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The Answer Doc with Dr. Christopher Munger, M.D.
Men should seek treatment for BPH
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    Perhaps you have seen the commercials.  Perhaps you are or know a man that has to frequently go to the bathroom at night or rushes to the restroom on short notice.  The truth is more than 50 percent of men greater than the age of 50 and 80 percent of men older than 70 have some degree of benign prostatic hypertrophy or BPH.
    BPH occurs when the prostate gland, which lies below a man’s bladder, becomes enlarged.  This enlargement is believed to be caused by an abnormal response to normal male hormones. The most common symptoms of BPH that man might experience are as follows:
    - 1. Difficulty starting the urine stream
    - 2. Weak urine stream
    - 3. Dribbling after urination
    - 4. Feeling of not completely emptying the bladder
    - 5. Have to go frequently
    - 6. Waking up to urinate several times a night
    - 7. The feeling that if you don’t urinate now!, an accident will happen!
    So how is BPH diagnosed? The diagnosis is most often made by a combination of physical exam findings and a discussion of symptoms with your doctor.  Yes, this does mean the dreaded finger.  Digital rectal examination of the prostate is something that all men over the age of fifty should have on a yearly basis as part of screening for prostate cancer.  Often times in BPH, the prostate is enlarged above the normal size of a horse chestnut.  If the diagnosis is not easily made, prostate size can be determined with ultrasound and urologist can perform test that look at dynamic nature of how a man urinates or perform biopsies of the prostate in order to make the diagnosis.
    So you have BPH, how is it treated? Most commonly, BPH is treated with medication prescribed by a physician. These medicines fall in two main categories:
     1. Alpha-blockers: these medicines work by reducing the muscle tone of the urethra as it moves through the prostate to allow for better urine flow. Some common alpha blockers include Flomax, Cardura, and Hytrin
     2. Anti-antrodrogens:  these medicines work by blocking the effect of male hormones on the prostate allow the prostate to shrink thus reducing symptoms. Medicines from this class include Proscar and Advodart.
There are over the counter medicines that have been shown to help in numerous studies to combat the symptoms of BPH.  The most common and well-studied is Saw Palmetto which can have affects similar Flomax. You should discuss your symptoms with your doctor prior to starting saw palmetto.
    There are cases where BPH is so severe that surgical intervention is necessary. Urologists have been performing these procedures for many years and they often can provide significant improvement in symptoms with minimal downtime.
    If you think you may have BPH, don’t hesitate to rush into your doctor’s office and see if relief is a possibility!

    Dr. Christopher Munger’s column appears every other Sunday. Dr. Munger is board certified in family practice. He is a member of the Family Health Care Center in Statesboro and admits patients to East Georgia Regional Medical Center. He is originally from California. He recieved his bachelors degree from UCLA, his medical degree from Columbia University in New York City, and completed his training in family practice at the University Of Virginia. He lives in Statesboro with his wife and two dogs.
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