Report from a Sample Size of One

 

Part I: An Enlarged Prostate

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BPH: Benign Prostatic Hyperplasia

 

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.

 

After living with BPH for somewhat over twenty years, I developed a further problem, signaled by quite a lot of blood in my urine. I went in to the Stanford Health Center, was diagnosed with a seriously infected prostate, spent about five days there and was scheduled for surgery to reduce the size of my prostate. Unfortunately, the surgeon had a busy schedule, so I ended up spending over a month with a catheter in me waiting for surgery. Which gets us to:

Part II: Living with a Catheter

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. When I was finally sent home to spend over a month with a catheter waiting for surgery, I adopted a policy of irrigating every day or two even if there appeared to be no problem, in order to prevent a gradual buildup. That appeared to work.

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.

 

Tomorrow I go in for surgery. After which perhaps I will have a part III for this essay.