Self-Help and Medication Tips

 

Self-Help

Tip : Don’t restrict your water intake all day long in the hopes that you’ll have much fewer trips to the bathroom. Your body needs water to function, to keep your urinary system free of infections, and to prevent stressing your kidneys. It’s better to drink a normal amount for the day. However, it’s all right to avoid drinking a large amount all at once and to cut back on fluids just before going to bed or before going out if you won’t have easy access to a bathroom.

Tip : Remember that alcoholic drinks and food or drinks that contain caffeine (such as chocolate, coffee, tea, or caffeinated sodas) stimulate the kidneys to make urine and fill up your bladder. You may want to cut back or avoid these types of drinks at night or at other times when you don’t want to be going frequently to the bathroom.

Tip : Be patient if it takes longer to get your urine started and longer to finish because becoming anxious makes it harder to urinate, and straining to urinate is bad for your bladder. If you’re in a public bathroom, go into a stall for some privacy and relax; try sitting down to make it easier to relax and release urine. If you’re at home and have your own bathroom, keep a book or magazine there so you can think of something else.

Tip : After you’ve finished urinating, relax for a couple of minutes, then try urinating again. Often there is a little remaining urine that couldn’t escape from your bladder completely while your muscles were contracted, and this makes it easier for you to expel it.

Tip : Try urethral “milking,” which is also known as bulbar urethral massage, to prevent dribbling. Dribbling is an involuntary leakage of urine that comes after you have finished urinating. If you can milk this extra urine forward through your urethra while you are still at the toilet, you can eliminate it and avoid an involuntary dribble on your clothes.

(The urethra is the urinary tube that carries urine from your bladder to the outside of your body. The bulbar urethra is a part of the urethra located closer to the bladder than to the tip of the penis.)

First, place a finger in the area between your scrotum (the bag of skin that holds your testicles) and your anus (the opening you use to have a bowel movement). Press your finger upward on your skin, and draw your finger forward toward your scrotum while keeping up the pressure. Let go and repeat a few times (don’t move the finger backward). Then try again to urinate.

Tip : Exercising your pelvic floor muscles may give you more control over urination. (These exercises are also called “Kegel” exercises.) The pelvic floor muscles are the muscles that lie at the lowest part of your pelvis, stretching from the front to the back of your body. They support the pelvic organs above them and help you control excretion. If you’re not sure what muscles these are, place your finger on your skin between your scrotum and anus to feel the slight upward muscle movement as you contract the muscles you would use to stop urinating or to hold back gas. To strengthen them, sit or stand with knees apart, contract them firmly and hold for a few seconds, then repeat for about 5 minutes every day.

Tip : Avoid constipation, as it can put pressure on your urethra and make urination harder. Use a high-fiber diet, good fluid intake, and modern treatments (if warranted) to clear it quickly and prevent it.

Tip : Drink cranberry juice as part of a balanced, healthy diet – it is a good source of vitamin and has many other health benefits, including antibacterial properties that help prevent urinary infections.

Tip : If you find you are suddenly unable to expel any urine from your bladder, you are experiencing a complication called acute urinary retention. You cannot let this condition go on, as it will damage both your bladder and your kidneys. Call your doctor or go to a hospital emergency department. If you think it may work and will not cause too much delay, you can first try sitting in a warm bath, relaxing, and releasing your urine in the water. You are much more likely to be able to urinate while relaxed than if you are anxious and tense.

Tip : Bladder training may help overcome some of your problems with feeling that you need to go to the bathroom frequently and urgently. Speak with your physician first before trying it, to make sure you don’t put yourself at risk of acute urinary retention. In bladder training, after you sense that you need to go to the bathroom, you wait for a short time and allow your bladder to become a little more full before urinating. This is done slowly and consistently (ask your physician for details) to allow the time you can wait before urinating to gradually build up. The result is a bladder that has been stretched just enough to hold a little more urine and allow you to go to the bathroom less frequently and with less of a sense of urgency.

5-alpha-reductase Inhibitors

Tip : There are two types of drugs that help shrink the prostate by blocking the enzyme 5-alpha-reductase. These drugs are:

• Dutasteride (Avodart®), marketed in the United States by GlaxoSmithKline (http://www.gsk.com)
• Finasteride (Proscar®), marketed in the United States by Merck (http://www.merck.com)

Tip : Know how drugs in this country are legally approved and made available to the public. A good source of information about legally approved drugs in the United States is the U.S. Food and Drug Administration (FDA), Center for Drug Evaluation and Research (CDER): http://www.fda.gov/cder/cderorg.htm

Tip : Women and children should never take Avodart or Proscar; it is safe for men only. Avodart or Proscar can pass through the skin, so women and children should not handle Avodart or Proscar pills. If a pregnant woman carrying a male baby is exposed to Avodart or Proscar, her baby will be at risk of birth defects involving the sex organs.

Tip : If you are taking Avodart, do not donate blood. You should not donate blood unless it has been at least 6 months since your last dose of Avodart. This is because the Avodart in your blood could be harmful if the blood is used for a woman or child. Proscar is also potentially harmful to women and children in the same way.

Tip : Because Avodart and Proscar are broken down by the liver, it may not be safe for you to take either drug if you have liver disease. Be sure you tell your doctor if you have any kind of liver disease before accepting a prescription for Avodart or Proscar.

Tip : Be patient while waiting for results with Avodart. You may see improvement in your urinary symptoms as early as 1 month after starting the drug, but most likely it will take 3 to 6 months. You need at least 6 months before it is clear whether Avodart has worked or not. Once you do see improvement, it may last as long as 4 years. Proscar also needs at least 6 months before it is possible to tell whether it has worked.

Tip : Avodart or Proscar should be taken only once per day. Only one capsule should be taken per day. If you forget to take a dose, you can make it up later in the day – but don’t take two doses the next day.

Tip : Avodart and Proscar can be taken with or without meals.

Tip : Some men have experienced problems with erections or a decrease in sex drive after taking Avodart or Proscar. If this happens to you, talk to your doctor about possibly switching medication, or whether you and your doctor think you can cope until your course of Avodart or Proscar is finished.

Tip : Some men have experienced enlargement of the breasts and breast tenderness after taking Avodart or Proscar. If this happens to you, check your breasts for lumps or discharge of fluid from the nipples. If you see these changes, feel pain in your breasts, or have any other changes in your breasts that you find disturbing, call your doctor right away.

Tip : Some men taking Avodart or Proscar have experienced a decreased amount of semen ejaculated during sex. This does not affect the enjoyment of sex and is only an issue if you and your partner are trying to have a child. In that case, you may want to bank semen before you start taking Avodart or Proscar.

Tip : Be sure you know exactly when you are supposed to return to your doctor for checkups after starting Avodart or Proscar. Your tolerance of the drug, its effects, and the size of your prostate need to be continually monitored.

Tip : Both Avodart and Proscar lower the amount of prostate-specific antigen (PSA) in the blood. PSA blood levels are often used as a screening test for prostate cancer. However, as long as a doctor is aware that you are taking Avodart or Proscar, he or she will take that into account and will still be able to use PSA to screen you for prostate cancer.

Tip : Remember that Avodart and Proscar are not treatments for prostate cancer.

Alpha Blockers

Tip : There are four types of drugs that help shrink the prostate by blocking alpha receptors. These drugs are:

• Alfuzosin (Uroxatral®), marketed in the United States by Sanofi-Aventis (http://www.sanofi-aventis.us/live/us/en/index.jsp)
• Doxazosin (Cardura®), marketed in the United States by Pfizer (http://www.pfizer.com/pfizer/main.jsp)
• Tamsulosin (Flomax®), marketed in the United States by Boehringer-Ingelheim (http://www.boehringer-ingelheim.com/corporate/home/home.asp)
• Terazosin (Hytrin®), marketed in the United States by Abbott (http://www.abbott.com/global/url/home/en_US)

Tip : Uroxatral is taken once per day. Take the drug after the same meal each day. Do not take it on an empty stomach. A Uroxatral tablet is not meant to be chewed or crushed.

Tip : Flomax should be taken once per day, about a half hour after the same meal each day. Do not chew or crush the Flomax capsule.

Tip : If you have liver problems, do not take Uroxatral. It may also be necessary for you to avoid Cardura if you have liver problems. Tell your doctor about your liver condition before you accept a prescription for any alpha blocker.

Tip : If you have kidney problems, it may not be a good idea for you to take Uroxatral. Bring this up with your doctor before accepting the prescription so that your doctor can advise you.

Tip : If you are taking the antifungal drugs ketoconazole or itraconazole, or anti-HIV drugs like ritonavir, do not take Uroxatral. These drugs will increase the levels of Uroxatral in your blood to the point where you may suffer toxic effects.

Tip : If you have QT prolongation (a type of heart arrhythmia or disturbance in heart rhythm), or if you are taking other drugs that cause QT prolongation, do not take Uroxatral. Speak with your doctor if you believe this is a concern.

Tip : If you have a sulfa allergy, you may be more likely to develop an allergy to Flomax. Speak with your doctor if this is a concern.

Tip : Women and children should not take Uroxatral, Cardura, Flomax, or Hytrin. These drugs are for men only.

Tip : Alpha blockers may cause postural hypotension, meaning they may cause your blood pressure to drop when you stand up. This can cause dizziness and/or fainting. If you are taking an alpha blocker, be sure you don’t routinely put yourself in situations where sudden fainting could cause you or others to get hurt. Since this risk is greatest after your first dose of the alpha blocker, after a dose increase, and after treatment is interrupted (once you start taking it again), you should not drive, operate heavy machinery, or perform hazardous tasks at those times.

Tip : Alpha blockers may cause you to feel drowsy, sleepy, or not fully alert. If you are feeling these effects, you should not drive, operate heavy machinery, or perform hazardous tasks.

Tip : Starting doses of Hytrin are given with instructions to take at night because of the strong possibility of postural hypotension and fainting. The dose should only be increased gradually as your doctor recommends to prevent this problem. If you don’t take Hytrin for a few days, you will need to start again at the lower, nighttime dose – speak with your doctor first.

Tip : If you develop chest pain after starting an alpha blocker, contact your doctor immediately.

Tip : On very rare occasions, some men experience prolonged erections after using alpha blockers. This is a condition that needs to be treated immediately to prevent scarring within the penis that would be very likely to cause still more problems with erections in the future. If you have an erection that lasts for 3 hours and does not go away, contact your doctor immediately for emergency help. If your doctor is not available or does not provide this type of emergency help, go to the emergency department of a hospital where you can be treated.

Tip : If you are taking an alpha blocker, or even if you have previously taken the alpha blocker and since stopped, you should discuss this with your ophthalmologist before undergoing cataract surgery. Some patients have developed intraoperative floppy iris syndrome (IFIS) after taking alpha blockers. This is a condition in which the iris (a part of the eye) becomes limp and behaves differently during surgical manipulation than the ophthalmologist may expect. Be sure to let your ophthalmologist know about your medication history so that he or she can take this into account when planning surgical technique.