue, an increased risk of fatigue-related accidents and an increased risk of fall-related nighttime injuries. Fatigue has a negative effect on just about everything, even influencing us to mindlessly eat.

Nocturia is the medical term for the need to awaken from sleep to urinate. One’s natural response is to think urinary bladder problem and seek a consultation with a urologist, the type of doctor who specializes in the urinary system. Although nocturia manifests itself via the bladder and much of the time is a urological issue, it is often not a bladderproblem. Rather, the kidneys are frequently culprits in contributing to the condition.

The kidneys are remarkable organs that can multitask like no other. They not only filter blood to remove waste products, but are also responsible for other vital body functions: They are in charge of maintaining the proper fluid volume within our blood stream. They regulate the levels of our electrolytes including sodium, potassium, chloride, etc. They keep our blood pH (indicator of acidity) at a precise level to maintain optimal function. They are key players in the regulation of blood pressure. Furthermore—and unbeknownst to many—they are responsible for the production of several important hormones: calcitrol (calcium regulation), erythropoietin (red blood cell production), and renin (blood pressure regulation). The kidneys regulate our blood volume by concentrating or diluting our urine depending on our state of hydration. When we are over-hydrated, the kidneys dilute the urine to rid our bodies of excess fluid, resulting in virtually clear urine. When we are dehydrated, the kidneys concentrate urine to preserve our fluid volume, resulting in very concentrated urine that can look as dark as apple cider.

Nocturia correlates with aging and the associated decline in kidney function and decreased ability to concentrate urine. Although having an enlarged prostate may certainly contribute to nocturia, it is obviously much more complicated than this since women do not have prostates and nocturia is equally prevalent in men and women. As simple as getting up at night to urinate sounds, it is actually a complex condition often based upon multiple factors that require careful evaluation in order to sort out and treat appropriately. When a urology consultation is sought, our goal is to distinguish between urological and non-urological causes for nighttime urinating. It often comes down to one of three factors: nighttime urine production by the kidneys; capacity of the urinary bladder; and sleep status. In the elderly population, excessive nighttime urine production is a factor almost 90% of the time.

Nocturia can ultimately be classified into one or more of 5 categories: global polyuria (making too much urine, day and night); nocturnal polyuria (making too much urine at night); reduced bladder capacity; sleep disorders; and circadian clock disorders (problems with our bio-rhythms). Global polyuria can result from excessive fluid intake from overenthusiastic drinking or from dehydration from poorly controlled diabetes mellitus (sugar diabetes). The pituitary gland within our brain manufactures an important hormone responsible for water regulation. This hormone is ADH—anti-diuretic hormone—and it works by giving the message to the kidneys to concentrate urine. Diabetes insipidus is a disease of either kidney origin—in which the kidneys do not respond to ADH—or pituitary origin—in which there is deficient secretion of ADH. In either case, lots of urine will be made, resulting in frequent urination, both daytime and nighttime. Medications including diuretics, SSRIs (selective serotonin reuptake inhibitors), calcium blockers, tetracycline and lithium may induce global polyuria.

Nocturnal polyuria may be on the basis of excessive fluid intake, especially diuretic beverages including caffeine and alcohol, a nocturnal defect in the secretion of ADH, and unresponsiveness of the kidneys to the action of ADH. Congestive heart failure, sleep apnea and kidney insufficiency may also play a role. Certain conditions result in accumulation of fluids in tissues of the body such as the legs (peripheral edema); when lying down to sleep, the fluid is no longer under the same pressures as determined by gravity, and returns to the intravascular (within the blood vessels) compartment. It is then subject to being released from the kidneys as urine. Such conditions include heart, kidney and liver impairment, nephrotic syndrome, malnutrition and venous stasis. Circadian clock disorders cause reduced ADH secretion or activity, resulting in dilute urine that causes nocturia.

Nocturia may also be caused by primary sleep disorders including insomnia, restless leg syndrome, narcolepsy, and arousal disorders (sleepwalking, nightmares, etc.)

There are numerous urological causes of reduced bladder capacity. Any abnormal process that occurs within the bladder can irritate its delicate lining, causing a reduced capacity: bladder infections, bladder stones, bladder cancer, bacterial cystitits, radiation cystitis, and interstitial cystitis. An overactive bladder—a bladder that “squeezes without its owner’s permission”—can cause nocturia. Some people have small bladder capacities on the basis of scarring, radiation, or other forms of damage. Prostate enlargement commonly gives rise to nocturia, as can many neurological diseases that often have profound effects on bladder function. Incomplete bladder emptying can give rise to frequent urination since the bladder is already starting out on a bias of being partially filled. This problem can occur with prostate enlargement, scar tissue in the urethra, neurologic issues, and bladder prolapse.

The principal diagnostic tool for nocturia is the frequency-volume chart (FVC), a simple test that can effectively guide diagnosis and treatment. This is a 24-hour record of the time of urination and volume of urination, requiring a clock, pencil, paper and measuring cup. Typical bladder capacity is 10–12 ounces with 4–6 urinations per day. Reduced bladder capacity is a condition in which frequent urination occurs with low bladder capacities, for example, 3–4 ounces per void. Global polyuria is a condition in which bladder volumes are full and appropriate and the frequency occurs both daytime and nighttime. Nocturnal polyuria is nocturnal urinary frequency with full and appropriate volumes, with daytime voiding patterns being normal.

Lifestyle modifications to improve nocturia include the following: preemptive voiding before bedtime, intentional nocturnal and late afternoon dehydration, salt restriction, dietary restriction of caffeine and alcohol, adjustment of medication timing, use of compression stockings with afternoon and evening leg elevation, and use of sleep medications as necessary.

Urological issues may need to be managed with medications that relax or shrink the prostate when the issue is prostate obstruction, and bladder relaxants for overactive bladder. For nocturnal polyuria, synthetic ADH (an orally disintegrating sublingual tablet) in dosages of 50-100 micrograms for men and 25 micrograms for women can be highly effective.

Bottom Line: Nocturia should be investigated to determine its cause, which may often in fact be related to conditions other than urinary tract issues. Nighttime urination is not only bothersome, but may also pose real health risks. Chronically disturbed sleep can lead to a host of collateral wellness issues.

Andrew Siegel, MD

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health; available in e-book (Kindle, iBooks, Nook) and coming soon in paperback.

www.MalePelvicFitness.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