How do we Protect the Bladder when we have BPH

I need to put something in front of you that cuts across things I have said in this community more than once.

I have told you an enlarged prostate is not an emergency. I have told you not to let anyone rush you into an operation. I have told you the menu of options is longer than most men are shown. I stand behind every bit of that.

But I read a review over the last day that makes the other half of the argument, and it would be dishonest of me to sit on it just because it is less comforting.

The argument goes like this. We all talk about the prostate. The prostate is not the organ taking the damage. The bladder may be.

Your bladder is a muscle. If the outlet is narrowed, that muscle spends years pushing harder than it was built to push. The authors make one point that stopped me: you can transplant a heart. You cannot transplant a bladder. A man whose bladder has given out entirely is looking at catheters for the rest of his life.

They lay out five stages in the plainest words I have seen in a journal, taken from what men actually report.

One. Things slow down. An annoyance.

Two. Up in the night, urgency, always needing to know where the toilet is. Anxiety and exhaustion.

Three. Leaking. The smell and the stains. Embarrassment.

Four. Suddenly you cannot go at all. Terror.

Five. The bladder stops working. Their word for it is anguish.

Their case is that somewhere in the early stages there is a window where dealing with the blockage still protects that muscle, and that we do not currently have any reliable way of telling when a man is slipping past it.

Now I am going to be straight with you about how much weight this can carry, because I would rather you trusted me than agreed with me.

This is a proposal. The authors call it hypothesis-generating. Their staging system has never been validated, has no cut-offs, and they describe it themselves as a way of talking to patients rather than a diagnosis. There is also a figure in the paper that contradicts itself between the table and the text, which is why I am not quoting percentages at you from it.

And the balancing fact, which is in their own paper: by the guidelines they cite, only about half of men with these symptoms have a genuine blockage. So a lot of men reading this are absolutely fine as they are.

I am not telling you to go and get operated on. I am not a doctor and I would not know where to start.

What I am telling you is that "I have a tablet and I am managing" is an answer about symptoms, not an answer about your bladder. Those are two different questions and most of us have only ever been asked the first one.

So at your next appointment, ask the second one. Is my bladder still doing its job properly, and how would we know if that changed? This is a question I plan to ask the next time I get checked.

Here is what I want to hear from you. Has anyone ever tested your bladder function, rather than just asking how bad the symptoms are? Because I have a suspicion about the answer and I would like to be wrong. I know mine has not been tested.

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How do we Protect the Bladder when we have BPH