askthedoctor Prostate Health A
Medical Emergency If a man is completely unable to urinate, this is a true medical emer- gency. If he has fever and chills with painful and frequent need to urinate, blood in the urine, or pain or significant discomfort in the lower abdomen and urinary tract, im- mediate medical care is essential.
50 MILITARY OFFICER APRIL 2017
By age 50, half of men have some prostate enlargement. However, not all will experience symptoms, and fewer still require specifi c treatment. By Rear Adm. Joyce Johnson, D.O.
An enlarged prostate, or benign prostatic hyperplasia (BPH), is nor- mal as men age. By age 80, 75 percent of men will experience BPH. The specifi c cause of BPH is not known, but it seems to be related to endocrine (hormonal) factors. The most signifi cant risk factor is increasing age; genetics also might play a role. Though BPH causes symptoms that might require management or treatment, it is not related to prostate cancer. Because the urethra passes through the prostate, BPH can constrict, or even completely block, the passage of urine from the body. Symptoms of BPH include a sudden need to urinate, a weak urinary stream, incomplete emptying of the blad- der, and frequent waking at night to uri- nate. Constriction of the urethra by the prostate and gradual weakening of blad- der elasticity over time result in diffi culty forcing out urine. Though the symptoms of BPH are chronic and annoying, they are not usually life-threatening.
BPH generally is a clinical diagnosis based on symptoms as well as a medical evaluation, which can rule out cancer in the region. This evaluation might include: a rectal exam;
urodynamic tests to measure urinary
fl ow and other parameters; a cystoscopy to examine the inside of
the urethra and bladder; an ultrasound evaluation; and blood tests, including a prostate-spe- cifi c antigen (PSA) test, to screen for pros-
tate cancer. Your PSA level can be elevated due to infl ammation, infection, or other factors. If it is high, additional evaluation such as a biopsy might be needed. Management of BPH varies with the ex- tent of symptoms. Behavioral changes such as minimizing fl uid intake before bedtime, urinating on a preset schedule, and mini- mizing alcohol and caff eine can help, as can pelvic-fl oor muscle exercises. Preventing constipation also is useful. Some men fi nd sitting to urinate increases urinary fl ow and the ability to empty the bladder. If possible, avoid medications that
make urination more diffi cult (e.g., anti- histamines, decongestants, opiates, and tricyclic antidepressants). Other medica- tions are helpful and might be prescribed for treatment. Always consult your medi- cal provider before changing medications. More complete blockage of the urethra
can make the passage of urine diffi cult or impossible or require a man to self- catheterize to urinate. Various outpatient and inpatient surgical options are available. Transurethral resection of the prostate (TURP) is an inpatient procedure to remove prostate tissue, relieving pressure around the urethra and allowing it to open for urine fl ow. However, TURP is a major surgery and not recommended for everyone.
MO
— Rear Adm. Joyce Johnson, USPHS (Ret), D.O., M.A., is a health care consultant in Chevy Chase, Md. Find more health and wellness resources at
www.moaa.org/wellness. For sub- mission information, see page 4.
PHOTO: STEVE BARRETT
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88