Archive for the ‘alpha-blockers’ Category

Saw Palmetto for the Enlarged Prostate Gland-What You Need to Know

January 23, 2015

Over 30 million Americans suffer from the enlarged prostate gland. The symptoms include getting up at night to urinate, frequency of urination, and dribbling after urination. Constantly rushing to the bathroom is a common complaint among the millions of men who develop an enlarged prostate gland, or benign prostatic hyperplasia (BPH). This blog will discuss the treatment with the herbal product, saw palmetto.

Saw palmetto has been used to treat urologic conditions since the days of the ancient Egyptians. It is a common non-medical approach to the enlarged prostate gland.

Here are five reasons you should skip saw palmetto and head to the doctor for advice instead.
1. It’s no better than a placebo.
Researchers have shown that saw palmetto is no better than a placebo at alleviating symptoms. Large studies have also shown the same effect in scientific studies comparing saw palmetto to placebo.

2. Its dosage may vary.
Even if you wanted to try taking a regular dose of saw palmetto, there’s currently no guarantee that the supplement you choose contains what it says it does. One study analyzed six different brands of the supplement and found that half of them contained less than 20 percent of the amount stated on the label.

3. It might not be safe.
Saw palmetto doesn’t seem to have any major side effects, but some users have reported headaches, nausea, and dizziness. However, we haven’t seen studies proving that saw palmetto is actually safe for the long term. In addition, supplements, including saw palmetto, are not well regulated by the FDA, and it’s not uncommon for wily manufacturers to distribute tainted products. You may think you’re taking a “natural” herbal remedy, but for all you know, you could be taking prescription, or even experimental, drugs.

4. It might mask another problem.
If you have symptoms of an enlarged prostate, including frequent urination, it doesn’t necessarily mean that you have an enlarged prostate. The same symptoms might pop up if you have prostatitis (an inflamed or infected prostate gland) or a bladder infection that can be treated with an antibiotic. Or the symptoms might even be a side effect of another medication. If supplements relieve your symptoms for some reason, you might neglect treating another ailment.

5. It’s a waste of money.
Instead of throwing your dollars away on saw palmetto supplements, see your doctor to get a proper diagnosis and find out about approved drugs that can help. Common treatments include alpha-blockers and 5-alpha-reductase inhibitors. Visit Consumer Reports’ Best Buy Drugs to find out more about drugs it recommends for treating enlarged prostate.

Bottom Line: The enlarged prostate is a common problem affecting millions of American men. Saw palmetto is an over the counter non-medical, herbal supplement that probably has minimal or even no benefit at all. All men with symptoms prostate enlargement should seek medical care as solutions are available.

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Losing Your Urine? It May Be Due to Your Medications

September 4, 2014

Urinary incontinence impacts millions of American men and women. Often times the solution may be to have your doctor check your medications and see if the medications may be the culprit.
There are four groups of medications doctors commonly recommend that can cause or increase incontinence. If you are taking any of these, you should let your doctor know about your incontinence and discuss your medications (both prescription and over-the-counter) to see if there is another approach to control or eliminate the problem.
The most common incontinence problems arise from medications in the following four categories:

1. Diuretics to reduce excess fluid
Diuretics, also known as “water pills,” stimulate the kidneys to expel unneeded water and salt from your tissues and bloodstream into the urine. Getting rid of excess fluid makes it easier for your heart to pump. There are a number of diuretic drugs, but one of the most common is furosemide (Lasix®).
Approximately 20 percent of the U.S. population suffers from overactive bladder symptoms which consists of urgency of urination and loss of urine when the man or woman cannot reach the toilet in a timely fashion.
Many of those patients also have high blood pressure or vascular conditions, such as swelling of the feet or ankles. These conditions are often treated with diuretic therapies that make their bladder condition worse in terms of urgency and frequency.
A first step is to make sure you are following your doctor’s prescription instructions exactly. As an alternative to water pills you might try restricting salt in your diet and exercising for weight loss. Both of these can reduce salt retention and hypertension naturally. Also, if you take diuretics, use them in the morning so you have frequency during the day and not at night after you go to sleep.

2. Alpha blockers for hypertension
Another class of drugs used to reduce high blood pressure or hypertension by dilating your blood vessels can also cause problems. These medicines are known as alpha blockers. Some of the most common are Cardura®, Minipress® and Hytrin®.
Men typically take these to treat an enlarged prostate (benign prostatic hyperplasia or BPH) which can restrict urination by putting pressure on the urethra. By relaxing the muscles in the bladder neck, alpha blockers allow smoother urine flow for those patients but may result in incontinence.

3. Antidepressants and narcotic pain relievers
Some antidepressants and pain medications can prevent the bladder from contracting completely so that it does not empty. That gives rise to urgency or frequency or voiding dysfunction. They can also decrease your awareness of the need to void.
Some of these drugs can also cause constipation. Constipation, in turn, can cause indirect bladder incontinence because being constipated takes up more room in the pelvis that the bladder needs to expand. Also, a full rectum can press on the bladder and result in stimulation of the bladder to contract and result in urgency and frequency as well as incontinence.

4. Sedatives and sleeping pills
Using sedatives and sleeping pills can present a problem, especially if you already have incontinence. They can decrease your awareness of the need to void while you are sleeping.
The best way to address this situation is to take other steps to relax and improve your sleep. Getting more exercise earlier in the day to make you tired, for example, can help. It’s also important to maintain a regular bedtime and wake-up schedule. Try to find other ways to relax before bed — meditation, reading a book or listening to soothing music or sound effects (e.g., rain or waves) — can also help you sleep better.

Bottom line: the side effects of medication can result in urinary incontinence. If you think this is a problem, check with your physician.

The Enlarged Prostate-Spending Too Much Time On the Toilet

June 1, 2013

Normal prostate (L) vs. Prostate gland enlargement (R)

Normal prostate (L) vs. Prostate gland enlargement (R)


Prostate enlargement affects million of American men over age 50 who have symptoms of frequency and urgency of urination, poor force and caliber of the urine stream and getting up multiple times a night to go to the restroom to urinate. The enlarged prostate gland can impact a man’s quality of life. Nearly all men can achieve relief from this common medical problem.

There are several effective treatments for prostate gland enlargement. In deciding the best option for you, you and your doctor will consider your particular symptoms, the size of your prostate, other health problems you may have and your preferences. Your choices may also depend on what treatments are available in your area. Treatments for prostate gland enlargement include medications, lifestyle changes and surgery.

Medications are the most common treatment for moderate symptoms of prostate enlargement. Medications used to relieve symptoms of enlarged prostate include:
Alpha blockers. These medications relax bladder neck muscles and muscle fibers in the prostate itself and make it easier to urinate. These medications include terazosin, doxazosin (Cardura), tamsulosin (Flomax), alfuzosin (Uroxatral) and silodosin (Rapaflo). Alpha blockers work quickly. Within a day or two, you’ll probably have increased urinary flow and need to urinate less often. These may cause a harmless condition called retrograde ejaculation — semen going back into the bladder rather than out the tip of the penis.
5 alpha reductase inhibitors. These medications shrink your prostate by preventing hormonal changes that cause prostate growth. They include finasteride (Proscar) and dutasteride (Avodart). They generally work best for very enlarged prostates. It may be several weeks or even months before you notice improvement. While you’re taking them, these medications may cause sexual side effects including impotence (erectile dysfunction), decreased sexual desire or retrograde ejaculation.
Combination drug therapy. Taking an alpha blocker and a 5 alpha reductase inhibitor at the same time is generally more effective than taking just one or the other by itself.
Tadalafil (Cialis). This medication, from a class of drugs called phosphodiesterase inhibitors, is often used to treat impotence (erectile dysfunction). It also can be used as a treatment for prostate enlargement. Tadalafil can’t be used in combination with alpha blockers. It also can’t be taken with medications called nitrates, such as nitroglycerin.

Laser surgeries use high-energy lasers to destroy or remove overgrown prostate tissue. Laser surgeries generally relieve symptoms right away and have a lower risk of side effects than older surgical procedures such as the TURP or transurethral resection of the prostate that require 3-4 days of hospitalization and requires a catheter for several days after the procedure. Some laser surgeries can be used in men who shouldn’t have other prostate procedures because they take blood-thinning medications.

The laser used in my practice is the green light laser (GLL). It is performed in the hospital or a one-day surgery center. Men go home after the 30 minute procedure with a catheter which is usually removed the day after the procedure.

Less than 1% of patient will experience erectile dysfunction after the procedure, and 1/3 of the patients have retrograde ejaculation after the procedure. Some of the common side effects include mild burning with urination. Although incontinence can occur with this procedure, it is very uncommon, especially when it is performed by an experienced urologist.

For more information on managing the enlarged prostate gland with the green light laser, please view my video on YouTube: http://www.youtube.com/watch?v=r4Qh_mStsUw

11 Suggestions For Decreasing Prostate Symptoms

May 11, 2010

The prostate gland is walnut sized organ at the base of the bladder.  In order men the gland increases in size and causes symptoms such as going to the bathroom frequently, dribbling after urination, and getting up at night to urinate.  Here are a 11 suggestions that you might consider to relieve those symptoms.

1.  Don’t drink anything several hours before you go to sleep.

2.  Avoid caffeinated beverages such as coffee and tea as the caffeine acts as a diuretic

3.  Limit your alcohol consumption especially at the dinner meal.

4.  Avoid spicy foods.

5.  Take medications such as your diuretics or water pills early in the day when going to the bathroom to urinate is not such an inconvenience.

6.  Avoid antihistamines and decongestants

7.  Don’t hold off going to the restroom

8.  Use the clock to help with urination. Make an effort to urinate every 3-4 hours.  Putting your bladder on a schedule is very helpful and a good habit to have.

9. Go and then go again. Stand at the toilet and empty your bladder, walk away from the toilet for a minute or two and then return and try emptying the bladder again.

10. Avoid cold seats such as at football games in the winter.

11. If you bike ride, especially for long distances, stand on the pedals every 10 or 15 minutes to take the pressure off of your prostate gland.

Bottom Line: These steps won’t cure the enlarged prostate but they will lessen the symptoms.  If your symptoms persist, consider a visit to your urologist

Pass That Kidney Stone-Use Alpha-Blockers

May 5, 2010

Kidney stones affect millions of American men and women.  When a kidney stone is in the ureter, the tube between the kidney and the bladder, and blocks the flow of urine, this causes severe pain on the affected side.  The stone causes spasm of the ureter and causes more pain and retards the passage of the stone out of the urinary tract.  This pain and discomfort is relieved with pain medication but the spasm of the muscles in the ureter can be relaxed with the use of alpha-blocker medications such as Cardura, Hytrin, Flomax, and Uroxatrol.

These drugs are used to treat a non-cancerous prostate condition known as benign prostatic hyperplasia (BPH). The drugs work by relaxing the smooth muscle in a channel that runs through the prostate gland, allowing for better urine flow.

Kidney Stones

Kidney stones are formations of crystals that have separated from the urine. The separation occurs within the urinary tract if the patient’s urine is lacking in the chemicals that normally prevent their formation. Most will pass through the tract without notice. The crystals that do not separate form into larger stones, which may be difficult to pass.

Alpha Blockers and Passing Stones

Alpha-blockers can assist in passing stones because when it relaxes the smooth muscle, water can pass through more easily. This may reduce the pain of passing kidney stones, and speed up their exit from the body.  Alpha-blockers must be obtained with a prescription.

Bottom Line: Kidney stones are a common painful condition affecting millions of Americans.  Stone passage can be facilitate by the use of alpha-blockers