← Rena Malik, MD Podcast
Rena Malik, MD Podcast
Gas Station ED Pills? The Dangerous Truth No One Tells You
00:17:26
In this episode, Dr. Rena Malik, MD answers listener questions on nighttime urination, the safety of gas station erectile pills, and menopause-related mood changes. She offers practical tips and medical insights to help listeners manage these health issues and improve their overall well-being.
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A
are you noticing that you're waking up more at night to pee? Have you ever been curious about those pills at the gas station? And has your wife's mood changed quite a bit lately? Well, today on our Ask Me Anything episode, we're going to answer all those questions. Now, if you want to see the rest of the AMA where we talk about a whole host of other things, you can join our premium membership at rename supercast. Com. As a premium member, you get early access to all our podcast episodes that are ad free. You get access to our full Ask Me Anything episodes and of course you get to support all the work that we're doing here. So let's get right into it.
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C
I think I'm starting to have signs, signs of prostate enlargement. I go to the bathroom a lot in the middle of the night. Even when I stop drinking too much water after 6pm, I still wake up to pee at minimum two times a night, sometimes more. How can I fix this?
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A
So let's start off with what is normal, because I think before we can get into what's abnormal, people need to understand what is normal. So after about mid age, so around your 50s, everyone wakes up once at night. And there's a reason for this. As you age, your body starts sending more signals from the heart through this molecule called ANP that tells your body to actually make more urine at night. So in fact you make about a third of your urine output at night. And so it becomes, you know, very difficult for most people to hold that much urine at night. And so everyone usually wakes up once and that's considered normal. Now, if you're waking up more than once, that's where we say, hey, this is abnormal. Now, could it be your prostate? I. A lot of the times it is. Having an enlarged prostate is so, so common and we see it in upwards of 50% of guys who are above 50. And if you look at your 70 year olds, you're going to get about 80% of guys with prostate enlargement. And so what happens then is when you have an enlarged prostate, oftentimes it becomes very difficult to empty your bladder completely. For a lot of guys, they might notice that they're straining to pee, the pee is starting and stopping, or they're waiting for their stream to start and they feel like they're not completely done. And so when you go to bed, if you're not completely empty, then your bladder fill up more quickly and you have to urinate more often. Now, the other thing that can happen is that because of your prostate being enlarged, your bladder can still squeeze urine through pretty well. But the bladder becomes overactive because it has to work really hard to get that urine out. So you might empty your bladder just fine, but you find that you've got this urge to go, got to go, got to go. You're going very often and then you're also waking up a lot at night. And this is because the bladder has changed and become more overactive. Now, overactive bladder can be due to a number of different things, but it can also be very commonly due to enlarged prostate. So let me tell you what you can do just to start at home. And then if these things aren't working or you want to consider more options like medications, then it would be a great option to talk to your primary care doctor or see a urologist to kind of figure out what the next best step is for you in terms of things that you can do yourself. One is stop drinking about two hours before bed. If you take pills at night, just take them with a sip of water or even ask your doctor if you can take them a little bit earlier in the day. So try to minimize your fluid at night, which means that you have to stay hydrated during the day. A lot of people who are working especially, they forget to drink a lot during the day. So when they come home in the evening after a full day's work, they're very thirsty. Instead of drinking a lot, you also need to think about what you're drinking. So there's certain things that can irritate the bladder and even things you're eating. That means caffeine particularly, and alcohol. Both those things can really irritate the bladder lining and make you feel the urge to go more often, especially if you've had them in the evening and they'll wake you up at night. Other things that you know may affect some people, but not all are spice, spicy foods, artificial sweeteners, citrusy fruits and juices, tomato based products, and for some people, even artificial sweeteners. So what I tell people is don't just like stop all of these things because literally there will be no joy left in life. But you can stop one or two things at a time and see if it makes a difference. And if it doesn't, put it back in your diet. For me, I love my coffee in the morning, but I certainly stop at noon because I don't want it to affect my nighttime. And so you got to figure out what works for you. Now, if you're constipated, that's another one that a lot of people forget. If you're constipated and you can't empty your bowel, that stool will sit in the rectum and push against the bladder, making it more overactive, making you wake up more at night, making you have more urge to pee and sometimes even have accidents. So make sure you treat your constipation. There's so many different ways to do it. I have all my patients take fiber supplements because very few people are getting enough fiber. That helps a lot of people with their bowels. But also there's a whole host of options you can talk to your primary care doctor about, or if you have really bad constipation, see a gastroenterologist because they have so many tools in their toolbox that can help. And we've had a number of gastroenterologists on this podcast. Dr. Kum Kum Patel, Dr. Will Bulshowitz, and we have one coming out, Dr. Trisha Pasrija coming out in the next month. So you'll have plenty of options to sort of learn about your bowels and how to make them healthy. Now, other things are how much you drink. So we often think when you're having trouble with urination that people tend to limit how much fluid they're taking. Now if you're not drinking enough, your urine becomes that, you know, that dark yellow color. And what that is is that dark, concentrated urine actually serves as a bladder irritant, so it irritates the bladder lining, so you have to pee more. Now if you drink too much, like you've got a big 40 ounce bottle that you carry around with you, then also you're going to urinate more frequently and probably you're going to wake up more at night, you want your urine to be lemonade yellow. Now, if you're not feeling thirsty and your urine is lemonade yellow, then you're doing a great job. And you don't need to worry about getting enough fluid because you also get fluid from your fruit, from your vegetables, from everything you eat as well. Trying to get eight glasses of water is sort of reductive. So in terms of that, make sure urine is light yellow, not too concentrated, not too full. And then if you're overweight, losing weight has been shown to help with ur. Urinary symptoms as well. And if you smoke, the last thing is if you smoke. Smoking is a bladder irritant. It is also a risk factor for bladder cancer and of course lung cancer, a number of other things, esophageal cancer. So definitely talk to your doctor about quitting smoking. It is very, very difficult. But there are many options that we have now to help people get through it. You just have to make up your mind that you want to quit and then your doctor can help you.
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A
Now, in terms of other options, there are medications that we can try to help you relax your prostate or relax your bladder, depending on which sort of issue we think is going on. And I've talked about those many times on this channel and on this podcast. But there's things like tamsulosin and alfuzosin, which help relax the prostate. They're called alpha blockers. There's also medications like finasteride or dutasteride, which prevent the conversion of testosterone to dht, which helps shrink the prostate over. Now, these are not my favorite medications because they do have sexual side effects, but certainly if you are struggling with your urination and you want to try these medications, it's certainly an option. And then tadalafil daily, which is medication that you may have heard about from me, for erections, or Cialis, taking a low dose of this every single day can actually help your prostate and help you pee better. So those are the options for the prostate. And then we have a whole host of medications for overactive bladder. And these either help prevent the bladder from squeezing or relax the bladder a bit more. Now, I tend to prefer the medications that help the bladder relax because they have less side effects, whereas some of the older medications do have side effects, like dry mouth, dry eyes, constipation. So talk to your doctor. Figure out what works for you. But we have lots of options. And if you don't want to take medications, there's also many, many procedures and surgeries available. Some are very minimally invasive. In fact, we even had an expert from interventional radiology on the podcast to talk about prostate artery embolization. And so there's so many options available to you. I made a full podcast episode reviewing, like, the 10 different surgeries you can get for your prostate. So that's a great resource, if you're thinking about surgery, to go back and listen to that one or watch that one again. And particularly if you're listening, if you watch the video, there's actually clips from surgery, so you can see what's happening in those surgeries. So, yeah, there's so many options available to you, but you have a lot of things that you can do at home that might make a huge difference. And I'll tell you, I see it all the time. My patients make these changes. They fix their constipation and they're so much better without ever having to take a medication or do any sort of procedure.
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C
These gas station pills, you know the ones I'm talking about, are they anywhere close to something like Calis or Viagra?
- [10:24]
A
Yeah. So these gas station pills are pretty unsafe. A lot of them do have really high doses of PDE5 inhibitor medications like you mentioned, Cialis or Viagra, and they're not pulled off the market right away. They actually have to get reported. And then the FDA recalls them because they don't go through the same pathways as like, regular pharmaceuticals. And so I generally say it's not really generally safe to take those medications. It's much better if you're struggling with erectile dysfunction or you want to get a stronger erection to talk to your doctor. And the reason is that we have these wonderful medications like Tadalafil and Sildenafil, which are the generic names for Viagrance Cialis, that are very affordable. Like, you can get them for cents. And so they're really, really cheap, and they can help you get better, stronger erections. But also the more important thing is that when you're having trouble with erections, this can be a sign. It can be a. That you might be developing heart disease, you might be developing high blood pressure, you might be developing high cholesterol. So take it as an opportunity to say, hey, I'm having these issues. I'm really worried about my overall health, and I want to improve those. And the reason being is that if you want to sustain strong erections for your lifetime, then you need to sort of treat these underlying issues. Otherwise the erections are just going to get worse over time. And I see guys time and time again who've dealt with it for decades, and they come to me like, no one explained to me that if I fixed my blood sugar or if I'd manage my blood pressure or if I manage my cholesterol, that I would have been able to have strong erections well into my old age. And if they had told me that, I would have done it. And I've seen it again and again where guys, they're at the point where they need to have surgery for their erectile dysfunction, and they do miracles to get their blood sugar under control so they can have the surgery. And that's how much erections mean. And so I understand that completely, but I want you to do it long before you have to make more difficult decisions. You know, Also, I'll tell you guys, I have a book coming out September 1st called the Hard Truth, which really goes into Detail about how your body and your sexual health are really intertwined with your overall health and your longevity and how you can basically look at your life and build the pillars of your sexual health so that at the base of it all, you have this really strong foundation to maintain strong sexual health well into your old age. So check it out. The Hard Truth. It will be available for pre order very soon and I would deeply appreciate it if you considered pre ordering the book. I know it's not coming out till September, but it tells people that, it tells publishers and book buyers that, hey, this is a book that people want and it tells them that, hey, men need books like this. Appreciate you guys if you can consider doing that for me.
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C
Wife has been in a foul mood. I thought it was a midlife crisis because she's been having stress at work, but my co worker thinks she's going into menopause. She's 51, but I thought menopause was more so something that happened at 65 and older. What should she do?
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A
I'm so glad you're asking this question because 51 is actually the average age of menopause. And so what is menopause? First of all, I think, you know, there is some discussion more, more so now talking about menopause, but I think it's still very confusing. So menopause is just one point in time. It's after your partner has had 12 months without a period. So it's really just an arbitrary time point. But basically it means like, hey, you're no longer menstruating. All the estrogen in the body is basically almost zero and all the progesterone in the body is basically zero. How does this affect mood and health and over everything? So before that time point, anywhere from four to even up to seven years before that, women start going into perimenopause. And perimenopause is essentially a roller coaster where their estrogen progesterone are going up and down like a roller coaster. And so they will some days have really high estrogen. They'll feel great, they'll feel strong, they'll feel happy, and some days they'll have really low estrogen. They'll feel feel terrible and their mood will be down. They'll be sort of maybe more tearful, maybe more irritable, maybe more anxious because these hormones are so intertwined into your overall health. We have estrogen receptors in our brain, in our bones, in our hearts and in our genitals. So when women have low estrogen, they can absolutely have these really Significant consequences. Now, most people will talk about hot flashes. Now, hot flashes are essentially happening because these fluctuations in hormones are triggering the hypothalamus and the brain to change the set point where your body is trying to dissipate heat. And so it makes these hot flashes happen. And, in fact, men can have hot flashes, too, when their testosterone goes really, really low. I think the important thing here is to realize is that this can be a very chaotic time for women because they're just really going through these crazy fluctuations. Now, if you are a man who struggled with low testosterone, you can imagine what that feels like. It doesn't feel great. You have brain fog, you have maybe loss of sexual desire, maybe you feel less vigorous. It's more difficult to do physical activity. So the same things can apply basically, to women going through perimenopause and menopause. This is all to say that there are, you know, biological reasons that your partner may be showing you signs that something is off. And so it would be great if you said, hey, like, I'm worried about you. I love you. I want to make sure you're feeling okay. Do you want to see your doctor? Do you want to go together? Or you could even go on this podcast. I've made videos on podcast episodes on estrogen and how it affects your body, and I've talked to many menopause experts. Dr. Mary Claire Haver, Dr. Lauren Stryker, Dr. Kelly Casperson on the podcast. So you can check out those episodes and send them to her. Say, hey, I listened to this episode was so great, and I think you should listen to it, and it will give her a lot of information about why this is happening and what she can do about it, because there are certainly many things you can do. And, you know, even before trying hormone therapy, which I think is great for the people who want to try it and can be very, very transformative to help maintain symptoms. Getting good sleep, sleep, exercise, eating enough protein, eating enough fiber, all these things can be super helpful to sort of maintain a little bit of mental health. And sleep is really the biggest one. I think that oftentimes, because women are getting hot flashes, they're not sleeping well. And this can sort of spill into so many other negative health consequences. So, so important to sort of think about those things. How can we optimize sleep? How can we feel better? And so thank you for asking, because really, I think most people just, like, don't want to deal with it, and they, you know, they just, like, move on. And they're like, okay, like, she'll get over this when she gets over it. But I think ultimately, when you're there with your partner trying to help them through it, I think it can really be so meaningful to your partner. So thank you for asking. Okay, if you guys want to see the rest of that, ask me anything. Make sure to sign up@renamelic.supercast.com and as always, remember, take care of yourself because you're worth it.