Sailing with benign prostatic hyperplasia and prostate cancer
The prostate is a small gland in the pelvis, found only in men. About the size of a satsuma, it’s located between the penis and the bladder and surrounds the urethra.
The main function of the prostate is to produce a thick white fluid that creates semen when mixed with the sperm produced by the testicles.
Benign prostatic hyperplasia – signs and symptoms
Benign prostatic hyperplasia (BPH) — also called prostate gland enlargement — is a common condition as men get older. An enlarged prostate gland can cause uncomfortable urinary symptoms, such as blocking the flow of urine out of the bladder. It can also cause bladder, urinary tract or kidney problems. The severity of symptoms in people who have prostate gland enlargement varies, but symptoms tend to gradually worsen over time.
Common signs and symptoms of BPH include:
- Frequent or urgent need to urinate
- Increased frequency of urination at night (nocturia)
- Difficulty starting urination
- Weak urine stream or a stream that stops and starts
- Dribbling at the end of urination
- Inability to completely empty the bladder
Less common signs and symptoms include:
- Urinary tract infection
- Inability to urinate
- Blood in the urine
Treatments for enlarged prostate
A wide variety of treatments are available for enlarged prostate, including medication, minimally invasive therapies and surgery. The best treatment choice for you depends on several factors, including the size of your prostate, your age, your overall health and the amount of discomfort or bother you are experiencing.
If your symptoms are tolerable, you might decide to postpone treatment and simply monitor your symptoms. For some men, symptoms can ease without treatment.
Medication is the most common treatment for mild to moderate symptoms of prostate enlargement. The options include:
- 5-alpha reductase inhibitors
- Combination drug therapy
- Tadalafil (Cialis)
Minimally invasive or surgical therapy might be recommended if your symptoms are moderate to severe and medication hasn’t relieved your symptoms or if you have a urinary tract obstruction, bladder stones, blood in your urine or kidney problems. The obstruction may be intrinsic (e.g., prostatic enlargement, bladder stones, urethral stricture) or extrinsic (e.g., when gastrointestinal mass compresses the bladder neck causing outlet obstruction). Urinary retention often occurs without warning. It is basically the inability to pass urine. In some people, the disorder starts gradually but in others, it may appear suddenly.
Acute urinary retention is a medical emergency and requires prompt treatment. The pain can be excruciating when urine is not able to flow out. Moreover, one can develop severe sweating, chest pain, anxiety and high blood pressure. Other patients may develop a shock-like condition and may require admission to a hospital. Serious complications of untreated urinary retention include bladder damage and chronic kidney failure. Urinary retention is a disorder treated by a doctor and the quicker one seeks treatment, the fewer the complications. Acute urinary retention is treated by catheterisation. This is usually done by a trained health care professional.
What to do if it happens to you in the middle of the sea while you are alone and far away from medical help?
- Run the water
Turn on the faucet in your sink. Sit on the toilet. Try to relax, close your eyes, and focus on the sound of the water.
- Rinse your perineum
The perineum is the area of flesh between the genitals and the anus. Sit on the toilet and try to relax. Use a squirt bottle to rinse your perineum with warm water.
- Hold your hands in warm or cold water
Fill a shallow bowl with warm or cold water and place your fingertips into it. Hold them there until you get the urge to pee, and then try to do so into the toilet.
- Go for a walk
Physical activity can sometimes stimulate the bladder. Try walking around a room or a hallway until you feel you need to pee.
- Sniff peppermint oil
The smell of peppermint oil may give you the urge to pee. Place a few drops on a cotton ball and bring it with you to the toilet. Sit on the toilet, relax, and sniff the cotton ball. You might also want to try putting the peppermint oil directly into the toilet.
- Bend forward
Sit on the toilet and relax. When you’re ready to try to pee, bend forward. This may stimulate your bladder.
- Try the Valsalva maneuver
Sit on the toilet and bear down, as if you were having a bowel movement. Use your forearm to press gently on your lower abdomen — but take care not to press directly on your bladder. Urine that moves back up into the kidneys can cause infection or damage.
- Try the suprapubic tap
Sit on the toilet and relax. Use your fingertips to rapidly tap the area between your navel and penis (for men). Tap once a second for up to 30 seconds.
- Use relaxation techniques
Sit on the toilet and relax as much as you can. To relax further, close your eyes and begin breathing deeply. Make an effort to relax all of the muscles in your body, from head to toe.
- Touch your thigh
Sit on the toilet and relax. Stroke your inner thigh with your fingertips. This may stimulate urination.
If you still have trouble passing urine after attempting these techniques you may require catheterization. Self-catheterization sounds frightening to many people. It seems as if it would be painful or embarrassing. In fact, it is amazingly easy and there is rarely any discomfort. You need to relax and take some deep breaths before you start. Male patients require the following equipment for intermittent self-catheterization:
- Catheter – Usually a clear, soft plastic or soft red rubber.
- Lubricant – Use a water-soluble lubricant, NOT petroleum jelly.
- Cleansing packet or washcloth – Use a cleanser that is mild.
- Container to drain urine in
- Plastic bag or plastic-lined pouch – to store the catheter.
You may catheterize yourself while standing over the toilet, sitting on a commode, reclining in a chair, or lying in bed. The procedure for men is as follows:
- Wash your hands with soap and water. You may wash the catheter at the same time by wrapping it around your hand. Rinse your hands and the catheter with running water. Dry your hands and shake excess water out of the catheter.
- Hold the penis with your non-dominant hand (the hand you do not write with or use to feed yourself) and wash the head of the penis.
- Lift the penis gently upward and outward. With your dominant hand (the hand you write with or feed yourself with), grasp the catheter 2″ to 3″ from its tip. Dip the catheter tip into lubricating jelly. Pass the lubricated tip of the catheter into the opening in the penis and slowly advance the catheter with constant, steady pressure until the catheter reaches the bladder and urine begins to drain. When the catheter reaches the area of the prostate, it may be difficult to continue. Take some deep breaths to relax and be patient. Leave the catheter in place until all urine stops draining and then slowly pull the tube out, stopping whenever urine begins to drain again. Allow the urine to drain completely before beginning to pull the tube out again. The urine may be drained into the toilet or into a container.
- Once the catheter is removed, run tap water through it and wash your hands and the catheter with soap and water. Rinse the catheter and your hands well. Dry your hands, shake the catheter and put it in its bag or pouch for the next use.
So it is very important to put these items in your first aid kit just in case you need it somewhere where you are not able to quickly get to the hospital.
How does sailing help?
Physical activity has myriad health benefits, which may also extend to protection against benign prostatic hyperplasia development and progression. Any kind of physical activity has been proposed to protect against BPH by several possible mechanisms, including reducing body size, decreasing sympathetic nervous system activity, and lowering levels of systemic inflammation. Lack of physical activity can make you retain urine. Activities like walking, jogging, and swimming can help reduce urinary problems. Consistent with this hypothesis, several studies have observed protective findings between physical activity and BPH-related outcomes (physician diagnosis of BPH, BPH surgery, BPH medication use, and clinical indicators). Sailing is a sport that will work many aspects of physical fitness such as core and muscle strength, aerobic fitness and balance and agility. Sitting too much might not just give you a big belly – it can also raise the red flag for your prostate health. As your activity level drops, your blood levels of a certain protein linked to prostate cancer spike, according to research published in the Journal of Physical Activity and Health. The researchers measured the participants’ physical activity levels and found that men with an extra hour of sedentary time in their day had a 16 percent greater chance of having elevated prostate-specific antigen (PSA) levels. On the other hand, guys with an hour more of light physical activity per day were 18 percent less likely to have big PSA scores. When sitting on traditional chairs the weight of the upper body, which can be considerable, presses the pelvis. Also, we sit for longer periods of time, and men are also heavier than before.
- Men who stand more and whose work is physical have 23% less prostate cancer than office workers.
- About 49% of all cancers of men in Europe concentrate in the region between the sacrum, pubic bone and sitting bones (in an area the capacity of which is about one litre) where men have the prostate, bladder, urethra, anus, rectum, and part of the colon. As much as 70% of all those cancers occur in the prostate.
- Men who have prostate infection feel pain on all seats, but considerably less on a two-part saddle seat where the gap prevents pressure from building up inside the pelvis.
- There is a growing number of men, who’s already enlarged prostates have shrunk back after they have used a two-part saddle chair with about a 40 mm wide gap under the pelvic opening.
- The prostate is very close to the skin, just round the edge of the pubic bone, and thus gets a lot of sitting pressure.
Prostate cancer – what is it and what can you do to help yourself
Prostate cancer begins when cells in the prostate gland start to grow out of control. Almost all prostate cancers are adenocarcinomas. These cancers develop from the gland cells (the cells that make the prostate fluid that is added to the semen). Other types of cancer that can start in the prostate include:
- Small cell carcinomas
- Neuroendocrine tumors (other than small cell carcinomas)
- Transitional cell carcinomas
These other types of prostate cancer are rare. If you are told you have prostate cancer, it is almost certain to be an adenocarcinoma. Some prostate cancers grow and spread quickly, but most grow slowly. In fact, autopsy studies show that many older men (and even some younger men) who died of other causes also had prostate cancer that never affected them during their lives. In many cases, neither they nor their doctors even knew they had it. ASCO, the American Urological Association, American Society of Radiation Oncology, and the Society of Urologic Oncology recommend that men with high-risk early-stage prostate cancer that has not spread to other areas of the body should receive radical prostatectomy or radiation therapy with testosterone suppression therapy as standard treatment options.
Locally advanced prostate cancer (stage III) may be treated with external-beam radiation therapy, testosterone suppression therapy, or surgery. Treatments may be given in different combinations to stop cancer from growing and spreading. Active surveillance is also an option.
It is widely accepted that at least 24 months of testosterone suppression therapy is needed to control the disease, but 18 months may also be enough. For those who have a radical prostatectomy, radiation therapy is given after the surgery. This is called adjuvant or salvage radiation therapy.
On June 22 2018, Rich Stearns embarked on a 333-mile sailing adventure. Starting in Chicago, his sailing boat, J/88 Hokey Smokes, guided him through the waters of Lake Michigan to Lake Huron to his final destination, Mackinac Island. He made the bucket-list trip by himself. As a sailing boat enthusiast, Stearns is no stranger to the allure of the water. He has been racing sailboats since 1962 and has been selling sailboats through his company, Stearns Boating, LCC, for nearly two decades. But this time the trip was personal.
“After a bout with prostate cancer, I thought it might help survivors to see someone doing crazy things, and show them that prostate cancer is not the end of the world,” he said. “So, I decided to undertake the challenge to raise money for prostate cancer awareness and information.”
Stearns’ trip was part of the 22nd Great Lakes Singlehanded Society’s Chicago to Mackinac Island Challenge. The sole challenge is considered one of the toughest sailing challenges on the Great Lakes, taking between 50 to 80 hours to complete with temperatures averaging 40 to 50 degrees at night. Stearns completed the challenge in 70 hours, placed first in his class and fifth overall, and raised more than $10,000 for prostate cancer supportive services at the University of Chicago Medicine’s Section of Urology under the direction of Arieh Shalhav, MD.
Two years ago, Stearns was diagnosed with prostate cancer and was referred to UChicago Medicine by a fellow sailor. For him, it’s important that others know the options available if they or a loved one are diagnosed with prostate cancer.
“This sailing event raised money so others will be able to get the knowledge they need if it happens to them,” he said. “Cancer is not something that always happens to someone else.”
An Olympic Silver Medalist Steve Benjamin (1984, 470 class), and lead salesman with North Sails, Benjamin is known fondly throughout the sailing community as “Benj.” He has re-dedicated his Tripp 41 Custom as Robotic Oncology in tribute to the life-saving skills of Dr David B. Samadi, Chief of Robotics and Minimally Invasive Surgery at Mount Sinai in New York, N.Y. because he is a prostate cancer survivor. Anyone familiar with prostate surgery would say, “Surgery six months ago and he’s out sailing?!” And anyone familiar with Benjamin would say, “That guy has the most positive attitude!” The successful return to the helm of a racing boat is largely credited to positive thinking by the patient and to robotic rather than “open” surgery
where the recovery time is lessened.