When I was in my forties,
I was diagnosed with an enlarged prostate, a problem common in
aging men. The prostate is a donut shaped gland surrounding the
urethra, the tube that carries urine from the bladder when you
urinate. When it becomes enlarged, it squeezes that tube, making
urination more difficult. A later web search turned up a good
deal of information on prostate cancer but not much useful for
how to live with the less serious but much more common
problem. After doing so for over twenty years, I thought my
observations might be of use to others.
For some reason, the
problem tends to be worse at night. If I wake up, feel the need
to urinate but have difficulty doing so, one solution is to stay
up for a while. After ten or twenty minutes, my prostate
apparently decides it must be daytime and loosens up somewhat.
The function of the
prostate is to provide the liquid component of semen when you
ejaculate, which is why it is located where it is. The problem
of an enlarged prostate is thus a consequence of the kludge in
mammalian design that uses the same machinery for urination and
insemination. One result, again by my experience, is that after
orgasm urination becomes easier for a while. That makes sense,
since the prostate has presumably emptied itself and so
contracted a little. What makes less sense is that the same
thing seems to happen, to a lesser extent, after prolonged
arousal without orgasm.
The oddest thing I have
observed about the problem is the close link between mind and
body. I am driving along the interstate and decide I should pull
off at a rest stop to use the facilities. As I park, the need to
urinate suddenly becomes much stronger. As I approach the men’s
room, stronger still. Somehow whatever part of the system sends
those messages knows I am about to have access to a toilet. I
was told by a urologist that the pattern is a familiar one, more
commonly associated with a sudden urge while pulling into your
garage or approaching your front door.
The main tactic for
avoiding problems is to make sure not to have a need to urinate
when doing so is not convenient. That means drinking nothing
much for an hour or so before teaching a class or giving a
lecture and emptying my bladder as best I can immediately
before. To reduce the number of times I have to get up during
the night, I tried to avoid drinking much for several hours
before going to bed.
One common prescription medicine for treating the symptoms of
BPH is Tamsulosin, trade name Flomax. Cialis, better known as a
treatment for erectile disfunction, is also prescribed for the
purpose. I used both, did not do enough experimenting with not
using them to be sure how much good they were doing. A
non-prescription treatment is saw palmetto. There seems to be a
good deal of disagreement as to whether it works but nobody I
read thought it was dangerous, so I took that too.
Finasteride (Proscar) is a medicine used to shrink the prostate.
It works by preventing the conversion of testosterone to DHT, a
downstream hormone, and is considered an alternative to surgery.
If you look up side effects, you may read that there is some
slight risk of "diminished libido." I was on it for a while,
concluded that "diminished libido" was a euphemism for
impotence, and stopped using it. According to the Wikipedia
page, "A 2010 review found moderate quality evidence that
finasteride increased the risk of sexual dysfunction, but not
that people stopped using it because of sexual side effects."
They didn't ask me.
Finasteride is also used to treat baldness in men, and a web
search found complaints by men who had used it for that purpose
and were quite unhappy with the effect on their sex life.
A urinary catheter is a
tube run up the urethra and past the prostate to the bladder.
Its function is to continuously drain urine from the bladder
through a tube into a plastic bag, an external bladder. It can
be attached to a relatively short tube that drains into a bag
attached to the lower leg and concealed by your pants, a leg
bag, or a longer tube that drains into a larger bag that can be
attached to something nearby, a bed bag. The bed bag is intended
mainly for when you are sleeping but in my experience it is more
comfortable than the leg bag, so I spent most of my time at home
in a bathrobe with the bed bag either hanging by its convenient
hook from something next to me or from the pocket of my robe. Fortunately
I had chosen to spend this year on leave, mostly to see whether
I liked it enough to want to retire, so I was free to spend
almost all of my time at home.
The main requirement for either bag was that it be
lower than my bladder, so that urine would drain into it. If I
had to go out and did not have to be too careful about
concealing my medical attachments, I used the bed bag, wore
shorts and over them a long coat to conceal the bag and tube.
Shorts constrained the system less than pants and so seemed to
make moving around less uncomfortable. If I wanted better
concealment of bag and tube I wore leg bag and pants and put up
with the resulting discomfort.
Speaking of which … .
Moving around with the catheter in me tended to result in mild
discomfort at the tip of my penis, where the catheter went into
me. While I am not certain, I think I identified at least part
of the cause. The catheter slides in and out, with a play of an
inch or more. In the process it tends to accumulate residue,
blood, mucus, or something similar, which dries on it, forming
small bumps and ridges. I think at least part of the discomfort
is from the uneven surface rubbing against the urethra. To
reduce it, I tried to keep the surface smooth, wiping off
residue and, if it had dried hard, first softening it with a wet
tissue.
One problem with a
catheter is that it can clog up, have the holes in its upper end
that urine comes through blocked by blood clots or mucus, at
which point you are back with a steadily filling bladder and no
way of emptying it. I ended up back in the emergency room
of Stanford Health Center, where a urologist spent an hour or
more getting blood clots washed out of my bladder and I then
spent considerably longer with a special sort of catheter that
irrigated the bladder by pumping water in through one set of
holes, back out through another.
I also got instructions on how to deal with the problem
myself in the future.
To do so, you disconnect
the catheter from the tube it feeds into and attach it to what
looks like an oversized plastic hypodermic syringe. That is used
to force sterile water or saline solution up the catheter,
hopefully dislodging anything blocking the holes. It is then
used to suck the liquid back out, with luck pulling out the
blood clots or whatever. Repeat until solids stop coming out,
then reattach the tube. If it doesn’t work, go back to the
emergency room.
The catheter was held in
position by a plastic clamp attached to a butterfly shaped piece
of plastic sheeting glued to my leg. That meant that if the tube
caught on something as a I was moving and pulled, it pulled at
my leg but did not try to pull out the catheter. Over time, the
plastic sheeting gradually came free and the plastic under the
clamp tore, almost entirely freeing the clamp. I had been
provided with a replacement for the clamp and sheeting unit,
which I used. What I should have done was to use a felt tip pen
to mark around the edge of the sheeting before removing it, in
order to get the replacement in exactly the same place. I
didn't, but seem to have gotten it close enough for practical
purposes.
When I was sent home there
was still blood in my urine from the infected prostate, making
the urine in the tube or bag noticeably pink. Over a few days of
antibiotics, that stopped. Since then, the urine has been
reasonably clear most of the time.
But not always. From time to time, for no obvious reason, it is
again for a while pink to red. One nurse I asked about that
thought the reason was the catheter itself. It rubs against the
inside of the urethra or the bladder, mildly abrades it, starts
a little bleeding. I think there is some correlation between
that and times when I did a significant amount of walking and
suffered associated discomfort, but I am not sure.
The surgery was entirely successful. Because my prostate was more enlarged than in most cases it wasn't practical to use what is now the current high tech process, in which the surgeon operates through the urethra hence without any need for an incision. I acquired a neat vertical scar on my belly. The problem has entirely gone away and now, about two years after the surgery (I had forgotten that I planned to update this page), the only remaining effect is retrograde ejaculation. That would be inconvenient if I was planning to father another child, but I'm not.
One free bonus. My surgeon told me afterwards that my body
appeared to be about a decade younger than it ought to be given
my calendar age, which was reassuring.