Hi everyone,

I am having the worst time of my life.  I just had a TURP (transurethral
resection of the prostate), and now I am worse than ever (the urologist says
to wait).  Before the surgery, I had a little bit of BPH, and a lot of
prostatitis, plus a restriction from bladder neck surgery in 1995, and was
having trouble urinating, along with a lot of pain and discomfort.

Anyway along with the constant pain/pressure and feeling I have to urinate
all the time I also have rectal itching which may be from my internal
hemorrhoids (although the theory is internal hemorrhoids do not cause
discomfort since you only feel pressure in the rectum, because there are no
pain sensors above the dentate line - I don't buy that 100%- I have had many
instances in my life of rectal pain and itching as well as pressure).  Doc
says rectal itching probably not from surgery, although I also have itching
in the urethral/prostate areas which is right next store.

I bought some prep H cream today, and it has the standard warning not to use
it if you have difficulty urinating due to an enlarged prostate.  I assume
this is because the phenylephrine HCL in it is a vasoconstrictor, which is
the opposite of alpha blockers that are used to relax smooth muscle in the
prostate, and are vasodilators (since they also relax the smooth muscle in
blood vessel walls and can be used to treat hypertension).  Alpha blockers
are used treat BPH, by modifying the muscle tone which supposedly results in
less pressure on the urethra.  I can not take alpha blockers since they plug
my nose up immediately and completely.

I have a couple questions.  It is believed that alpha blockers relax the
smooth muscle in the prostate and bladder neck (I'm not talking about the
smooth muscles in the blood vessel walls that are in the prostate and
bladder neck, but they will be relaxed also and result in vasodilatation).
There seems to be a juxtaposition here.  If relaxing the smooth muscle in
the prostate and bladder neck (that is non blood vessel muscle) results in
less pressure on the urethra and increased urine flow, then why doesn't the
relaxing of the blood vessel wall muscles in the prostate and bladder neck
result in a counter effect, and swell up the prostate as a result of the
vasodilatation (like it swells up my nose and closes my nasal passages, and
I can't breathe).  This may be a little technical, and my analogy to the
nose may not be totally appropriate, but I think it is a legitimate
question.

My second question relates to the risk of applying a topical application of
prep H cream (with phenylephrine HCL, a vasoconstrictor) in the rectum, and
I guess causing the prostate to enlarge more (I don't know how -
vasoconstrictors are used as decongestants to open the nasal airways up).
Since the prep H is topical and not systemic (except for small amounts that
diffuse into the blood stream), I don't consider that using it will make my
prostate condition any worse, and therefore why the warning on the box about
enlarged prostate.  I can understand if you were taking alpha blockers for
BPH you wouldn't want to take phenylephrine HCL since one is vasodilator and
one is vasoconstrictor.

I believe it would be safe to take the prep H cream since I do not take
alpha blockers, and it is topical and not systemic, and I do not see how it
will enlarge my prostate.  Do you agree.

Thanks for your time in reading this, and I look forward to your feedback.

Pete