Aging: What to expect as you get older
From MayoClinic.com
Special to CNN.com

Looked in the mirror lately only to find a few more wrinkles and gray hairs? Those are just a few of the changes you’re likely to notice as you get older. But what exactly is going on with your body? Here’s what you can expect as you age.

Natural changes with age

Regardless of how long you live, time takes a toll on the organs and systems in your body. How and when this occurs is unique to you. Some typical changes to expect as you age include:

Cardiovascular system
Over time, your heart muscle becomes a less efficient pump, working harder to pump the same amount of blood through your body. Also, your blood vessels become less elastic. Hardened fatty deposits may form on the walls of your arteries (atherosclerosis), narrowing the passageway through the vessels. The natural loss of elasticity, in combination with atherosclerosis, makes your arteries stiffer, causing your heart to work even harder to pump blood through them. This can lead to high blood pressure (hypertension).

Bones, muscles and joints
Your bones reach their maximum mass between ages 25 and 35. As you age, your bones shrink in size and density. One consequence is that you might become shorter. Gradual loss of density weakens your bones and makes them more susceptible to fracture. Muscles, tendons and joints generally lose some strength and flexibility as you age.

Digestive system
Swallowing and the motions that automatically move digested food through your intestines slow down as you get older. The amount of surface area within your intestines diminishes slightly. The flow of secretions from your stomach, liver, pancreas and small intestine may decrease. These changes generally don’t disrupt your digestive process, so you may never notice them. But you might notice more constipation.

Kidneys, bladder and urinary tract
With age, your kidneys become less efficient in removing waste from your bloodstream. Chronic conditions, such as diabetes or high blood pressure, and some medications can damage your kidneys further.

About 30 percent of people age 65 and older experience a loss of bladder control (urinary incontinence). Incontinence can be caused by a number of health problems, such as obesity, frequent constipation and chronic cough.

Women are more likely than men to have incontinence. Women who’ve been through menopause might experience stress incontinence as the muscles around the opening of the bladder (the sphincter muscles) lose strength and bladder reflexes change. As estrogen levels decline, the tissue lining the tube through which urine passes (urethra) becomes thinner. Pelvic muscles become weaker, reducing bladder support.

In older men, incontinence is sometimes caused by an enlarged prostate, which can block the urethra. This makes it difficult to empty your bladder and can cause small amounts of urine to leak.

Brain and nervous system
The number of cells (neurons) in your brain decreases with age, and your memory becomes less efficient. However, in some areas of your brain, the number of connections between the cells increases, perhaps helping to compensate for the aging neurons and maintain brain function. Your reflexes tend to become slower. You also tend to become less coordinated.

Eyes
With age, your eyes are less able to produce tears, your retinas thin, and your lenses gradually turn yellow and become less clear. In your 40s, focusing on objects that are close up may become more difficult. Later, the colored portions of your eyes (irises) stiffen, making your pupils less responsive. This can make it more difficult to adapt to different levels of light. Other changes to your lenses can make you sensitive to glare, which presents a problem when driving at night. Cataracts, glaucoma and macular degeneration are the most common problems of aging eyes.

Ears
Hearing loss is one of the most common conditions affecting adults who are middle-aged and older. One in three people older than 60 and half of all people older than 85 have significant hearing loss. Over the years, sounds and noise can damage the hair cells of your inner ears.

Also, the walls of your auditory canals thin, and your eardrums thicken. You may have difficulty hearing high frequencies. Some people find it difficult to follow a conversation in a crowded room. Changes in the inner ear or in the nerves attached to it, earwax buildup and various diseases can all affect your hearing.

Teeth
How your teeth and gums respond to age depends on how well you’ve cared for them over the years. But even if you’re meticulous about brushing and flossing, you may notice that your mouth feels drier and your gums have pulled back (receded). Your teeth may darken slightly and become more brittle and easier to break.

Most adults can keep their natural teeth all of their lives. But with less saliva to wash away bacteria, your teeth and gums become slightly more vulnerable to decay and infection. If you’ve lost most or all of your natural teeth, you might use dentures or dental implants as a replacement.

Some older adults experience dry mouth (xerostomia), which can lead to tooth decay and infection. Dry mouth can also make speaking, swallowing and tasting difficult. Oral cancer is more common among older adults. Your dentist checks for oral cancer when you go for regular cleanings and checkups.

Skin, nails and hair
With age, your skin thins and becomes less elastic and more fragile. You’ll likely notice that you bruise more easily. Decreased production of natural oils may make your skin drier and more wrinkled. Age spots can occur, and skin tags are more common. Your nails grow at about half the pace they once did. Your hair may gray and thin. In addition, you likely perspire less — making it harder to stay cool in high temperatures and putting you at increased risk of heat exhaustion and heat stroke.

How fast your skin ages depends on many factors. The most significant factor is sun exposure over the years. The more sun your skin has been exposed to, the more damage you may attain. Smoking adds to skin damage, such as wrinkles. Skin cancer also is a concern as you age. You have a 40 percent to 50 percent chance of getting skin cancer at least once by the time you reach 65.

Sleep
Sleep needs change little throughout adulthood. If you need six hours of sleep nightly, chances are you’ll always need six hours — give or take 30 minutes. However, as you age, you’ll likely find that you sleep less soundly, meaning you’ll need to spend more time in bed to get the same amount of sleep. By age 75, some people find that they’re waking up several times each night.

Weight
As you age, maintaining a healthy weight — or losing weight if you’re overweight — may be more difficult. Your metabolism generally slows, meaning that your body burns fewer calories. Calories that were once used to meet your daily energy needs instead are stored as fat. Your level of activity may decrease, resulting in unwanted weight gain.

Sexuality
With age, sexual needs, patterns and performance may change. Women’s vaginas tend to shrink and narrow, and the walls become less elastic. Vaginal dryness is a problem. All of this can make sex painful.

Impotence becomes more common in men as they age. By the time they’re 65, up to one in four men have difficulty getting or keeping an erection about one in every four times they have sex. In others, it may take longer to get an erection, and it may not be as firm as it used to be.

How long can you live?

The longest documented human life span is 122 years. Though a life span that long is rare, improvements in medicine, science and technology during the last century have helped more people live longer, healthier lives. If you were born in the early 1900s in the United States, your life expectancy was only about 50 years. Today it’s around 77.

And if you’re sure you’ve already done too much damage to yourself to hope for a long life, think again. Researchers say it’s never too late to adopt a healthy lifestyle. For example, if you quit smoking now, your risk of heart disease begins to fall almost immediately. Living a healthy lifestyle can improve how you age. Eating a variety of fruits and vegetables and getting out for a daily walk are ways you can begin preparing now for your later years.

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The prostate gland is located just below a male’s bladder and surrounds the top portion of the tube that drains urine from the bladder (urethra). The gland’s primary function is to produce most of the fluids in semen, the fluid that nourishes and transports sperm.

From birth to young adulthood, the prostate grows from about the size of a pea to about the size of a walnut. Most men experience a second period of prostate growth in their mid- to late 40s. At this time, cells in the central portion of the gland — where the prostate surrounds the urethra — begin to reproduce more rapidly, resulting in prostate gland enlargement. As tissues in the area enlarge, they often compress the urethra and partially block urine flow. Benign prostatic hyperplasia (BPH) is the medical term for prostate gland enlargement.

Prostate gland enlargement affects about half of men in their 60s and up to 90 percent of men in their 70s and 80s. The presence or absence of prostate gland enlargement is not related to the development of prostate cancer.

Treatment of prostate gland enlargement depends on your signs and symptoms and may include medications, surgery or nonsurgical therapies.
Signs and symptoms

Prostate enlargement varies in severity from man to man, and doesn’t always pose a problem. Only about half the men with prostate enlargement experience signs and symptoms that become noticeable or bothersome enough for them to seek medical treatment. These signs and symptoms may include:

* Weak urine stream
* Difficulty starting urination
* Stopping and starting again while urinating
* Dribbling at the end of urination
* Frequent need to urinate
* Increased frequency of urination at night (nocturia)
* Urgent need to urinate
* Not being able to completely empty the bladder
* Blood in the urine (hematuria)
* Urinary tract infection

Causes

At birth, a boy’s prostate gland is about the size of a pea. It grows slightly during childhood and then at puberty undergoes a rapid growth spurt. By the time a man reaches age 25, his prostate is fully developed and is about the size of a walnut.

The causes of noncancerous growth of tissue inside the prostate later in life are unclear. Researchers believe that with age, the prostate becomes more susceptible to the effects of male hormones, including testosterone.
Risk factors

The main risk factor for prostate gland enlargement is aging. Prostate gland enlargement rarely causes signs and symptoms in men younger than 40, but approximately half the men in their 60s experience some signs and symptoms. In addition to age, other risk factors include:

* Heredity. A family history of prostate enlargement can increase the odds of developing problems from prostate enlargement.
* National origin. Prostate enlargement is more common in American and European men than in Asian men.
* Marital status. For unknown reasons, married men are more likely to experience prostate enlargement than are single men. There’s no evidence that supports a link between sexual activity and prostate growth.

When to seek medical advice

If you’re experiencing urinary problems, seek medical advice. Your doctor can help determine whether you have prostate gland enlargement and whether your symptoms warrant further evaluation and treatment.

If you don’t find your symptoms troublesome and they don’t pose a health threat, you may not need treatment. That doesn’t mean that it’s all right to let urinary symptoms go without medical evaluation. Instead of an enlarged prostate gland, your symptoms could be early warnings of a more serious condition, including a bladder stone, a bladder infection, side effects of medication, heart failure, diabetes, a neurological problem, inflammation of the prostate (prostatitis) or prostate cancer.
Screening and diagnosis

To diagnose prostate gland enlargement, your doctor will likely begin by asking you about your symptoms, when they developed and how often they occur. Your doctor will also want to know about other health problems, medications you’re taking and whether there’s a history of prostate problems in your family. Over-the-counter (OTC) drugs, such as aspirin, decongestants and antacids, are considered medications, so tell your doctor about those too. The history of when you start and stop medications also is important for your doctor to know.

In addition, your checkup may include:

* Digital rectal exam. To perform this exam, your doctor puts on an examination glove, applies a lubricant to one of his or her gloved fingers, and then gently inserts the lubricated finger into your rectum. Because the prostate gland is located adjacent to the rectum, your doctor can feel the back wall of the gland. This allows your doctor to determine whether your prostate is enlarged and to help rule out prostate cancer.
* Urine test. Having a sample of your urine analyzed in the laboratory can help your doctor rule out an infection or other conditions that can produce symptoms similar to those of prostate enlargement, such as prostatitis, cystitis and kidney disease.
* Prostate-specific antigen (PSA) blood test. Prostate-specific antigen is naturally produced in your prostate gland to help liquefy semen. A small amount circulates in your blood. Higher than normal levels in your blood can indicate BPH, prostate cancer or prostatitis.

Additional tests
If the results of these tests suggest prostate enlargement, your doctor may want to perform additional exams. The following can help confirm the diagnosis of prostate enlargement and determine its severity:

* Questionnaire. A short questionnaire, developed by the American Urological Association, asks you about specific urinary symptoms associated with prostate enlargement and how often they occur. In addition to helping determine the severity of prostate gland enlargement, this symptom index is helpful in monitoring the progression of the condition over time.
* Urinary flow test. This test measures the strength and amount of your urine flow. By charting the results of this test, your doctor can determine if your urinary flow patterns change over time and at what rate. Keep in mind that your peak flow rate normally decreases as you age. Restricted urine flow can also be a sign of other problems, such as a weakened bladder muscle.
* Postvoid residual volume test. This test measures whether you can empty your bladder. The test is done one of two ways: by inserting a thin, soft tube (catheter) into your urethra and up into your bladder or by using ultrasound imaging to see inside your bladder. The ultrasound method is more common and less uncomfortable, but often less accurate. Because the results of this test can vary, you may need to have it done more than once to get an accurate reading.
* Ultrasound. Imaging through ultrasound is used to estimate the size of your prostate gland. In addition, it can help detect problems such as an obstruction of your kidney, stones in your kidneys or bladder, calcifications of your prostate, or a tumor in your prostate.
* Urodynamic studies. If your doctor suspects that your symptoms may be related to a bladder problem rather than prostate gland enlargement, he or she may recommend a series of tests to measure bladder pressure and function. These tests are done by threading a small catheter through the urethra and into your bladder. Water is gently injected into your bladder to measure internal bladder pressure and to determine how effectively your bladder contracts. Bladder pressure is measured during bladder filling and urination.
* Cystoscopy. This procedure involves the use of a thin tube containing a lens with a light system (cystoscope) that’s gently inserted into the urethra under local anesthesia. It allows your doctor to see inside the urethra and bladder. The procedure can detect problems including enlargement of the prostate, compression of the urethra due to enlarged prostate, obstruction of the urethra or bladder neck, an anatomical abnormality, and the presence of stones in your bladder. These disorders may cause your bladder to weaken.
* Intravenous pyelogram. An intravenous pyelogram is an X-ray image of the urinary tract used to help detect an obstruction or abnormality. Dye is injected into a vein, and an X-ray is taken of your kidneys, bladder and tubes that attach your kidneys to your bladder (ureters). The dye makes it possible to identify urinary stones, tumors or a blockage above your bladder.

Complications

If your signs and symptoms are mild and don’t bother you, your doctor may suggest watchful waiting as an appropriate response to an enlarged prostate. Your doctor will periodically evaluate your condition to see if it improves, stays the same or worsens.

The risk you take in following this approach is that your condition could worsen over time and other problems could develop, such as infection, bleeding and kidney damage. However, these complications are uncommon.

Prostate gland enlargement becomes a serious health threat only if it interferes with your ability to empty your bladder. A bladder that’s continuously full can interfere with your sleep, cause recurrent bladder infection or result in kidney damage. If you’re unable to pass urine at all, seek immediate medical attention.

Treatments for prostate gland enlargement don’t reduce or increase the risk of prostate cancer. Even if you’re being treated for an enlarged prostate gland, you still need to continue regular prostate exams to screen for cancer. Surgical treatment for prostate gland enlargement can identify cancer in its early stages.
Treatment

Treatment for an enlarged prostate is determined by your signs and symptoms and their severity. If you have significant problems, such as urinary bleeding, persistent urinary tract infections, bladder and kidney damage, your doctor generally will recommend treatment. If your prostate is enlarged but you experience little or no discomfort, treatment often isn’t necessary.

A wide variety of treatments are available to ease the signs and symptoms of an enlarged prostate. They include medications, other nonsurgical therapies and surgical procedures.

Medications
Medications are the most common method for controlling moderate symptoms of prostate enlargement. Doctors use a variety of medications to treat prostate gland enlargement:

*

Alpha blockers. These drugs were originally developed to treat high blood pressure. They relax the muscles at the neck of your bladder, making it easier to urinate. The Food and Drug Administration (FDA) has approved four alpha blockers for prostate enlargement: terazosin (Hytrin), doxazosin (Cardura), tamsulosin (Flomax) and alfuzosin (Uroxatral).

Alpha blockers are effective in many men who take them. The drugs work quickly. Within a day or two, most men notice an increase in urinary flow and a decrease in how often they need to urinate. You may need to take an alpha blocker indefinitely.

Doctors are uncertain about the long-term benefits and risks of alpha blockers. To reduce your risk of side effects, your doctor may start with a low dose of medication and gradually increase the dosage. Alpha blockers taken with drugs for impotence, such as sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis), may interact and cause low blood pressure. Discuss with your doctor the possible side effects of these medications before taking them.
*

Finasteride (Proscar, Propecia) and dutasteride (Avodart). These drugs relieve symptoms in a totally different manner than alpha blockers do. Instead of relaxing your muscles, they shrink your prostate gland. For some men with large prostates, the drug may produce a noticeable improvement in symptoms. It’s generally not effective, though, if you have only a moderately enlarged or normal-sized prostate.

Finasteride takes a longer time to work than does dutasteride. You may notice some improvement in urinary flow after three months, but for complete results generally it takes up to a year. A small percentage of men who take finasteride experience impotence, decreased libido and reduced semen release during ejaculation. But in most men, finasteride produces only slight side effects. The long-term effects of this drug are unknown.

Finasteride has been shown to prevent or delay the onset of prostate cancer in men 55 years and older. However, finasteride also has been shown to adversely affect sexual function and to slightly raise the risk of developing higher grade prostate cancer.
* Combination drug therapy. One study found that taking finasteride and the alpha blocker doxazosin together significantly reduced the risk of further prostate gland enlargement to the point where invasive surgery was not needed. This therapy also appears to decrease urination problems often caused by an enlarged prostate.

Nonsurgical therapies
Several nonsurgical treatment methods are available to reduce the size of the prostate. These therapies focus on enlarging the urethra, making it easier for you to urinate.

Heat therapy. Heat therapy uses heat energy delivered through the urethra to destroy excessive prostate tissue. It fills the gap between medications and invasive surgery. It’s more effective than are medications for moderate to severe symptoms, and it doesn’t produce as many side effects as surgery.

Heat therapy is often performed on an outpatient basis. But depending on the procedure, your doctor and how quickly you’re able to urinate on your own, you may need to stay in the hospital overnight. Heat therapy ordinarily requires only a few days’ recovery time. An exception is laser therapy. Some older laser procedures require that you wear a catheter for up to three weeks. Newer techniques often require use of a catheter for only 24 hours.

Several types of heat therapy are available. These may include:

*

Microwave therapy. Transurethral microwave therapy (TUMT) uses computer-controlled heat in the form of microwave energy to safely destroy the inner portion of the enlarged gland.

The size and shape of an enlarged prostate is critical to the success of microwave therapy. If your prostate is very large or growing in an unusual shape into your bladder, this treatment generally isn’t effective.

During the procedure a machine emits microwave energy through a urinary catheter. The catheter includes a tiny internal microwave antenna to deliver a dose of microwave energy that heats the enlarged cells and destroys them. Cool water circulates around the tip and sides of the antenna during the procedure to protect the urethra from the heat.

A local anesthetic helps control pain. You may feel some heat in the prostate and bladder area. You may also have a strong desire to urinate and may experience bladder spasms. These responses usually disappear after the treatment is finished. You can go home when you’re urinating satisfactorily, usually the same day.

It may take several weeks before you begin to see a noticeable improvement in your symptoms. Those who seem to respond best over time are men whose initial symptoms are mild. The long-term effectiveness of the procedure is uncertain.

It’s normal to have urgent, frequent urination and small amounts of blood in your urine during recovery. There may be changes in the amount of semen you ejaculate. However, unlike more invasive surgery, TUMT generally doesn’t produce impotence, incontinence or retrograde ejaculation. With retrograde ejaculation, semen flows backward into the bladder during ejaculation instead of out through the penis, and can result in infertility.

TUMT isn’t recommended if you have a pacemaker or any metal implants.
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Radiofrequency therapy. Transurethral needle ablation (TUNA) works by sending radio waves through needles that are inserted into your prostate gland, heating and destroying the tissue. As in TUMT, a special catheter is inserted through your urethra. The needles are inserted into your prostate by maneuvering the catheter.

TUNA typically is less effective than traditional surgery in reducing symptoms and improving urine flow. Its long-term effectiveness also isn’t known. Another drawback of the procedure is that it doesn’t work as well in men with very large prostates. Side effects may include urine retention, blood in your urine, painful urination and a small risk of retrograde ejaculation.
* Electrovaporization. Transurethral electrovaporization of the prostate involves a special metal instrument that emits a high-frequency electrical current to cut and vaporize excess tissue while sealing off the remaining tissue to prevent bleeding. This procedure is especially useful for men at higher risk of complications, including those who take a blood-thinning (anticoagulant) medication. Its long-term benefits aren’t yet known.
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Laser therapy. This procedure is performed similarly to other heat therapies, except it uses a laser instead of microwave energy, radio waves or electrical current to produce heat. It generally doesn’t cause impotence or prolonged incontinence. However, some laser procedures require lengthy use of a catheter. Laser therapy includes transurethral evaporation of the prostate (TUEP), noncontact visual laser ablation of the prostate (VLAP), interstitial laser therapy, and photosensitive vaporization of the prostate (PVP).

TUEP is similar to electrovaporization. The difference is that your doctor destroys prostate tissue with laser energy instead of electrical current. The procedure is generally safe and causes limited bleeding. It’s often effective, with noticeable improvement in urine flow soon after the procedure.

VLAP involves applying enough laser energy to dry up and destroy excess prostate cells. Because of swelling and prolonged sloughing off of the dead tissue, you’re likely to retain urine for several days and will need to wear a catheter. You may also experience a burning sensation during urination for days to weeks.

Interstitial laser therapy directs laser energy inside the prostate growths rather than at the urethral surface. It safely and moderately increases the urinary flow rate and reduces the volume of the prostate. It also seems to work well among men with large prostates. Because of substantial tissue inflammation after treatment, you may need to use a catheter for up to three weeks. Uncomplicated urinary tract infections also are common. Interstitial laser therapy is a good option if you can’t have surgery because of other health complications. It doesn’t cause any blood loss and uses a combination of local anesthesia and intravenous sedation to control pain during the procedure.

PVP is a newer form of laser treatment for prostate gland enlargement. This procedure and its results are similar to transurethral resection of the prostate (TURP), which is the most common surgical treatment for enlarged prostate. However, photosensitive vaporization uses laser energy — instead of the electrical current used by TURP — to destroy prostate tissue. In general, photosensitive vaporization is better for smaller prostates. PVP may also result in less bleeding and a shorter recovery time than with TURP.

A drawback of heat therapies is that no tissue is taken (biopsied) from your prostate gland. During surgical treatments for an enlarged prostate, a small sample of your prostate generally is taken by your doctor and examined by a pathologist for possible cancer.

Prostatic stents. A prostatic stent is a tiny metal coil. During this procedure, the stent is inserted into your urethra to widen the urethra and keep it open. Tissue grows over the stent to hold it in place. This treatment produces little or no bleeding and doesn’t require a catheter. It may be an option for men who are unwilling or unable to take medications or who are reluctant or unable to have surgery. Stents often aren’t ideal for older men who have difficulty wearing or maintaining them, or who are unable to tolerate the procedure.

Some men find that the stents don’t improve their symptoms. Others experience irritation when urinating or have frequent urinary tract infections. These complications, along with the high cost and potential difficulties in removing the stents, have reduced the popularity of this treatment.

Surgical and other procedures
At one time surgery was the most common treatment for BPH. But because of increased use of medications and the development of other less invasive therapies, surgery is on the decline. Today it’s used mainly for more severe signs and symptoms or if you have complicating factors, such as:

* Frequent urinary tract infections
* Kidney damage from urinary retention
* Bleeding through the urethra
* Stones in the bladder

Surgery is the most effective of all therapies for relieving symptoms of an enlarged prostate. It’s the “gold standard” by which all other treatments are judged, and many doctors have extensive experience with it. However, it’s also the most likely to produce side effects. Fortunately, most men experience few problems. Among those with certain health conditions, such as uncontrolled diabetes, cirrhosis of the liver, a major psychiatric disorder, or a serious lung, kidney, or heart condition, surgery isn’t usually recommended unless absolutely necessary.

Surgery for an enlarged prostate requires a hospital stay. If you have surgery, you may need to take up to a month off work. You’ll also need to avoid heavy lifting, jarring to your lower pelvic area or straining of your lower abdominal muscles for up to two months.

The types of surgery for an enlarged prostate include:

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Transurethral resection of the prostate (TURP). This is the most common surgery for an enlarged prostate. During the procedure, you’re given a general anesthesia or anesthetized from the waist down with a spinal block. A surgeon threads a narrow instrument (resectoscope) into your urethra and uses small cutting tools to scrape away excess prostate tissue. You can expect to stay in the hospital for one to three days after surgery. During your recovery, you’ll have a urinary catheter in place for a few days.

TURP is effective and relieves symptoms quickly. Most men experience a stronger urine flow within a few days. You can expect some blood or small blood clots to appear in your urine afterward. Before you leave the hospital, you should be able to urinate on your own. At first you may feel some pain or a sense of urgency when urine passes over the surgical area. This discomfort should gradually improve. In some cases, you may be sent home from the hospital with a catheter that is later removed in your doctor’s office.

In some cases, TURP can cause impotence and loss of bladder control. Generally, these conditions are only temporary. Pelvic floor muscle exercises (Kegels) often help restore bladder control. Normal sexual function often returns within a few weeks to months. However, it can take up to a year to make a full recovery from these side effects.

Another more common side effect of surgery is retrograde ejaculation. TURP may also produce scarring and narrowing in the urethra or bladder neck. This often can be remedied by stretching of the scar tissue, done on an outpatient basis. Some men who have TURP may need some sort of prostate surgery again because the prostate grew back or the scar tissue from a previous procedure needs to be removed.
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Transurethral incision of the prostate (TUIP). This surgery is an option if you have only a moderately enlarged or small prostate gland. It’s also an option for men who aren’t good candidates for more invasive surgery for health reasons or because they don’t want to risk sterility.

Like TURP, TUIP involves special instruments that are inserted through the urethra. But instead of removing prostate tissue, the surgeon makes one or two small cuts in the prostate gland. The cuts help enlarge the opening of the urethra, making it easier to urinate.

The procedure produces less risk of complications than other kinds of surgery. It doesn’t require an overnight hospital stay, but it’s less effective and often needs to be repeated. Some men experience only a small improvement in urinary flow.
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Open prostatectomy. This type of surgery is generally performed only if you have an excessively large prostate, bladder damage or other complicating factors, such as bladder stones or urethral strictures. It’s called open because the surgeon makes an incision in your lower abdomen to reach the prostate rather than going up through the urethra. During an open prostatectomy, only the inner portion of your prostate gland is removed, leaving the outer portion intact.

Open prostatectomy is the safest and most effective therapy for men with extreme prostate enlargement. But it poses the greatest risk of side effects. Complications of the procedure are similar to those of TURP, and their effects may be more severe. The procedure usually requires a hospital stay of three to five days.

Self-care

Making some lifestyle changes can often help control the symptoms of an enlarged prostate and prevent your condition from worsening. Consider these measures:

* Limit beverages in the evening. Stop drinking water and other beverages after 7 p.m. to reduce your need to go to the bathroom at night. In particular, beverages that contain caffeine will increase urine production, cause bladder irritation and aggravate your symptoms.
* Empty your bladder. Avoid letting your bladder get full. Try to urinate all that you can each time you go to the bathroom. For some men, sitting on the toilet is more effective than is standing. Try following a daily time schedule for urinating, such as on long trips.
* Limit alcohol. Alcohol increases urine production and irritates your bladder.
* Be careful with over-the-counter decongestants. These drugs can cause the band of muscles that control urine flow from your urethra (urethral sphincter) to tighten, making urination more difficult.
* Keep active. Inactivity causes you to retain urine. Even a small amount of exercise can reduce urinary problems caused by an enlarged prostate.
* Stay warm. Cold weather can lead to urine retention and increase your urgency to urinate.

Complementary and alternative medicine

Health food stores carry a number of herbs that are marketed to treat prostate enlargement. But only saw palmetto has been studied in large, long-term trials and proved to show some effectiveness. However, scientific data is still lacking.

Saw palmetto is extracted from the ripened berries of the saw palmetto shrub. It’s thought to work similar to the medication finasteride by preventing testosterone from breaking down into another form of the hormone associated with prostate tissue growth. However, studies on this herb have produced varied results. While some studies have shown saw palmetto to be as effective as finasteride, a recent study suggests saw palmetto has no effect on symptoms. These differing results may be because of the variability of herbal products and study methods.

One drawback of this herb, and many other such herbal products, is that it may suppress your baseline PSA level. This action can interfere with the effectiveness of the PSA test for prostate cancer. Herbal products also may increase your risk of bleeding and adverse reactions to anesthetics. If you take saw palmetto or another herbal medicine, be sure to tell your doctor.

Be aware that the FDA does not regulate herbs. This means their safety and effectiveness has not been proved. Check with your doctor before taking any herb.

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As an Alzheimer’s caregiver, you may feel as if you’re riding a roller coaster — never sure of what the next curve may bring. It’s incredibly stressful; yet it can also be rewarding.

Rocked by this dizzying mix of emotions, you walk a tightrope, balancing your own needs against those of your loved one. Learning to recognize and defuse stress can make it easier to keep your balance. Focusing on the rewards from your efforts also helps.

The rewards of caregiving

“Two of the main things I hear people talk about are feelings of satisfaction in making good on a commitment and in paying back loved ones,” says Glenn Smith, Ph.D., a neuropsychologist at Mayo Clinic,Rochester, Minn.

Another reward Dr. Smith notes is a sense of accomplishment. “People often express that they realize they are stronger than they ever thought they could be,” he says.

The benefits of caring for someone with Alzheimer’s disease won’t always be obvious to you. That’s normal.

“It’s important that people don’t try to deny the grief that they may feel,” says Dr. Smith. “To work through that grief is part of the growth a person can experience.”

According to Dr. Smith, some of the ways in which you can address your grief — and still reap rewards — include:

* Accept your grief and understand it as a normal process.
* Set realistic goals and recognize that at some point you may not be able to continue to provide total care.
* Take stock of what you have accomplished and the goals you have met.

Are you a ‘hidden patient’?

Caring for someone with Alzheimer’s can be all-consuming. The stress of caregiving makes you more likely to become ill or depressed. This is especially true if you’re older or if you don’t get enough help. Even in situations when friends and family are able to help, many caregivers insist on doing everything themselves. Doctors often think of such caregivers as hidden patients.

Common signs of caregiver stress include:

* Depressed mood
* Frequent crying
* Decrease in energy
* Sleeping too little or too much
* Unintended weight gain or loss
* Increased irritability and anger

Taking care of yourself

If you’re like a lot of people, you probably take better care of your car than you do yourself. Eating healthy foods, getting enough sleep and staying in touch with friends are just routine maintenance for the average person.

When you’re stressed, you need to take even better care of yourself. Schedule times when you can take regular breaks. Maybe a friend can spend time with your loved one, reading a book aloud or watching a movie together, while you get out of the house. Or you might place your loved one in elder care two or three days a week.

Where can you find help?

The National Eldercare Locator can link you to local organizations that provide services to seniors. This site is especially useful for family members who may live some distance from the person with Alzheimer’s. All you need is a ZIP code to find the services for that region.

A service of the Administration on Aging, the Eldercare Locator can be accessed via the Internet or by phone. The toll-free number, (800) 677-1116, has operators available Monday through Friday, from 9 a.m. to 8 p.m. Eastern time.

Area Agency on Aging (AAA) offices can be found through the Eldercare Locator or in the phone book, under “Aging” or “Social Services.”

In addition to senior centers, subsidized housing and adult day care services, AAAs also offer a wealth of in-home services, including:

* Meals-On-Wheels
* Homemakers, who help with such tasks as grocery shopping and housekeeping
* Chore Services, which include minor home repairs and yardwork
* Personal Care Services, which assist with bathing and feeding
* Respite Care, to provide a short break for caregivers

The Alzheimer’s Association offers a wide variety of programs, educational materials and support services. Most communities have a regional chapter of the organization, which sponsors local support group meetings.

The Alzheimer’s Association also provides:

* A 24-hour, toll-free Contact Center (800) 272-3900 that links callers to information about the disease, treatments, care strategies and community programs.
* The nation’s largest Alzheimer’s library, containing more than 5,000 books, journals, audiocassettes, videotapes and CD-ROMs. After browsing the online catalog, you can arrange for interlibrary loans through your local library.
* The Safe Return program, which helps families locate loved ones who have wandered off. More than 100,000 individuals with Alzheimer’s have been registered in the program nationwide.

A heartbreaking journey

Watching a loved one travel through the stages of Alzheimer’s is heartbreaking. Caring for them during this time is one of the hardest jobs imaginable. It requires an abundance of physical and emotional energy. Accepting help and taking care of yourself are crucial to success.

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A particularly virulent strain of E.coli, called E. coli O157:H7, can cause severe, bloody diarrhea, kidney failure and even death. Most cases of E. coli O157:H7 have been traced to undercooked ground meat, but the bacteria can also contaminate raw fruits, particularly melons, and vegetables, such as lettuce, sprouts, tomatoes, spinach and green onions. Prepackaged vegetables and salad mixes may present a particular risk. Although it’s not always possible to prevent food poisoning, knowing how E. coli spreads and how to handle food safely can help you avoid getting sick.

Dissecting the bad bugs

Not all disease-causing E. coli bacteria are created equal. One strain, enterotoxigenic E.coli, is a leading cause of diarrhea in children in developing nations. It’s also responsible for most cases of traveler’s diarrhea and is an increasing source of food-borne infection in industrialized countries.

Enterotoxigenic E.coli bacteria spread in contaminated food — including raw fruits and vegetables, raw seafood, and unpasteurized dairy products — and in contaminated water. Signs and symptoms, which include watery diarrhea and abdominal cramping, usually last just a few days. The infection normally clears on its own without treatment, and most adults and children have no lasting ill effects.

But E. coli O157:H7 is different. It produces a toxin that damages the lining of the small intestine, leading to intense abdominal cramps and severe, bloody diarrhea. You may have 10 or more bowel movements a day, some consisting almost entirely of blood. The marked loss of fluids and electrolytes causes dehydration and fatigue.

Nevertheless, many people recover completely from the infection in five to 10 days. But others, especially older adults, children under the age of 5 and people with weakened immune systems, may develop a serious complication called hemolytic uremic syndrome. This syndrome damages the lining of the tiny blood vessels in the kidneys, sometimes leading to kidney failure.

Even with the best of care, including blood and platelet transfusions and kidney dialysis, a few children die every year of hemolytic uremic syndrome. Others may have lifelong kidney problems or require long-term dialysis. Still others develop further complications such as high blood pressure, seizures, blindness and paralysis.

How E. coli spreads

You develop an E. coli infection when you accidentally ingest the bacteria. These are the most common sources of infection:

* Contaminated food. E. coli bacteria exist naturally in the intestine of many animals, including cattle. Meat can become contaminated with fecal matter containing the bacteria when cattle are slaughtered or processed. The problem is particularly serious in modern feedlots, where animals spend their lives in crowded, filthy conditions. Although beef in general may be contaminated, ground meat is a special concern because grinding combines meat from different animals and transfers bacteria from the meat’s surface to its interior. The bacteria also can spread from one surface to another, which means that bacteria on a cow’s udder or on equipment can end up in milk. Pasteurization kills the bacteria, but raw milk can be a source of infection. Other foods that may become contaminated with the bacteria include dry cured sausage, salami, alfalfa sprouts, lettuce, and unpasteurized apple juice and apple cider.
* Contaminated water. Runoff from feedlots can contaminate ground and surface water, including water used to irrigate crops. Drinking or inadvertently swallowing untreated water from lakes and streams can cause infection. So can eating unwashed raw fruits and vegetables. And although public water systems use chlorine, ultraviolet light or ozone to kill E. coli, some outbreaks have been linked to contaminated municipal water supplies. Private wells are a greater cause for concern. If you have a private well, have it tested once a year for pathogens, including E. coli. Your state health department can help you find a laboratory certified to conduct the tests.
* Person-to-person contact. E. coli bacteria can easily travel from person to person, especially when infected adults and children don’t wash their hands properly. Family members of young children with the infection are especially likely to become sick themselves. Children can shed the bacteria in their stools for up to two weeks after symptoms improve.

Keeping E. coli at bay

It’s not always possible to avoid food poisoning, but common-sense precautions can go a long way toward preventing infection with E. coli O157:H7 bacteria.

* Cook all ground meat, hamburger or roast beef thoroughly. Meat, especially if grilled, is likely to brown before it’s completely cooked, so use a meat thermometer to ensure that meat is heated to at least 160 F at its thickest point. If you don’t have a thermometer, cook ground meat until no pink shows in the center.
* To prevent the growth of bacteria in your kitchen, thoroughly wash anything that comes in contact with raw meat, including your hands, counters and utensils. Use hot, soapy water, bleach or disinfecting wipes. Never put cooked hamburgers on the same plate you used for raw patties.
* Order beef cooked medium or well-done when eating out. Be persistent about getting what you ask for, even if it means sending your food back more than once.
* Drink pasteurized milk, juice and cider. Any boxed or bottled juice kept at room temperature is likely to be pasteurized, even if the label doesn’t say so.
* Wash raw produce thoroughly, using plenty of running water and a scrub brush or a vegetable wash. Children, older adults and people with weakened immune systems should avoid alfalfa sprouts.
* Avoid drinking untreated water from lakes and streams and swallowing water when swimming — even pool water, which can be contaminated with feces.
* Make sure that family members, including children, wash their hands after using the bathroom, changing diapers and before eating.

You’re sick: Now what?

Most E. coli infections — even those caused by E. coli O157:H7 — aren’t life-threatening. But the bacteria can cause serious and even fatal illness in some people. If you’re at high risk of hemolytic uremic syndrome, see your doctor at the first sign of profuse or bloody diarrhea. If you’re not at risk, seek medical advice if your symptoms are severe or persistent. You should have your stool checked for E. coli bacteria.

Most cases of traveler’s diarrhea clear up on their own in a few days, although doctors sometimes prescribe a short course of the antibiotic rifaximin (Xifaxan), which reduces the number of E. coli bacteria in the gut. When it comes to more severe infections such as O157:H7, however, no current treatments can cure the infection, relieve symptoms or prevent complications.

Anti-diarrheals can make O157:H7 worse by preventing your body from eliminating the toxins. And antibiotics increase the risk of hemolytic uremic poisoning. For most people with O157:H7 infection, rest and plenty of fluids to prevent dehydration are the best option.