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Elliot Ruff
Elliot Ruff,
Category: Urology
Satisfied Customers: 519
Experience:  GP at Whitstable Medical Practice
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Until about 18 months ago, I had a very good sex life with

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Until about 18 months ago, I had a very good sex life with my girlfriend. We got together 3 years ago and we were having sex almost every day. Then, my ability to have and retain an erection declined. Viagra helps a little (100mg) but not much. I have noticed other things that suggested to me that I might be having a prostate problem. When I urinate, it is often slow and does not finish as it used to. I often feel that I need to urinate again after urinating and a small trickle is the usual result. I have to get up once or twice in the night to urinate almost every night. I am not incontinent, yet. In the daytime, I estimate that I urninate 4 - 5 times a day. Another novelty is when I defecate. It is normal for me to empty my bladder just prior to defecating. Now, in addition, I find myself wanting to urinate (only a small quantity) a minute or two after defecating.
I took a PSA test about 5 weeks ago: result, normal.
My girlfriend is very attractive and I still find a lot of attraction when I see her but there seems to be little or no connexion between my brain and my penis.
I am 6.2 (1m 85) tall I weigh about 245 pounds (111 kilos). I am 71 years and 1 month. I am healthy (stent inserted November 2013). I work hard (desk work). I can walk more than 3 miles without discomfort. I do not smoke. I do not take recreational drugs. I drink about 3 glasses of wine per day.

Good evening, I am Dr Elliot, I am a GP Urologist so hope I can be of some help

It is reassuring that your PSA is normal, but your symptoms are suggestive of Benign Prostatic Hyperplasia, this would cause altered urination. Regarding passing urine after opening your bowels, if you have larger motions then this can add to the obstruction of the bladder due to the close proximity of the rectum to the prostate and bladder neck.

There are medications that would make a difference to this, equally there are surgical procedures available, used to be considered if medication does not work, but now there are procedures which people have as they do not want to take medication

You need your prostate examined. You will also need a kidney/ureter/bladder ultrasound and a flow study. This will probably require a referral to your local hospital. However medication can be started following an examination to see if there is a difference.

It would also be important to ensure you do not get constipated as this will aggravate your symptoms.

It may also be worth considering an alternative to Sildenafil and try something like Tadalafil. But this is quite expensive and I would suspect your GP would prescribe it if a local urologist advises on its use, or in the short term you could try an increased dose of the sildenafil

Customer: replied 12 days ago.
Great advice thank you

No problem at all, I hear these problems in my clinic quite a lot - very common

I would be very grateful if you would kindly rate my response, this is the only way I an credited for answering questions, thank you

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