Dr. Keith Roach

DEAR DR. ROACH: I am a 55-year-old male in good health and was diagnosed with a slightly enlarged prostate several years ago. My primary care doctor said he wasn’t concerned enough to prescribe any medications. I get an annual physical, and there haven’t been any changes. However, in the past couple of years, there have been times when, once I get the urge to urinate, I’ve got to get to a restroom posthaste. But it’s comical at times! Once, I was halfway through a three-hour road trip and started thinking I should stop. I made it all the way home without a problem, but couldn’t make it from my driveway to the restroom. I read up on Flomax, which appears to be for those who have trouble urinating. Are you aware of any over-the-counter medications for my situation? — R.J.
ANSWER: I’m glad you can see the humor in the situation. With even one episode of incontinence, I would consider medication if the person wanted it after a discussion.
There are several herbal treatments (such as saw palmetto, South African star grass, stinging nettle and African plum) for an enlarged prostate with symptoms. Some of my patients take them and feel like they are effective, but the evidence is not definitive. Supplements are not subject to the same standards of purity that prescription medications are. Consequently, I do not recommend these treatments. Tamsulosin (Flomax) and similar drugs are safe and well-tolerated for most men.
One way to assess severity of prostate symptoms is using the AUA score, available at tinyurl.com/BPHscore. Men who have a result of moderate or severe symptoms benefit from treatment.
DEAR DR. ROACH: Please tell the public about prolapses that women may experience and the fact that surgery may be totally successful. I was lucky to find my surgeon and, after surgery, have a dandy little old body. A majority of women do not know about the problems nor the solutions. — M.
ANSWER: Many women experience pelvic organ prolapse, especially older women who have had one or more children. The symptoms that alert a woman may be varied, but one screening question that identified most women with this issue was whether they had symptoms of “a bulge, or that something is falling out of the vagina.” Other symptoms include urinary incontinence, difficulty voiding, and problems with bowel movements, either constipation or incontinence.
Many women do not bring these symptoms up with their regular doctor, so I am glad you wrote. Unfortunately, some doctors are not experts at making the diagnosis of mild prolapse by examination, so consultation with a gynecologist is ideal. Women with mild prolapse and no symptoms do not need treatment. Many women with mild symptoms will do well with conservative treatment such as a vaginal pessary, a silicone device that supports the pelvic organ. Pelvic floor muscle exercises also may be tried before considering surgery. Surgery is indicated when conservative treatments have not been effective.
I am glad you had a good outcome with surgery, because not all women are so lucky — a third, or perhaps half, of women who get surgery for prolapse will require a second surgery for recurrence of symptoms.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected] or send mail to 628 Virginia Dr., Orlando, FL 32803.
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