Anybody see any positive impact on your fitness after going on prostate medicines?
I’m over 50 and wake up 3-4x per night to pee. Obviously this impacts my sleep - and probably my recovery?
I have an enlarged prostate and it looks like I will have the option to take medication that will reduce its size and hopefully allow me to sleep through the night.
Just wondering if anyone has gone through this and noticed any changes in your fitness if any due to the better rest/recovery you are getting at night.
I keep hearing how important rest, sleep and recovery are, but my sleep is awful and i wonder if it makes it harder for me to make fitness gains.
THanks
First, and it sounds like you did this, always speak to a physician. A lot of Primary Care Physicians will address lower urinary tract symptoms, but sometimes seeing a Urologist is also important. An enlarged or obstructive prostate are a very common cause of developing lower urinary tract symptoms in men, but there can be other reasons too, so important to get this sorted out. It can also be helpful to check that your bladder is emptying completely after voiding. This can be done by an office ultrasound scanner. If you have a significant amount of urine left in the bladder after voiding, it suggests the problem may be worse and that the bladder may be starting to fail (can generate enough squeeze to get the urine out).
Typically alpha-blockers, such as Tamsulosin (Flomax) are first line for lower urinary tract symptoms secondary to the prostate. Side effects are typically mild and include nasal stuffiness, lightheadedness when standing up (sort of like getting out of a hot bath tube too quickly), and retrograde ejaculation (common at about 30% of users but not dangerous). All these side effects are reversible after stopping the medication. Tamsulosin relaxes the smooth muscle is the urinary tract but doesn’t shrink the prostate. This can help improve the urinary stream, help with bladder emptying, and help to settle the bladder down and hopefully reduce the nocturia (getting up at night). Tamsulosin tends to work fairly quickly, and a lot of men notice some benefit within a week of starting it. It also wears off quickly when you stop it.
5-alpha reductase inhibitors, such as Finasteride, can also be used. They block the conversion of testosterone to DHT. This can result in a reduction in the size and vascularity of the prostate. However it takes a long time to see any benefit after starting the drug, usually 3 - 6 months. It works best in men who have very large prostates and is often used in conjunction with an alpha-blocker like Tamsulosin. Even then, the benefits tend to be pretty modest. It does have some significant side effects in some men, including sexual side effects. There is some controversy, but some reports have shown long lasting sexual side effects even after stopping the drug.
One thing that is really important to note is that your prostate doesn’t have to be really big to cause problems. Because muscles, and muscle tone, are involved, there are men with very small prostates that can have very bad lower urinary tract symptoms, while other men walk around with huge prostates and have little to no symptoms.
Ultimately, getting the problem addressed and sleeping better is undoubtedly going to help you feel better, boost your overall health, and thereby also help with your training.
Thank you very much for the detailed response. I did see a GP (manual prostate check) and have had an ultrasound and my urologist appointment is in a couple weeks.
Your answer gives me some things to research and better understand and be more prepared before I see him.
Thanks again!
I’m 66 an when I got to the stage that getting up multiple times in the night was starting to affect my life I thought that was as the time to seek medication. I’m now on Tamsulosin and whilst I’m still up in the night it’s nowhere near the number of times that it was before. I’ve found that my recovery is very much improved. Sadly though even a small amount of alcohol in the evening seems to negate the effect of the drug so I’m now dry. Also on decaf after noon. I don’t seem to have had any adverse side effects either.
In my experience you’ll never be able to recover properly whilst this is the case. Sounds like you are at the point I was when I saw the doc.
Very top of mind topic. I just turned 60 and have struggled for the past two years because of an enlarged prostate. The good news is that I’m now on the mend and life is returning to normal.
I had all of the typical enlarged prostate symptoms (frequent urge to urinate, painful urination, pain if I waited too long, waking up many times a night to urinate). It affected my training in that I never felt fully rested and recovered, as well as needing to stop to urinate on even short-ish rides (<2 hours), sometimes multiple times. The kicker is when my body crashed from exhaustion – that happened about 3X over 2 years.
Medication: I did Tamsulosin as well as one other (don’t recall). For me (n=1), the meds worked for a while, but then progressively didn’t. Ended up on Tamsulosin 2X per day and was still getting up 5X per night.
Procedures: I had Rezum (steam shrinking of the prostate) done in Dec. '21. It helped for a while, but then things slowly started to get worse again. Went back on the meds, but ultimately ended up needing another procedure. I had TURP (trans urethral resection of the prostrate) performed in early October. Finally feeling more normal. I’m now 5 weeks after the treatment and all seems headed in the right direction. Flow is good, able to go longer without urinating, able to sleep and only get up 2X per night.
I was off the bike for 3 weeks. I was mostly sedentary during that time. I got back on the trainer 2 weeks ago. When I first sit down, I might feel some mild discomfort, but once I get the sit bones set, no issues with pain. Longest ride so far since the procedure is 90 minutes, with lots of 1 hour sessions. Progressively adding more time. Plan to get outside in a week or two, as the strength builds back up. Also using the rowing machine to add strength – no pain issues there, given how you sit.
I got lucky in that my urologist is a cyclist. We’ve had multiple conversations about whether cycling is a contributing factor for the prostate. His take was that as long as you have good bike fit and not too much pressure on the nether regions, it shouldn’t be a factor.
I was prescribed Tamsulosin. My symptoms were gone within a week, but I suffered with light headedness and my power dropped by over 10% overnight after I started taking it. I spoke to my doctor about the side effects I was experiencing and we agreed to reduce the dose to one tablet every 2 days, I still felt terrible so stopped taking it completely. Thankfully my original symptoms have not returned and my power came back to its previous level.
Thanks for sharing MrBirchling.
I haven’t yet had my urologist consultation, so I’ll wait to see the options and recommendations he presents.
My nighttime urges have been going on for many years already (might be getting a bit worse - but not massively).
I don’t typically feel ‘tired’ due to my sleep interruption, but I dont know if its just because I’m used to it and don’t have the context to compare with real rested sleep.
Interesting. I didn’t really notice any side effects from the Tamsulosin and I was doing 2X per day for an extended period of time. I may not have been able to separate the possible side effects from the overall implication of the lack of sleep, etc. YMMV.
I use tamsulosin 2x day. It helps increase the flow, but it wasn’t a miraculous change. I feel like the benefit reduces with time. That said, I do notice when I go off it. This is TMI, but when I started taking it, I had dry ejaculations. That went away with time. I also take Oxybutynin, which reduces urgency. I still get up at least twice a night though. I think that’s just part of getting old. I have not done it, but another possible solution is a procedure called Urolift that you might want to look into.
I echo much of what I have read here. What I have not read is how diet can effect prostate size. Foods rich in Choline, chicken, eggs, red meat all bad. Cheese and sweets bad for both prostate health and cardiac health. Their is more that can be explored on the diet subject but what I would really like to share with the group is this……
Their is a Herb called Kella, it taste terrible. However, after one week of use you will not be getting up as much at night. It was suggested to me by a nationally recognized Natropath. Suggested dose is a dropper full on the two OZ bottle size before bed time. Incidentally, it is also good for bronchitis. Hope this helps the group.
I’m 65 and had the same issues in my 50s and went the same medication route. [Pending urologist evaluation], medication such as Tamsulosin (been there, done that) is both a temporary solution (i.e. things generally get worse, not better) and just a bandaid to areal solution unless your condition is mild and you are comfortable living with the situation.
For me, having lived with the situation for several years and come to the conclusion that I need to get this problem fixed, “the real solution” was a TURP (Transurethral resection of the prostate), or as my PCP called it, “a rotor rooter job”. After recovery from the surgery, the nighttime problem was gone (although I do pee during the day more than most). Seems to me that it is a no-brainer as a first step to go see your PCP to get a referral to a great urologist.
Update from my last post. Five or so months after TURP, I started experiencing symptoms again. Urologist put me back on Tamsulosin. Two weeks ago, after another appointment, he added Solifenacin, for over active bladder. Notes say it can take 4 weeks to see results. Some indication that it’s helping but it’s early days.
It’s a little unusual to relapse so quickly after a TURP, especially if you had been doing well initially. If you haven’t already, you should probably have a cystoscopy done to ensure there is not any scar tissue or signs of a bladder neck contracture. Occasionally there can also be some residual tissue that was missed during the first procedure. If you are having “obstructive” symptoms such as a weak stream or difficulty emptying this would be especially important.
More commonly after a TURP men still have some urgency and frequency. This can take a while to settle because the bladder is used to working against the obstructing prostate and now suddenly the restriction is lifted. Best analogy is lifting weights. If you are lifting heavy and then suddenly someone removes the weight, your arms are going to go fly up.
Thanks for the follow up. The urologist is perplexed. While the current symptoms are similar, they are not the same as before. That’s why the addition of meds for overactive bladder. He thinks this may have been masked by the prostate issues or, as you suggest, maybe this is an issue of the pendulum swinging back.
Early days, but the new meds are helping the daytime symptoms. Now just need to get the night time peeing under control.
Like many others, I have Lower Urinary Tract (LUTS) issues caused BPH but it hasn’t interfered much with training and racing. I am on Tamsulosin 1x and tadafil 1x to keep it the symptoms in check. In the last 6 months the symptoms got worse and had both pressure and video tests. Urologist has me doing intermittent catheter twice a day (messy). Looks like one of the Minimally Invasive Surgery Treatments (MIST) is next.
For anyone who wants to read more recommend:
“Additionally, long-term use of pharmacotherapy for LUTS in patients with BPH at very high risk for disease progression has been shown to potentially mask progressive increases in post void residual (PVR) volume and lead to further deterioration of detrusor muscle function.”
A PVR is very easy to get with an ultrasonic bladder scanner in the office. “Normal” is less than 50mL. It’s important to track this metric over time (as cyclists we all love metrics…). If it is trending up over months or years, that is a concern the bladder is failing, even if your symptoms are stable. For example if it goes from 50mL to 100mL to 150mL etc over multiple visits, that is a concern.
From a treatment perspective, HoLEP (holmium laser enucleation of the prostate) is one of the best options in terms of outcomes and need for any future therapy. However it is a procedure that has a steep learning curve for the surgeon and I would only consider having it done by a very experienced surgeon who does a lot of these procedures. There were only a few centers years ago that did a lot of these, but slowly there are more. Mayo Clinic Arizona, Vanderbilt, Northwestern, Ohio State U., and Methodist in Indiana are a number of the very busy places for HoLEP, but there are others.
When I had my kidney stone last month, I was prescribed Tamsulosin in an effort for me to pass the stone. At 58, it was wonderful to have a strong stream again .
That said, I had awful side effects from it…extreme nausea that basically had me in bed for a week. I finally figured it out when I skipped my dose one day ebcause I was going to be in a car for an extended drive and I didn’t want to stop every 20 minutes. By the end of the drive, my nausea was gone and I felt great.
I’m in my mid-60s, and had been on tamsulosin for some years with decreasing effectiveness. I was having to get up 3-4 times a night. I eventually had HoLEP back in April and it has been a life-changing experience. I sleep through each night and I can go on long bike rides without frequent stops. I was back doing gentle trainer rides after 10 days, racing after 14 days, and then a cycle tour after 5 weeks. I’m in the UK, and fortunately live near a hospital with HoLEP expertise. I didn’t stay overnight in the hospital, but had to go back the following day for catheter removal (which was quick but possibly the worst part of the experience!).
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