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Frequent urination

Enlarged Prostate - Frequent urination, especially when the man wakes up continually during the night to go to the bathroom, is a symptom of an enlarged prostate gland.

The prostate is a gland that is located just below the bladder and surrounds the urethra, the tube that carries urine from the bladder to the outside.

What is an enlarged prostate? - The main function of the prostate is to secrete fluids that nurture the sperm that come out with ejaculation. Prostatic disorders include:

• prostate infection
• prostate enlargement
• prostate cancer

What is a prostate infection? - Prostate infections are relatively common and usually occur in men in their 30s, 40s, and 50s. Symptoms include frequency of urination, burning with urination, and a discharge from the penis. Additionally, one can have a sensation of fullness behind the scrotum and in front of the rectum.

These symptoms occur because infection makes the prostate gland swell. The diagnosis is made by a rectal examination, urinalysis, and a check of the discharged fluid. The treatment involves antibiotics, soaking in a warm tub of water, and frequent ejaculation. (See not all medicine is bad, guys.)

Sometimes men may take antibiotics for a long period of time without any true benefit. In fact, many of these conditions are not infections but simply muscle spasms involving the prostate and surrounding tissue. This is a condition called prostatosis or prostadynia. Treatment for this includes muscle relaxants and warm baths. Hytrin or Cardura, typically used for high blood pressure are also muscle relaxants and have been shown to be successful.

What causes prostate problems? - As a man ages, the prostate enlarges with benign, or noncancerous, tissue. The medical term for this problem is "benign prostatic hypertrophy." Most doctors simply refer to enlarged prostate as "BPH."

There are two basic types of symptoms that are produced by an enlarged prostate. The first is obstructive symptoms. When a man has an enlarged prostate, he will have a thin stream of urine which stops and starts rather than a full stream of urine. He may have difficulty starting his urinary stream and may often have dribbling after he finishes urinating. As the symptoms progress, the bladder may not empty entirely and urine is retained, increasing the risk of infection.

The second type of symptoms for prostatic enlargement involve urinary irritability. A man may feel the urge to urinate more frequently and especially more often at night.

Am I at risk for an enlarged prostate? - Prostatic enlargement is very common, and 50% of men over the age of 50 will experience enlargement in their lifetime. If you are experiencing some or all of these symptoms, it is important to consult a urologist. There are a number of tests that can be performed to evaluate the enlarged prostate as well as the effect on the kidney and bladder.

These tests can usually be performed in the office or outpatient setting. It is important to stress that all men over the age of 40 should have a rectal examination once a year to screen for prostate cancer.

There is now a new blood test called PSA recommended for all men over the age of 50 with at least a life expectancy of 10 years, and all men over the age of 40 who are at high risk including African-American, and those who have a family history of prostate cancer. The PSA can be elevated with enlargement, infection, or cancer.

How do you treat an enlarged prostate? - Over the past five years, a large amount of research has been done on the prostate gland and BPH. Doctors now know more and can provide more useful treatments. Always look into the latest treatment alternatives--there are constantly new treatments coming out.

A doctor may recommend treatment when:

	the man is unable to urinate
	there are recurrent urinary tract infections
	there is recurrent blood in the urine
	there are hemorrhoids and hernias
	there may be damage done to the kidneys or bladder
	there are bothersome symptoms like frequently interrupting sleep to go to the bathroom
	there is an annoying sensation of always having to urinate
	there is dripping of urine after stopping

Most experts agree the more serious symptoms -- like the inability to urinate, kidney damage, or bladder damage -- all may require surgical treatment.

However, for other less serious symptoms, patients may need to consider whether the symptoms are bad enough to warrant some type of treatment. There is no one absolute treatment for bothersome symptoms. Each of the treatment alternatives listed below has its advantages and disadvantages.

Treatment #1: Watchful Waiting

For the individual with mild symptoms, no treatment or minimal treatment is indicated. In fact one study out of Milwaukee found a 30% improvement in mild symptoms over a six month period with no treatment.

For those individuals electing no treatment, close follow-up with urinary flow rates are indicated. As the prostate enlarges the symptoms potentially will worsen. Treatment can then be selected. This, however, is a decision primarily left up to the individual, and, again, it depends on the bothersome symptoms, their impact on daily living and quality of life.

Treatment #2: Drugs

Now there are medical alternatives to treat the enlarged prostate. Because the prostate is composed of glandular tissue and muscle cells, medications can be utilized to affect either the gland or muscle cells.

Recently, the Food & Drug Administration (FDA) approved Proscar, a new drug that treats enlarged prostate. This drug works intracellularly and does not effect the male hormone. Success with the drug is reported to be in the 30-40% range. It has been shown to shrink the prostate over a period of six months to a year and keep the prostate volume reduced from that point in time.

The medication must be taken indefinitely or the prostate will start to grow again. Complications are minimal with the rare reported case of decrease in desire or loss of sexual ability.

An interesting, but unconfirmed side effect of the medication is reversal of baldness, a nice benefit for bald guys.

Proscar has been shown to reduce the PSA (prostate-specific antigen, measured for the blood test to detect early prostate cancer) by about half.

After a period of a year, one can continue to monitor and screen for prostate cancer with this test, but it must be remembered that the values will be reduced.

Research is currently underway for specific anti-male hormones that act on the prostate cells in an even more efficient and effective manner. Alternatively, certain medications have been found to relax the muscle fibers within the prostate and outflow tube. This relaxation enlarges the channel and decreases the blockage. The medications do not shrink the prostate, and the prostate will continue to enlarge in size.

The medication is normally used to treat high blood pressure, but studies have shown that it will not reduce the blood pressure if it is already normal. It is unknown whether it will prevent an individual from developing high blood pressure.

There is the added benefit of reducing the blood pressure in those individual who already have a history of hypertension. The medication starts to work immediately. It is usually started at low dose and gradually increased to promote maximum benefit or when to determine side effects start to occur.

The symptoms will return immediately if the medication is stopped. Studies have shown a success rate of 40- 50% in terms of a decrease in symptoms and improving urinary flow. Side effects include dizziness, fatigue, light headedness, and fainting. For the first few days, the medication should be taken with caution at night, since when getting up to urinate there is the potential to pass out.

Treatment #3: Prostate surgery

The first prostate surgery was performed in 1844 by L. A. Mercier from France who designed specific metal dilators to internally stretch the prostate and bladder opening.

In the early 1900s, surgical procedures were designed to cut out the prostate completely. In the 1930s and 40s, the current form of treatment, transurethral resection (TURP) started to evolve.

This is a procedure performed under direct visual control of the surgeon -- that is, the surgeon can see exactly what he is doing. Using a fiber optic telescope, the lining of the prostate is internally shaved down to its outer shell with a cautery (hot wire). This reopens the urethra channel that the patient urinates through. Only the enlarged part of the prostate is removed.

A general or spinal anesthesia is required, and the procedure takes approximately an hour to perform. The TURP procedure requires hospitalization of three to five days (catheterization is required for 2-3 days), after which the patient must recuperate at home for two weeks. Hospital charges of up to $12,000 are not abnormal. Significant restrictions on patient activities are imposed for 4-6 weeks following the surgery.

Complications of the TURP surgery include:

• inability to control urine and attain erections (both less than 5%)
• bleeding, infection, and retrograde ejaculation of semen (sperm at the time of ejaculation passing back into the bladder and voided out with urination)
• urinary control can take days to weeks to return to normal

A modification TURP is TUIP, or transurethral incision of the prostate. In this procedure, an internal cut is made the length of the prostate on either side of the mid-line. This can be done with either a cauterizing knife or a laser.

This is like placing a knife inside of a donut hole and cutting from the inside out and allowing the hole to open. The theory behind TUIP is similar in that only the prostate itself is allowed to spread out. This procedure can be done on an out-patient basis with a catheter left in place for one to two days.

The recovery time is usually only one to two weeks. It is not as successful as TURP and rarely can be associated with bleeding or retrograde ejaculation. On the plus side, the recovery time is not as long as TURP. This procedure is indicated in men who have smaller prostate glands.

An additional modification of TURP is the use of a laser to remove prostate tissue. Lasers have been used in medicine for a number of years. They work by either vaporizing or destroying tissue. A laser fiber can be passed through a telescope and focused on the prostate gland to vaporize or eliminate tissue. This can produce the same results as the standard transurethral resection of the prostate. However, this can be done without the added risks of bleeding or requirement for prolonged catheterization.

This procedure can also be done on an outpatient basis with a catheter left in place for one to two days. The recovery time is usually three to four days. Because no tissue is removed, there tends to be swelling of the prostate following the procedure, and the symptoms can be actually get worse for up to three to six weeks. At that time the urinary symptoms will start to improve and patients report that within two months they are able to urinate much better than before the procedure.

Treatment #4: Microwaves

The FDA has recently approved the use of microwaves. This essentially shrinks the prostate and destroys some of the inner tissue. The procedure is done with a catheter which is passed through the penis and left in place for approximately an hour. Treatment results have been variable to date and patients are known to urinate loose tissue for three to four months after the procedure.

Treatment #5: Stents

Another recent advance is the use of prostatic stents. These are titanium/gold-like springs that are placed under direct vision through through the penis into the prostate to hold the prostate apart.

Some of these stents are temporary while others are permanent. The permanent ones will have tissue grow over them with time, but they both relieve the symptom of burning with urination. Additionally, stents are currently being investigated by the FDA and certainly appear to have a place in patients with very high risk of complications from surgery. For example, those men who tend to have a problem with excessive bleeding, may not be a candidate for prostate surgery.

A WRAP UP ON PROSTATE ENLARGEMENT - For most patients suffering from an enlarged prostate who do not have kidney damage or serious infection, The ultimate decision must be left to the patient. While there are absolute indications of intervention, most situations depend on how bothersome the symptoms are to the individual. All options need to be discussed and considered along with their advantages and disadvantages.

Here are some good questions to ask yourself, or if you are a woman checking this out for your partner, quiz him with these questions. Rate each question with the following points: Not at all=0, Less than 1 time in 5=1, Less than half the time=2, about half the time=3, more than half the time=4, almost always=5.

1. Over the past month, how often have you had a sensation of not emptying out your bladder completely after you finished urinating?

2. Over the past month, how often have you had to urinate again less than two hours after you finished urinating?

3. Over the past month, how often have you found you stopped and started again several times when you urinated?

4. Over the past month, how often have you found it difficult to postpone urination?

5. Over the past month, how often have you had a weak urinary stream?

6. Over the past month, how often have you had to push or strain to begin urination?

7. Over the past month, how many times did you most typically get up to urinate from the time you went to bed at night until the time you got up in the morning?

If the score is under 8, prostate disease is mild and no real treatment is needed; a score of 8 to 15 indicates moderate disease and treatment can be done; a score over 18 is severe disease and treatment is most frequently surgery.

Pain or blood with ejaculation

Prostate Cancer (SEE ALSO What is Prostatitis?) - Prostate cancer will strike nearly one in ten men. If a man lives to the age of 80, his chances of prostate cancer rise to one in three. Over 165.000 men will be diagnosed with prostate cancer this year, according to the American Cancer Society. It is the second leading cause of cancer death in American men. The disease primarily affects men over the age of 40.

THE PROSTATE GLAND - The prostate gland sits in the body below the bladder, and urine flows through it on its way out of the body. The function of the prostate is to secrete fluids that nurture the sperm that come out with ejaculation.

SYMPTOMS OF PROSTATE CANCER - Some of the symptoms of prostate cancer are also symptoms for a prostate infection, so it's important to see a physician if you experience any of these. Most cases of prostate cancer do not produce symptoms until it is too late. Symptoms that can be associated with prostate cancer include:

• difficulty with urination
• frequency of urination
• pain with ejaculation
• blood in the urine
• blood with ejaculation

TESTS THAT DETECT PROSTATE CANCER - Usually the cancer is discovered during an examination in which a finger is placed in the rectum and the prostate gland is felt. The American Cancer Society recommends that an annual rectal examination be done on all men over the age of 40. The normal prostate feels firm, while cancer will feel hard like a rock.

In addition to the rectal examination, a new blood test called prostate-specific antigen (PSA) has become available that has been shown to help diagnose prostate cancer at an earlier stage. The American Cancer Society currently recommends that all men over the age of 50 have the PSA blood test done annually. Additionally, men with a family history of prostate cancer and black men should have the examination starting at age 40. An elevated prostate-specific antigen does not mean cancer, since the blood test may also be elevated in enlargement of the prostate. Sound waves, or ultrasound, can also be used to visualize the internal parts of the prostate.

Treatment - If prostate cancer is not diagnosed early, it can spread. In contrast to some forms of cancer, prostate cancer is an extremely slow-growing cancer, and men will frequently live with prostate cancer for years. Once diagnosed, tests including blood, bone scan and other diagnostic x-ray procedures are done to see if there is any evidence that it has spread. If not, treatment alternatives include surgery to remove the entire prostate gland or radiation. Since prostate cancer grows in the face of the male hormones, removing the male hormone will slow the prostate cancer down. This is the basis of treatment of cancer of the prostate once it has spread, or in patients who do not select more aggressive treatment options. The male hormone may be reduced either through removal of the testicles or injections of certain hormones. Additionally, new medications have become available that may also be used in conjunction to slow the prostate cancer down.

Pain in low back area, inability to urinate

Kidney Stones - Kidney stones are an abnormal formation of deposits in the kidney. These deposits resemble rocklike pebbles in the urinary tract, which create painful blockages preventing the flow of urine out of the body.

Kidney stones vary in size from the head of a pin to the size of a golf ball. They are irregular in shape with burr-like projections coming out at different angles. The pain produced by a kidney stone can be excruciating. The sensation can resemble intense low back pain.

There are a number of different types of kidney stones: calcium, uric acid, amonium, and others. About 85% of kidney stones are composed of calcium.

Each type of stone is associated with different underlying medical problems. There are many tests that can be performed to determine the cause of kidney stones, and if other stones are present.

MEN ARE MORE LIKELY TO GET STONES - Stones are much more common in men than women and vary in frequency from location to location within the United States. Just because you had a kidney stone, however, does not necesarily mean you are likely to have a second stone. Some people have a single occurence and never have the misfortune a second time. For example, statistics have shown that a patient who has a first calcium stone is at no greater risk for a second one.

However, once a patient has had two stones, the chance of another stone increases, and the likelihood continues to increase with each succeeding stone.

WHAT CAUSES KIDNEY STONE PAIN? - When the stone resides in the kidney, it doesn't necessarily cause pain. But when the stone drops into the ureter -- the tube that carries the urine from the kidney to the bladder -- the blockage causes extreme pain. The pain is from the swelling of the tube, the blockage of the flow of urine, or the attempt to expel the stone into the bladder.

CAN KIDNEY STONES GO AWAY ON THEIR OWN? - In some cases stones can work their way through the ureter into the bladder and then out of the body. This typically only happens when the stone is small enough to fit through the narrow ureter passageway. A physician may try to encourage the passage of a small stone by having the patient drink more fluids and increase activity.

WHAT CAN A PHYSICIAN DO? - If a physician diagnoses a kidney stone, IVP x-rays may be recommended. The x-rays are done to determine the exact size and location of the stone, the amount of blockage to the kidney, and if other stones are present.

The treatment of kidney stones has undergone tremendous change over the past 10 years, with new technology and medication. Even so, giving a kidney stone a little time is still the best treatment. That's because the vast majority of small stones will pass out of the body if given enough time to work their way out. But the waiting game can be painful to the person who has a kidney stone.

There are several ways to get rid of a kidney stone:

1. ExtraCorporeal Shockwave Lithotripsy (ESWL) is a relatively new treatment option which involves the passage of sound waves into the body. The waves fragment the stone into fine particles which then can be passed out with the normal flow of urine.

2. Ureteroscopy involves the passage of a long, thin telescope up through the ureter passageway to the area of stone. The stone may then be fragmented with a laser or an ultrasonic probe, or manually grabbed and pulled out.

3. Indirect manipulation and extraction of the stone with wires and baskets.

Patients frequently ask whether their stone can be dissolved. Only uric acid stones have been found to be dissolvable with medication.

Can you prevent Kidney Stones? - Kidney stones can be prevented by increasing the amount of fluids you drink and reducing the amount of calcium in the diet. Calcium is found in milk, cheese, dairy products, and certain vegetables like broccoli.

Inability to control bladder

Incontinence - Loss of bladder control is called "incontinence." In some cases, there may not be anything a person can do to correct the problem. In other cases, there are several methods to improve control of your bladder.

1. Kegel Exercises - Kegel exercises help strengthen the muscles that control urination. They are described in detail below.

2. Timed voiding - Empty your bladder every 2-3 hours even if you don't feel the urge to do so.

3. Double voiding - Urinate normally. Get dressed and leave the bathroom and involve yourself in another activity for 10-15 minutes. Then return to the bathroom and urinate again. At this point the bladder muscle may have recovered enough from the fatigue associated with contracting to force urine out during the initial urination, so that the muscle is rested up enough to contract and force out any remaining urine. Remember, getting the bladder totally empty will help prevent leakage.

4. Don't wait - Empty your bladder at the earliest sign of fullness or urgency rather than hold it.

5. Go easy on fluids- but not too easy - By keeping a chart of fluid intake you may find that you can decrease the total amount of fluids, particularly in the evening. While eight to ten, eight ounce glasses of water are recommended per day for the average adult, many foods contain a large amount of liquid, and you may determine that drinking that amount of water per day is actually too much in that it aggravates the incontinence.

6. Don't smoke - Nicotine irritates the bladder surface.

7. Avoid those fluids that make you go - Avoid diuretic-type fluids that cause you to go to the bathroom. Caffeine (found in coffee and in high-caffeine soft drinks like Mountain Dew and Coke), alcohol, and grapefruit all force your body to urinate.

8. Don't get constipated - Keep bowels soft, to avoid straining. This can be done by eating lots of fiber. Fiber is found in cereal and other grains.

9. Don't panic if you have no warning - If the urge to urinate hits you, don't panic. Instead, at first notice, relax, then tighten your sphincter. Then relax your abdominal muscles. When the urge sensation passes, walk slowly, without panic, to the nearest restroom.

10. Anticipate accidents - If you know you are going to sneeze, cough, lift, or bounce up and down, squeeze that sphincter ahead of time and ward off an accident.

Kegel Exercises for men and women - Years ago, various exercises were developed to help patients preserve and regain bladder control. The purpose of these exercises is to strengthen the pelvic floor muscles that will help hold urine in the bladder.

There are two separate exercises that will be helpful to you. It will be important for you to continue to do these exercises regularly to maintain control.

You can do these sitting or standing. Without tensing the muscles of your legs, buttocks, or abdomen, imagine that you are trying to hold back a bowel movement tightening the ring of muscle around the anus. Do this exercise only until you identify the back part of the pelvic floor.

Step 1: When you are passing urine, try to stop the flow, then restart it. By doing this, you will be able to feel the muscles at the front part of the pelvic floor.

Step 2: Now you are ready to do the complete exercise. This exercise should be done starting at two minutes and increasing to 20 minutes at least three times a day. You should perform these exercises at least 200 repetitions per session.

Kegel exercises may take time to be successful. But then again, you can do these exercises anywhere, sitting or standing, while watching TV or waiting for a bus. There is no need to interrupt your normal daily activity. Do not tighten the abdominal, thigh or buttock muscles or cross your legs, in order to feel only the pelvic muscles. Their movement is distinct and separate from that of the other muscles and can be checked, if you are a woman, while you are in the bath or shower, by placing one finger inside the vagina and contracting the muscles. Men can check their success through improved urinary control or tightening of the rectum with the finger being placed in it.

Step 3: Strengthen your muslces that control flow of urine by starting and then stopping your urine stream five times each time you urinate. Squeeze to hold back, let go to resume flow. Hold back, let go, etc. Remember, do this every time you urinate.

Lump on testicle, or pain in testicle

Testicular Cancer - Cancer of the testicle is the most common cancer in men from age 18 to 34. Testicular cancer, however, when detected early, is one of the most easily cured types of cancer.

But unless testicular cancer is diagnosed and treated at an early stage, it may spread throughout the lymph node system into the lungs and remaining parts of the body. Testicular cancer can be especially dangerous because there are often no symptoms associated with it.

Testicular cancer starts as a small pea-sized lump within the testicle which may not be noticed unless self-testicular examinations are routinely performed. Finding a lump isn't necessarily reason to panic, however, as not all swellings or lumps in the scrotum are cancer. But it is important to have a physician check out all lumps or hard spots that a man or his partner may detect.

All men should perform monthly self-testicular examinations just as women do monthly self-breast examinations. The optimal time to perform the examination is while taking a warm shower. Both hands should be used to examine each testicle with the thumbs in front and the first two fingers behind the testicle. The testicle should be rolled between the fingers and thumb, feeling for any lumps or bumps.

The testicle normally feels like a hard-boiled egg without the shell. If lumps or bumps are discovered, a physician, preferably a urologist, should be consulted at once. The best chance of prevention is early detection and treatment.

Tremendous advances have been made, not only in diagnosis, but in treatment of testicular cancer. In addition to specific blood tests that are now available to detect testicular cancer, sound waves can visualize the testicle for any abnormalities.

Blood in stool, change in color, shape, or consistency

Colon Cancer - The American Cancer Society expects an estimated 67,600 men to be diagnosed with colon cancer in 1996. Of these new cases, about 27,400 will die of their disease. In the last 30 years, mortality rates have fallen 31 percent for women diagnosed with colon cancer. Unfortunately that decline doesn't apply to men...whose mortality rate from colon cancer has only dropped by 9 percent.

How to know if you are at risk - Colon cancer is most often detected in men who have a personal or family history of colorectal cancer or polyps, and inflammatory bowel disease. Other factors that make you at risk include physical inactivity and a high-fat diet and/or a low-fiber diet.

Warning signs of colon cancer include rectal bleeding, blood in the stool, or a change in bowel habits. Most often however, colon cancer has no symptoms until it's too late. The American Cancer Society recommends a stool blood test and a sigmoidoscopy after the age of 50 to detect colon cancer in patients who don't show any symptoms. These tests offer the best opportunity to remove polyps before they become cancerous.

What is Flexable Sigmoidoscopy? - Flexible sigmoidoscopy is the visual examination of the lining of the rectum and a portion of the colon using a lighted, flexible, fiberoptic tube that's about the thickness of your finger. This remarkable piece of equipment can be directed and moved around the bends in the lower colon and rectum.

The fear of the unknown keeps many men from having a flexible sigmoidoscopy. Yet this simple, outpatient exam takes only ten minutes and provides the phsyician with a great deal of useful information. The exam is performed while lying on your side, in a comfortable position. The procedure should be painless, although you may feel slight pressure or a bloating sensation.

How to prepare for the procedure - The morning of your flexible sigmoidoscopy have a light breakfast. One to two hours before the procedure take two Fleet enemas. These can be purchased at any drug store.

If your test reveals possible problems, more extensive studies, such as colonoscopy (exam of the entire colon) and barium enema (an x-ray procedure to view the intestines) may be needed.

Remember this - When colon cancer is detected early, before it spreads to other parts of the body, the five year survival rate is 91 percent. If the cancer is not caught in time, five year survival rates drop to 63 percent.