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This week we respond to questions about prostate enlargement and stretching.

Dear HOUSE Calls,

How can you treat an enlarged prostate without drugs?

This is a common question. Many patients want to avoid ‘medicines’. Yet symptoms of an enlarged prostate (waking at night to urinate, weak stream, dribbling) can be a real nuisance.

Just because a product is a natural herb that is available without a prescription, it does not mean that it is completely safe or effective. There are two natural products that we know of that people use for enlarged prostate, saw palmetto and pygeum. There has been years of controversy about the effectiveness of saw palmetto, however, the bulk of evidence shows no treatment effect. We therefore don’t routinely recommend this to our patients. There is even less compelling data to support the use of pygeum.

There are also ‘behavior’ options. These include decreased evening fluids, decreased caffeine and alcohol, and so called “double-voiding” which means going to the bathroom twice to try to empty your bladder more fully. There are also surgeries to reduce the size of your prostate, but most people would proceed to that only if medicine was not working. We hope that helps.

Dear HOUSE Calls,

I’m a tennis player and I’ve been getting injured a lot. What is the best time to stretch, before or after?

This a very common question. The latest research says that it really does not matter.

There was a recent systematic review of 5 studies found that stretching did not reduce soreness or injuries. Another systematic review showed that warming up did not reduce injuries. We are not sure we believe this.

There may be a couple of things going on here. With behaviors like warming up, cooling off, and stretching, bodies just do what they do, and randomizing people can only minimize or maximize behaviors but not eliminate them. We think that in most sports people warm up whether or not they identify the warm up. The first few minutes of a run or a tennis match is always a little slower.

The other thing is that not all stretching is alike. The latest that we hear from coaches and personal trainers as well as some physical therapists is that stretching a ‘cold’ muscle with a fixed or static stretch means you need to hold a position or 45 seconds to 1 minute. Dynamic stretches (stretching while moving) can be done more efficiently on cold muscles.

Lastly, not all sports are alike. Jogging allows a slow warm up period, while tennis is full on impact with every move. So the study of joggers may not be suited to tennis players. We don’t know if any of this matters or when it is best. We like to stretch briefly before activity, warm up for a few minutes, and stretch when done. Good luck.

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