I have been practicing pharmacy for over 25 years, working with the public, discussing different issues. All sorts of discussions happen at the pharmacy counter about all sorts of ailments, diseases and bodily functions. Most people are ready and willing to tell all about what they are going through, describing every detail of their particularly strange bodily function that is causing them grief. They realize that after a few minutes at the pharmacy counter with their trusted pharmacist they will have a better idea of what is going on and what they may need to do for follow-up.

After working in this environment for years I have one question, why are men so reluctant to discuss their penis and urinary issues? Perhaps we have some misguided concern deep in our hypothalamus that makes us feel like we will lose all that is precious to us if we disclose any shortcomings. I have found that when I am at the counter with a middle aged gentleman and there is an ever-so-silent moment, I am able to pick up on the point that perhaps he has a question to ask about his urinary difficulties. I take this as a signal to ask him a question such as, "Do you find yourself needing to get up quite a few times during the night to use the restroom?" This is usually enough to get the conversation going.

Benign prostatic hyperplasia (BPH) or enlarged prostate is a non-cancerous increase in the size of the prostate. Women do not have a prostate, so this is not an issue for them. In men, the prostate grows initially through puberty and then typically stops growing until mid-life, where it begins growing again very slowly. Even though there are different phases of prostate growth, urinary problems usually do not develop until the final growth phase of a man's life, usually after 55 or 60 years old.

The prostate is located just below where the bladder empties into the urethra. The urethra is the tube that carries urine from the bladder, through the penis to outside the body. As the prostate slowly grows, it pushes up against the urethra and causes any number of uncomfortable urinary symptoms. These symptoms might include urinating much more often than usual, an urgent feeling that you need to urinate immediately, the need to get up many times during the night to urinate, and a difficult time starting a urine stream.

I advise patients to not disregard these urinary symptoms. This is something that usually may be treated with a simple evaluation and some prescription medication. I encourage them to discuss these symptoms with their physician.

There are two different mechanisms of medication therapy to treat these symptoms. The first medication category works to help relax the muscles in the prostate and the opening of the bladder. By doing this, the urine and flow may be increased and therefore will decrease the urinary symptoms. The issue is, the prostate may continue to slowly grow and over time the medication may lose its effectiveness.

The second category is involved with the development of the prostate. The prostate requires the conversion of testosterone to dihydrotestosterone (DHT) for its continued growth. An enzyme called 5-alpha reductase is required for this conversion. There are a couple medications that will work to inhibit this enzyme, thus blocking the conversion of testosterone to DHT. This process allows for the prostate to slow its growth and possibly shrink in size.

About the Author

Dr. Steve Leuck owns and operates an online Medication Specific Counseling program called AudibleRx which is dedicated to increasing medication education and understanding at the patient level.

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