Men's Plumbing Problems cause Embarrassment

Housecall with Dr. Denise
urban NDN - August 2008 - issue 3

My 62 year-old grandpa has been complaining of problems with urination. He says he goes to the washroom to pee so often--even during the night--that his sleep is always disturbed. He further states that, when he has to go pee, he has to go right away; it takes him a long time to finish peeing, but he feels that there’s still something there left. The funny part of the story is when he says that he’s “dripping”! He feels embarrassed when that happens and we would tease him “stinky”! He is strong and has never been sick in his life. What’s wrong with him, is this part of getting old? What should we do about this?

Your grandpa is most probably experiencing what many men in his age group are having. I am referring to a condition called Benign Prostatic Hypertrophy (BPH). Simply put, the prostate gland, which is located around the opening of the male urinary bladder, enlarges, causing it to obstruct the normal flow of urine, thus leading to the kind of symptoms your grandpa’s noticing. How it develops is not yet fully known, but it is thought that impaired hormonal factors are involved. This is commonly seen in men over age 50; it is usually a progressive disease where patients also notice their force/stream of urine is decreased and or interrupted. Hesitancy (experiencing difficulty starting the flow of urine) and urinary tract/bladder infections are not uncommon. I would recommend your grandpa visit his physician to be examined. There are various ways of treating this disorder, either by taking pills to shrink the prostate or improve the symptoms or by undergoing one of the surgical procedures to remove/scrape the prostate gland. For now, I ‘d suggest that your grandpa not drink too much fluid, particularly caffeine-containing beverages and alcohol, before going to bed to avoid getting the urge to urinate at night. There are also some drugs he should avoid, such as decongestants that can stimulate smooth muscle in the bladder neck and prostate, increasing the obstruction and others types that can affect bladder muscle contractility. There are some “alternative” drugs such as Saw Palmetto and African plum tree which are examples of plant extracts used by patients to reduce BPH symptoms, but identification of and how the active ingredients work and long-term efficacy and safety are often unclear in these mixtures.

P.S. Some patients ask me, about their concern of decreasing their “manliness” (eg. Problems achieving/maintaining erections) after prostate surgery, the answer, generally, is NO, although it could be a remote complication they should discuss in more detail with the urologist.


Dear Dr. Denise,

My husband has been having difficulty getting erections for the last several months, and our sex life is suffering. Is there something wrong with him, or is it me?? Help!

Erectile dysfunction (ED) is the persistent inability to achieve or maintain an erection sufficiently firm for satisfactory sexual activity. There are many underlying conditions that could present as ED, including reversible (eg., including certain medications, depression, prostatitis) and irreversible (eg., including high blood pressure, smoking, high cholesterol, neurologic disease, diabetes, pelvic surgery or trauma damaging the pelvic nerves related to erections) factors. If sleep-induced and self-stimulated erections are firmer than erections with the sexual partner, this could point to psychological factors such as personal issues he is struggling with (eg., insecurity, perfectionism) or interpersonal issues/difficulties within the relationship. Decreased sexual desire/fewer sexual thoughts and fantasies could be a sign of depression, decreased testosterone levels, increased prolactin hormone levels, medications, and psychodynamic issues (likely complex, such as a learned response not to feel emotions generally). Delayed ejaculation may suggest a medication effect or decreased testosterone. Early and painful ejaculation may be due to prostatitis. The effect of certain drugs, depression, and decreased testosterone levels may lead to decreased orgasm intensity. Whereas generalized and lifelong ED may be due to a congenital or past traumatic blood vessel damage, potentially amenable to microvascular surgery. It is important that you go, preferably as a couple, to see a doctor who would likely review a sexual and medical history and perform a physical examination and laboratory investigations to try to distinguish reversible from irreversible factors as well as look for risks associated with resumption of intercourse and orgasm (eg. Cardiac risk, respiratory or other physical compromise). Depending on the factors contributing to the ED, treatment ranges from psychotherapy/couple’s therapy, to Vacuum Erection Devices, and drugs that can be taken orally such as Viagra/Cialis and those that can be given by injection/urethral instillation. These various forms of treatment all have important contraindications that should be ruled out, so please make sure to have an open, frank discussion with your doctor first.

Remember: your health (not just physical/body, but also emotional, spiritual, and mental health) is foremost in your own hands; health starts at home. Take care, and mind your health! Meegwetch!