Enlarged Prostate (BPH)

What is the prostate?

The prostate is a gland in the male reproductive system. It lies just below the bladder. It makes fluid that is part of semen.

An enlarged prostate is when your prostate gland becomes larger than normal. It's also called benign prostatic hyperplasia or BPH for short. Benign means not cancer. And hyperplasia means too much cell growth. BPH isn't cancer and it doesn't increase your risk of getting prostate cancer.

Usually, the prostate gland continues to grow during adult life. That's why BPH is the most common prostate condition in people over age 50. As the prostate gets bigger, it may press against the bladder and pinch the urethra. This can slow or block the flow of urine out of your bladder.

Over time, the bladder muscle may become weak from trying to pass urine through a narrow urethra. When this happens, your bladder may not empty completely when you urinate. A narrowed urethra and weak bladder cause many of the urinary problems you may have with BPH.

Researchers aren't sure why the prostate keeps growing. Some researchers think changes in hormones with aging may cause the prostate to get bigger.

You're more likely to develop BPH if you:

• Are age 40 or older. The chance of getting BPH increases as you get older.
• Have family members who have had BPH.
• Have certain health conditions such as:
  • Obesity.
  • Heart disease and problems with blood circulation.
  • Type 2 diabetes.
  • Erectile dysfunction.
• Don't get enough physical activity.

Symptoms of BPH include:

• Having a frequent or urgent need to urinate
• Waking up many times to urinate
• Having problems with urine flow, such as:
  • Trouble starting to urinate
  • A stream that's weak, slow, or stops and starts
  • Dribbling after urination
  • Urinary incontinence
  • Feeling that you can't completely empty your bladder
• Pain after ejaculation or during urination
• Urine with an unusual color or smell

It's important to see your health care provider if you have any of these symptoms because they could be from a more serious health problem.

You should get medical help right away if you:

• Can't urinate at all
• Have fever and chills with urination that's painful, frequent, and urgent
• Have blood in your urine
• Have pain in your lower abdomen (belly) and urinary tract

For most people, BPH doesn't cause other problems. But BPH increases your chance of developing serious conditions, including:

• Acute urinary retention. With this condition, you suddenly can't urinate at all. This a medical emergency. Acute urinary retention is common in older males and the chance of having it increases with age. It may be triggered by:
  • Taking certain over-the-counter cold or allergy medicines
  • Drinking alcohol
  • Cold temperatures
  • Not moving enough over a long period of time
• Urinary tract infections (UTIs)
• Bladder damage and bladder stones
• Kidney damage

To find out if you have BPH, your provider will:

• Ask about your medical history. Be sure to tell your provider about all the medicines you take, because certain medicines can make BPH symptoms worse.
• Ask about your family health history.
• Examine you. The exam may include a digital rectal exam (DRE) of your prostate. In a DRE, your provider inserts a gloved finger into your rectum to check if your prostate is large, tender, or irregular in any other way.
• Order medical tests, if needed, such as:
  • Urine tests.
  • A PSA blood test (prostate-specific antigen test).
  • Urodynamic testing to see how well you can hold and release urine.
  • Cystoscopy to look inside your urethra and bladder.
  • Ultrasound pictures of your prostate and urinary tract.
  • A prostate biopsy to diagnose or rule out prostate cancer.

Not everyone needs treatment for BPH. Treatment options depend on how much your symptoms bother you, your health, age, and the size of your prostate:

• Lifestyle changes may improve mild symptoms. They include:

  • Drinking less before bedtime or going out
  • Avoiding or cutting back on beverages with caffeine and alcohol
  • Bladder training and exercising the muscles that control urine flow
  • Preventing or treating constipation

• Medicines can help mild to moderate symptoms by:

  • Stopping the prostate from growing
  • Shrinking the prostate
  • Relaxing muscles to improve urine flow

  Sometimes combining 2 types of medicine helps more than taking just one type of medicine.

• Medical procedures can help improve moderate to severe BPH symptoms when medicines don't help enough. There are several different types of procedures. They all use an instrument inserted into the urethra to either:

  • Widen the urethra
  • Destroy part of the prostate with heat

• Surgery may be helpful when symptoms are severe, other treatments haven't helped, or you have another problem, such as bladder damage. Different types of surgery are used to:

  • Remove part or all of the prostate
  • Make cuts in the prostate to take pressure off the urethra

  Most BPH surgery is done with tools inserted into the urethra.

Your provider can explain the possible benefits and side effects of your treatment options so you can decide what's best for you.

Researchers haven't found ways to prevent BPH. You can take care of your prostate health by:

• Talking with your provider about your risk for developing an enlarged prostate
• Getting regular checkups
• Paying attention to your symptoms so you can get treatment early if you see signs of BPH

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Esophagus Disorders

What are esophagus disorders?

Esophagus disorders are problems with how your esophagus works. The esophagus is the tube that carries food from your mouth to your stomach. You usually don't notice it unless you swallow something too big, hot, or cold. You might also notice it if something is wrong. When that happens, you might feel pain or have trouble swallowing (dysphagia).

The cause depends on the type of disorder. Some run in families. Others are linked to allergic reactions to food or substances in your environment. Sometimes, the cause is unknown.

You may be more likely to develop an esophagus disorder if you:

• Are overweight or have obesity
• Are pregnant
• Take certain medicines
• Have had radiation treatmentt to your neck or chest
• Smoke or are around secondhand smoke

The most common esophagus problem is gastroesophageal reflux disease (GERD). This happens when the muscle at the bottom of your esophagus doesn't close properly. Stomach acid can move back up and irritate the esophagus.

Other esophagus disorders include:

• Heartburn is a burning feeling in your chest or throat. It is often caused by acid reflux.
• Barrett's Esophagus happens when the lining of your esophagus changes. It is often caused by chronic (long-term) GERD.
• Achalasia is a problem where the lower muscle in your esophagus doesn't relax like it should.
• Esophageal Spasms are muscle contractions that cause chest pain or swallowing problems.
• Eosinophilic Esophagitis (EoE) is a rare condition where certain white blood cells (eosinophils) build up in the esophagus, causing swelling, pain, and trouble swallowing.
• Esophageal Cancer is a type of cancer that starts in the tissues of the esophagus.

Symptoms can be different for each condition but may include:

• Pain in your chest, abdomen (belly), or back
• A cough or sore throat that doesn't go away
• Trouble swallowing or feeling like food is stuck
• A hoarse voice or wheezing
• Heartburn or a burning feeling in your stomach
• Tasting acid or food in the back of your mouth
• Food or liquid coming back up into your mouth (regurgitation)
• Losing weight without trying

Get medical help right away if you have chest pain with shortness of breath, or pain in your jaw or arm. These could be signs of a heart problem.

Your health care provider will ask about your symptoms and medical history. They may order one or more tests, such as:

• Upper gastrointestinal (GI) endoscopy. This test uses a tiny camera to look inside your esophagus and stomach.
• Biopsy. This test takes a small tissue sample to check.
• Barium swallow. This test uses imaging to see how you swallow.
• Esophageal manometry. This test checks how well your esophagus moves food to your stomach.
• Esophageal pH test. This test measures how often acid backs up into your esophagus and how long the acid stays there.

Treatment depends on what's causing the problem and your overall health. Some esophagus disorders get better with over-the-counter medicines, diet changes, or lifestyle changes. Others may need prescription medicine or surgery.

Without treatment, some disorders may lead to other problems, such as pneumonia, from food entering the windpipe. GERD, Barrett's esophagus, and achalasia can also raise your risk for esophageal cancer.

You can help prevent or reduce symptoms by:

• Not smoking and limiting alcohol
• Eating smaller meals
• Avoiding eating close to bedtime
• Wearing loose-fitting clothes
• Sleeping on your left side or raising the head of your bed
• Maintaining a healthy weight

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Eyelid Disorders

What are eyelid disorders?

Eyelid disorders include a variety of conditions that affect your eyelids. Your eyelids protect your eyes and help keep them healthy. When you blink, they spread tears across your eyes and help wash away dirt or dust. You also close your eyelids when something comes near your eyes to protect them from injury.

Like other parts of your body, your eyelids can get infected, become swollen, or develop growths or eye cancer.

The cause depends on the type of disorder. Some eyelid disorders may run in families, while others happen for unknown reasons.

There are many kinds of eyelid problems. They can cause swelling, infection, irritation, or change how your eyelids look or move. Some may cause lumps or growths on or around the eyelids.

Eyelid disorders that cause swelling, redness, or infection include:

• Stye (hordeolum). A small, red, painful bump caused by a bacterial infection in an oil gland. A chalazion is a painless lump that may form after a stye.
• Blepharitis. Makes your eyelids red, itchy, or burning and can cause crusty eyelashes. It's often linked to bacteria or skin conditions like rosacea.
• Periorbital cellulitis. A bacterial infection of the eyelid and nearby skin. If it spreads behind the eye (orbital cellulitis), it needs immediate medical care.

Eyelid disorders that affect eyelid position or movement include:

• Ectropion (eyelids turn out). The inner eyelid is exposed, which can cause irritation or tearing.
• Entropion (eyelids turn in). The eyelashes rub against the eye, causing discomfort or damage.
• Ptosis (drooping eyelid). Often caused by weak muscles, aging, or nerve damage.

Eyelid growths include:

• Xanthelasma. Yellowish patches of cholesterol near the inner corners of the eyelids.
• Papilloma. A benign (noncancerous), wart-like skin growth.
• Basal cell carcinoma. The most common eyelid cancer, often on the lower eyelid.
• Squamous cell carcinoma. A less common but faster-growing skin cancer.
• Sebaceous gland carcinoma. A rare but serious cancer of the eyelid's oil glands.

Eyelid disorders that affect blinking or eyelid movement include:

• Blepharospasm. Eyelid blinking or twitching you can't control.
• Myokymia. A minor, occasional eyelid twitch often caused by fatigue or stress.

Symptoms can vary depending on the condition but may include:

• Feeling like something is in your eye
• Burning or stinging
• Watery or itchy eyes
• Red, swollen eyelids
• Blurry vision

Your eye care specialist may diagnose eyelid disorders during an eye exam. They may also ask about your medical and family history to help find the cause.

Treatment depends on the cause of the disorder. Some eyelid conditions get better on their own or may be related to another health condition. Keeping your eyelids clean can help prevent irritation and infection.

If you need treatment, it may include:

• Warm compresses
• Medicines or ointments
• Eye drops
• Surgery (less common)
• Lifestyle changes, such as getting more sleep or cutting back on caffeine

Fatigue

What is fatigue?

Fatigue is a feeling of weariness, tiredness, or lack of energy. It can interfere with your usual daily activities. Fatigue can be a normal response to physical activity, emotional stress, boredom, or lack of sleep. But sometimes it can be a sign of a mental or physical condition. If you have been feeling tired for weeks, contact your health care provider. They can help you find out what's causing your fatigue and recommend ways to relieve it.

Fatigue itself is not a disease; it's a symptom. It can have many different causes, including pregnancy and various medical problems, treatments, and lifestyle habits such as:

• Medical problems:
  • Chronic (long-lasting) diseases such as diabetes, COPD (chronic obstructive pulmonary disease), and heart, liver, kidney and thyroid diseases
  • Untreated pain and diseases like fibromyalgia
  • Anemia
  • Infections
  • Parkinson's disease
  • Sleep apnea and other sleep disorders
  • Recent stroke
  • Mental disorders such as depression and anxiety
• Treatments:
  • Cancer treatments such as chemotherapy, radiation, and bone marrow transplants
  • Recovering from major surgery
  • Taking certain medicines, such as antidepressants, antihistamines, and medicines for nausea and pain
• Lifestyle habits:
  • Not getting enough sleep
  • Staying up too late
  • Drinking too much alcohol
  • Substance use
  • Having too much caffeine (which can keep you from getting a good night's sleep)
  • Getting too little or too much exercise

Overwhelming fatigue is part of a disorder called myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). The fatigue caused by this disorder is different from a tired feeling that goes away after you rest. Instead, the fatigue in ME/CFS lasts a long time, does not get better with rest, and limits your ability to do ordinary daily activities.

If you've had fatigue that does not get better after several weeks, call your provider. They will ask questions about your sleep, daily activities, appetite, and exercise. They will likely do a physical exam and order lab tests. Once they decide on a diagnosis, they can tell you what treatments might help.

You can also make some lifestyle changes to feel less tired:

• Get regular physical activity
• Improve your sleep habits
• Stop smoking (if you smoke), since smoking is linked to many diseases that can cause fatigue
• Manage stress
• Eat a healthy diet and avoid alcohol

It also may be helpful for you to keep a fatigue diary. This can help you find patterns throughout the day, such as when you feel more tired and when you have more energy. It can also help you plan for activities that may give you more energy.

NIH: National Institute on Aging

Genetic Testing

What is genetic testing?

Genetic testing is a type of medical test that looks for changes, sometimes called variants or mutations, in your DNA. DNA contains the genetic instructions in all living things. Often, these changes have no effect, but sometimes, even a small change in DNA can cause disease or other health conditions.

Genetic tests take a sample of your blood or tissues and check your cells to look for any changes in:

• Genes are parts of DNA found in your cells that carry information that controls what you look like and how your body works. Many genes tell your body how to make proteins, which are needed for your body to work correctly.
  • Genome sequencing is a process that checks all your DNA.
  • Exome sequencing is a process that only checks the parts of your DNA that provide instructions to make proteins.
• Proteins do most of the work in your cells. If there are changes in the amount and activity level of proteins, they might be due to changes in the genes that produce those proteins.
• Chromosomes are thread-like structures in your cells. Each chromosome is made up of DNA tightly packaged around proteins. People usually have 23 pairs of chromosomes that contain all their DNA.

Most of the time, genetic testing is done through your health care provider. This is called clinical testing. It is done to find out about an inherited disorder (passed down through families) and to help make decisions about your care.

Other ways to get genetic testing include:

• Research-based testing is a genetic test done as part of a research study (clinical trial).
• Direct-to-consumer (DTC) testing is a genetic test that allows you to send a DNA sample and get the results. You may do this to learn about your ancestry or your risk for certain diseases.

Genetic testing may be done for many different reasons, including to:

• Find genetic diseases in a fetus. This is a type of prenatal testing.
• Screen newborn babies for certain treatable conditions.
• Lower the risk of genetic diseases in embryos that were created using assisted reproductive technology.
• Find out if you carry a gene for a certain disease that could be passed on to your children. This is called carrier testing.
• See whether you are at an increased risk of getting a specific disease. This may be done for a disease that runs in your family.
• Diagnose certain diseases.
• Identify genetic changes that may be causing or contributing to a disease that you were already diagnosed with.
• Help guide your provider in deciding the best medicine and dosage for you. This is called pharmacogenomic testing.
• To check for, monitor, or manage a disease. This is sometimes used to help find the best cancer treatment.
• To confirm the biological father (paternity) of a child, or how much genetic information is shared with other relatives.
• To explore the likelihood of having or developing certain physical traits, such as hair color or facial dimples, or to learn about your ancestry.
• To help advance our understanding of genetic conditions, learn how genes work, and find unknown genes.

Genetic tests are often done on a blood or cheek swab sample. But they may also be done on samples of hair, saliva, skin, amniotic fluid (the fluid that surrounds a fetus during pregnancy), or other tissue. The sample is sent to a laboratory. There, a lab technician will use one of several different techniques to look for genetic changes.

The benefits of genetic testing include:

• Helping your provider make recommendations for the management or monitoring of a genetic condition.
• Giving you more information for making decisions about your health and your family's health:
  • If you find out that you are at risk for a certain disease, you might take steps to lower that risk. For example, you may find out that you should be screened for a disease earlier and more often. Or you might decide to make healthy lifestyle changes.
  • If you find out that you are not at risk for a certain disease, then you can talk to your provider about when it would be appropriate to schedule checkups or screenings.
  • A test could give you information that helps you make decisions about having children.
• Identifying genetic disorders early in life so that treatment can start as soon as possible.

The physical risks of the different types of genetic testing are small. But there can be emotional, social, or financial drawbacks:

• Depending on the results, you may feel angry, depressed, anxious, or guilty. This can be especially true if you are diagnosed with a disease that does not have effective treatments.
• Despite the protections that are in place, you may be worried about genetic discrimination in employment or insurance.
• Genetic testing may give you limited information about a genetic disease. For example, it cannot tell you whether you will have symptoms, how severe a disease might be, or whether a disease will get worse over time.
• Genetic testing results might be inconclusive. For example, you might keep getting negative results or not get an answer at all.
• Some genetic tests may give you results that you didn't expect. For example, if you are tested to check for the cause of a rare disease, and a different variant is found that puts you at increased risk for something else that was previously unknown.
• Some genetic tests are expensive, and health insurance might only cover part of the cost. Or they may not cover it at all.

The decision about whether to have genetic testing is complex. In addition to discussing the test with your provider, you can meet with a genetic counselor. Genetic counselors have specialized degrees and experience in genetics and counseling. They can help you understand the tests and weigh the risks and benefits. If you do take a test, they can explain the results and make sure that you have the support that you need.