Prostate Enlargement and Its Connection to Autonomic Nervous System Issues

Understood, the final question, Dr. Lee?

Doctor's Advice: Generally speaking, if a transrectal ultrasound measures the prostate size and finds it to be greater than or equal to 30 cubic centimeters, the doctor will indicate that there is a problem with prostate enlargement.
However, it is not that simple; this is related to the patient's age, the shape observed, and the areas of hyperplasia.
In other words, while the overall measurement may indicate a larger prostate, the shape or the areas of hyperplasia associated with age may not be problematic.
Therefore, considering your age, we would not typically suspect that you have urinary obstruction due to prostate enlargement.
Based on your description, it seems more like an issue with the autonomic nervous system, which is likely related to everyday stress and lifestyle habits.
You might want to monitor your heart rate; if it is consistently elevated (more than 22 beats in 15 seconds after resting for 20 minutes), it is advisable to consult a neurologist for further evaluation and discussion with your doctor.
It appears that this may again be an issue of autonomic nervous system dysregulation.
About six years ago, I initially thought it was a heart problem and consulted a cardiologist, who performed various heart rhythm tests and X-rays but found no abnormalities.
I was then referred to a neurologist, who also conducted tests and ultimately diagnosed me with autonomic nervous system dysregulation, attributing it to my scoliosis and the physical sensations and stress affecting my nerves.
To address this condition, aside from surgery for scoliosis, maintaining a regular routine and a positive mindset is essential.
I was then referred to a rehabilitation specialist, who made a similar assessment and recommended some electrical and thermal therapies to help relax my body.
After that, I did not continue treatment, but I believe my urinary issues stemmed from previously not drinking enough water and having an irregular routine, leading to frequent bathroom visits.
The urologist advised me to hold my urine for about two hours to reduce bladder sensitivity and retrain my bladder.
However, as you mentioned, he still prescribed medication for prostate enlargement, which I think was intended to alleviate my symptoms.
I feel that my issue is more about sensitivity rather than obstruction.
If there is any correlation, it might be that occasionally, during urination, I feel a slight tightening in the anal area that interrupts the flow, but otherwise, it is smooth.
Not to mention, previously, when I drank water too quickly, the urination was very rapid, like a faucet running wide open.
Nonetheless, I wanted to show this to the doctor rather than attributing everything to autonomic nervous system dysregulation.
However, it is true that in September, my irregular routine and anxiety exacerbated my urinary and bowel issues.
After undergoing a colonoscopy, the doctor said everything was normal and there were no polyps.
Therefore, based on the evaluations from these two specialists and your advice, it seems that my previous anxiety and routine issues have indeed triggered autonomic nervous system dysregulation, worsening my urinary problems and irritable bowel syndrome! My final question is, while the doctor advised me to hold my urine, when I squat to use the toilet, urination still occurs naturally.
Will this affect bladder training? In the past few days, I have managed to control my urination to about 8-10 times during the day and 1-2 times at night (sometimes 3 times, but the third time is usually just before waking up and takes longer than the first two).
I wonder if my nocturia could be due to insufficient secretion of antidiuretic hormone, as I do have urine output at night, typically around 200-300 cc.
Could the issue with antidiuretic hormone also be related to autonomic nervous system influence?

Mr. Chen, 30~39 year old female. Ask Date: 2022/10/18

Dr. Li Xinyi reply Urology

Training the bladder by holding urine is something you should discuss with your physician to understand the rationale behind it.
Generally, before your appointment, you need to keep a voiding diary for two to three days, recording when you urinate, the volume of urine, and instances of urgency.
After documenting this information, it’s best to discuss it thoroughly with your doctor.

Additionally, nighttime urination may be related to poor sleep quality, so you might want to consult your neurologist about this.
Poor sleep can lead to increased nighttime urine production.
It’s particularly important to check for sleep apnea, which requires evaluation and treatment by an otolaryngologist.

Reply Date: 2022/10/18

More Info

Understanding the relationship between prostate enlargement, urinary issues, autonomic nervous system dysfunction, and sexual dysfunction is complex and multifaceted. Prostate enlargement, also known as benign prostatic hyperplasia (BPH), is a common condition in older men. It can lead to various urinary symptoms, including difficulty urinating, increased frequency, and urgency. However, the connection between BPH and autonomic nervous system (ANS) dysfunction is not straightforward.

The autonomic nervous system regulates involuntary bodily functions, including heart rate, blood pressure, and the function of the bladder. When the ANS is not functioning properly, it can lead to symptoms such as anxiety, palpitations, and gastrointestinal issues. In your case, the urinary symptoms your husband is experiencing could be influenced by stress and anxiety, which are known to affect the ANS. Stress can exacerbate urinary symptoms by increasing muscle tension and sensitivity in the bladder, leading to a feeling of urgency or discomfort when urinating.

In terms of prostate health, the size of the prostate is often assessed through imaging techniques such as ultrasound. A prostate volume of 30 cubic centimeters or more is typically considered enlarged. However, the shape and specific areas of enlargement can also play a significant role in determining whether the enlargement is causing urinary obstruction. It is important to note that not all men with an enlarged prostate will experience urinary symptoms, and the relationship between prostate size and symptoms can vary significantly.

Regarding sexual dysfunction, it is important to recognize that it can be influenced by both physical and psychological factors. In your husband's case, the combination of prostate issues, potential hormonal imbalances (as indicated by low testosterone levels), and autonomic nervous system dysfunction could contribute to erectile difficulties. The medications prescribed, such as Cialis and Androgel, aim to address these issues by improving blood flow and hormone levels, respectively.

The concern about whether these conditions are interrelated is valid. While the two doctors may have differing opinions, it is essential to consider that the body functions as an interconnected system. Stress and anxiety can lead to physical symptoms, including those related to the prostate and urinary function. Therefore, addressing the underlying causes of stress and anxiety may help alleviate some of the urinary and sexual dysfunction symptoms.

As for the question of whether these conditions can be treated effectively, the answer is generally yes. Many men experience improvement in their symptoms with appropriate treatment, which may include lifestyle changes, medication, and therapy for anxiety or stress management. However, it is also important to recognize that some conditions may require ongoing management rather than a complete cure.

Regarding your desire to conceive, it is essential to consult with a fertility specialist who can provide guidance on the best options available, including assisted reproductive technologies if necessary. Given your husband's commitment to improving his health through exercise and weight management, these efforts can positively impact his overall well-being and potentially improve his reproductive health.

In summary, the interplay between prostate enlargement, urinary symptoms, autonomic nervous system dysfunction, and sexual dysfunction is complex. A comprehensive approach that includes medical evaluation, lifestyle modifications, and psychological support may yield the best outcomes for your husband's health and your shared goals for family planning. It is crucial to maintain open communication with healthcare providers and seek further evaluations if symptoms persist or worsen.

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