Dear Dr G,

I am emailing you for a problem that has been happening to me since I turned 50.

I am a healthy chap who exercises and I watch my diet, but have noticed something that has become more apparent after my 50th birthday.

I started waking up at night to urinate and am struggling with the stream, as I noticed that I need to strain a little and this has caused urine to spray on the toilet seat.

Aside from this, I am also struggling with my erection, as I can long longer maintain a firm erection during sex, and the morning wood is getting less and less frequent.

My wife asked me to pay a doctor a visit, and the doctor told me the problem is caused by prostate enlargement, and this is the same issue that resulted in my father needing an operation.

The urologist reckoned I have the aging problem of Benign Prostatic Hyperplasia (BPH), and I would like to put Dr G on the spot, as I am struggling to come to terms with it

First of all, what causes the prostate to enlarge? Is this cancerous?

What are the causes of BPH? Is it genetic?

How does prostate enlargement cause poor urinary stream and erectile dysfunction; is there a correlation or pure coincidence?

My father needed an operation as he ended up unable to urinate – is this an inevitability for me?

Yours truly,

Prostatic Peter

Benign Prostate Hyperplasia is an age-related phenomenon commonly affecting men above the age of 50. The exact aetiology of this non-cancerous enlargement of the prostate gland is largely unknown; however the correlation with the changes in hormonal levels is speculated.

As men age, hormonal changes due to the increase in dihydrotestosterone (DHT) can lead to the proliferation of prostate gland cells. Several factors have been identified as potential contributors to BPH. These include hormonal imbalances – particularly the increased conversion of testosterone to DHT as it is considered a significant factor in the development of BPH. Genetic factors also play a role in predisposing certain individuals to BPH. Lastly, lifestyle choices, such as a sedentary lifestyle, obesity, smoking, and excessive alcohol consumption have been associated with an increased risk of BPH.

Benign Prostate Hyperplasia (BPH) is a common condition that affects many men with advancing age. The gradual overgrowth results in the compression of the urethra, leading to various urinary symptoms. Including poor flow, hesitancy in initiation, dribbling and straining of urination. In addition, the post-void residual urine can also result in day and night frequency of urination. When the symptoms become worse, it can also cause urgency and urge incontinence.

One of the most bothersome symptoms experienced by individuals with BPH is night- time urination, also referred to as nocturia. Nocturia is a common symptom experienced by individuals with BPH. The exact mechanism behind this correlation is not completely understood but is believed to be influenced by pressure on the urethra, restricting the flow of urine. This results in incomplete emptying of the bladder during daytime voiding.

Nocturia is the most bothersome symptom caused by prostate enlargement, having a significant impact on the quality of life for men affected. In addition, the night-time visits to the bathroom also can adversely affect partners and sexual relationships.

The constant pressure exerted by an enlarged prostate on the bladder may also lead to decreased bladder capacity. This means that the bladder fills up faster, requiring individuals to wake up and urinate during the night. In addition, the muscular changes of the bladder as a result of the constant obstruction caused by an enlarged prostate can also affect the ability of the bladder to retain urine for prolonged periods, resulting in nocturnal urination. While BPH itself does not directly cause erectile dysfunction (ED), its presence and associated symptoms can indirectly contribute to the development of this condition.

Erectile dysfunction (ED) is the inability to achieve or maintain an erection sufficient for satisfactory sexual performance. When men experience prostate enlargement, the pressure exerted on the urethra can disrupt normal blood flow. The blood vessels responsible for engorging the penis during sexual arousal is impeded, leading to difficulties in achieving and maintaining an erection. The prostate gland surrounds the urethra, which is responsible for transporting both urine and semen. The frustration and anxiety caused by the urinary symptoms associated with BPH can also negatively impact a man’s sexual confidence and performance. Such psychological stress can further contribute to erectile difficulties.

Fortunately, various treatment options are available to address both prostate enlargement and erectile dysfunction; lifestyle modifications, medication, or surgical procedures may be recommended depending on the severity of symptoms. In fact, oral medications such as long-acting Phosphodiesterase 5 Inhibitors (PDE5-I) are able to resolve both issues at the same time, effectively killing two birds with one stone.

Benign Prostate Hyperplasia, nocturnal urination and Erectile Dysfunction can significantly impact the quality of life for aging men. While prostate enlargement and erectile dysfunction may seem like separate concerns, the link between these two conditions goes beyond being mere coincidences. Having knowledge of effective treatment strategies allowing men to take proactive steps to maintain overall health and enjoying a fulfilling sex life is often the key.

When men facing problems with BPH put Dr G on the spot for solution, his view is that while a maturing prostate may be inevitable causing silent nights and an end to morning wood, knowledge of the treatment strategies can potentially fill two needs with one deed!

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