Can I stop prostate pills that make me impotent? DR MARTIN SCURR answers your health questions –

For years I have taken three tablets of tamsulosin, finasteride and bladder relaxant to relieve symptoms caused by an enlarged prostate.

They did not notice, but in February 2019 he had a TURP operation. But I’ve been on the verge of impotence for nearly ten years because of the pills. Is this side effect reversible?

Name and address reserved.

Thank you for writing about a sensitive topic that many men have a hard time talking about openly.

Almost all men experience some symptoms of benign (non-cancerous) enlargement of the prostate gland with age.

The prostate sits like a doughnut around the urethra (the tube through which urine leaves the body), and as the gland grows with age, it puts pressure on the urethra and bladder, causing urination problems.

The main urinary symptoms of enlarged prostate, a condition called benign prostatic hyperplasia or BPH, are impaired flow, nocturia (having to go to the bathroom more than once during the night), increased frequency, and hesitation (difficulty in the beginning). Medications known as alpha blockers, such as tamsulosin, help relax the muscles in the bladder and prostate to improve urine flow.

Since their introduction, these drugs have made such a difference that far fewer male keyhole procedures are needed – transurethral resection of the prostate (TURP) – to cut off excess tissue.

However, the drugs have a potentially significant side effect, some men experience retrograde ejaculation, in which semen passes back into the bladder. This must be weighed against the benefits of reducing urinary symptoms.

Not all men with BPH respond to alpha blockers, but there is another class of drugs that can help: 5-alpha reductase inhibitors such as finasteride.

These drugs shrink the prostate by blocking the effects of testosterone. However, impotence is a possible side effect, along with a decrease in sexual desire.

You were unfortunate that tamsulosin and finasteride did not cure your BPH, and as you mentioned in your longest letter, it took years to decide whether you needed surgery.

In a small number of cases, finasteride may cause erectile dysfunction that persists even after the patient has stopped taking the drug. It is not clear why.

I recommend prescribing tadalafil, an erectile dysfunction treatment that can also improve urinary symptoms associated with BPH.

The prostate sits like a doughnut around the urethra (the tube through which urine leaves the body), and as the gland grows with age, it puts pressure on the urethra and bladder, causing urination problems.

A regular low dose of this medicine can improve blood flow to the penis. If you respond well, you will still experience minimal ejaculation after surgery to remove some of the prostate tissue.

Hopefully your doctor will agree to a trial of tadalafil that will give you significant benefits in a week or two.

In recent years, I have woken up with pins and needles and pressure in my arm, hand and fingers while lying on my side in bed. I also have backache and severe pain in the arm fold after holding the phone. Am I right in thinking this is a nerve pain? I am 76 years old.

Carol Petteford, Bristol.

It looks like nerve pain. One possible explanation is that you have a condition called “cervical ribs”; this means you were born with extra ribs behind your collarbone, just above your first rib.

Over time, these extra ribs can irritate the nerves that run from the neck to the arms. The condition is rare, affecting less than 1 in 100 people, and in most cases never causes symptoms.

Another possible explanation is that over the years, poor sitting posture has led to aching parts of the brachial plexus, a network of nerves running from the base of the neck to the arms.

I recommend asking your referring doctor for a chest X-ray to check the cervical ribs. Treatment usually includes physical therapy to reduce pressure on the nerves.

However, if the x-ray is clear, you may need to be referred for a nerve conduction study, which involves applying a gentle electrical current to the skin to measure how fast it travels through the nerve.

This is usually done to check if a nerve is pinched at the root due to cervical spondylosis (age-related wear that affects the intervertebral discs in the neck).

Treatments for this vary, but it usually starts with physical therapy.

In my opinion: Our diet shortens our lives

Which do you prefer, a long life or a healthy life? I would choose the latter, but some people in the UK spend most of their lives in poor health.

And in the UK there are big differences: a Blackpool-born woman is expected to live 23 years longer than an Orkney-born woman.

While income, housing, and education can clearly affect wellness years, another important factor is the shift from diet and “subsistence” to highly processed snacks and meals heavily loaded with sugar and salt.

I was shocked to see a scientist on behalf of the Food and Beverage Federation speak out, boasting that the industry has reduced salt levels by 16% over the past five years, and that companies are investing in new ways to reduce levels without compromising product safety. .

Leaving the levels they are now at is endangering food security in itself. I fear that the years we spend in good health will never increase until we address the fact that so much of our diet is a mix of highly processed ingredients that provide little nutrition beyond calories.