When the Going Gets Tough

When the Going Gets Tough

We’ve all heard the cliché, “Guys don’t like to talk about their feelings.”

But there’s other stuff guys don’t want to talk about­­—or even think about—even though they should. Things like urinary difficulties and other prostate problems.

“Situations like these are common aspects of normal aging,” says urologist Zachariah Goldsmith, MD, PhD, “and they usually start to emerge after the age of 50.”

About half of all men have some degree of prostate swelling, medically known as benign prostatic hyperplasia (BPH). It’s one of the causes of nocturia—that aggravating need to wake up at night, trudge to the bathroom, and empty your bladder again and again. Other possible causes include too much fluid before bedtime, sleep disorders, and an actual obstruction of the urethra, the duct that allows urine to flow out of the body.

“The prostate is a funny thing,” says Dr. Goldsmith, “because it has a kind of design flaw. The urethra passes right through it, and as the prostate expands, it squeezes the urethra.” Over time, the bladder may become unable to empty completely. “Also, an enlarged prostate can lead to blood in the urine, urinary tract infections, or the need to insert a catheter,” he adds.

There are safe and effective medications (such as Flomax) to treat an enlarged prostate and related symptoms. “For the most part, they’ve been around for decades,” Dr. Goldsmith says. “They tend to work quickly and have relatively minimal side effects.”

But if medications don’t work­—or the side effects bother you—surgical intervention is another option. One such procedure is the UroLift—a once-and-done treatment that physically holds back the swollen prostate tissue. It uses no heat, no lasers, and removes no tissues. “It’s my specialty,” Dr. Goldsmith says, “and it offers the shortest downtime and fewest side effects.”
Although nocturia is mostly a nuisance, there’s a darker side of prostate problems: cancer. “It’s the most common internal cancer in men,” Dr. Goldsmith says, “afflicting about one in seven.” Some of its later-stage symptoms are difficult urination, blood in the urine, pelvic discomfort, and bone pain. But in its early stage, there may be no symptoms at all.

“Fortunately, it’s almost always curable­—if it’s found early enough,” he says. Two common detection methods are the prostate-specific antigen (PSA) test, and a rectal exam.

For any sort of prostate difficulty, it’s important to be proactive. “The best thing you can do is watch for symptoms—especially if you have a family history of prostate trouble—and report them to your primary care physician,” Dr. Goldsmith concludes. “I’ve seen guys who ignored early-warning symptoms for decades; if you wait too long, problems can be harder to fix.”

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