Rubman on Resolving Difficulties with Urination and Other Pelvic & Abdominal Functions

Right up there with growing hair and playing basketball, urination can get more difficult for many men over 50. After first ruling out a serious diagnosis such as prostate cancer, conventional doctors often attribute this and other associated symptoms to an enlarged prostate (benign prostatic hyperplasia or BPH). Their solution typically involves prescription drugs or, in severe cases, surgery.

In his naturopathic practice in Southbury, Connecticut, Daily Health News contributing medical editor Andrew L. Rubman, ND, takes a different view. He believes that all issues involving pelvic-abdominal function, which includes not only urination but also defecation and sexuality, are related. He prescribes botanical medicines and other natural modalities to resolve difficulties by bringing the system back into balance.


A specialized nerve system located in the front of the sacrum or tailbone and ascending to the spinal cord and brain controls many functions in the pelvic-abdominal area, Dr. Rubman explains — this nerve distribution center is called the sacral plexus. The close relationship among these nerves, organs and processes means that multiple factors can influence urine flow, so male urinary tract symptoms can be affected by nervous system issues in the gastrointestinal tract, the bladder, urethra (the tube that carries urine from the bladder) and/or reproductive organs.

According to Dr. Rubman, the culprit behind many urinary problems is inflammation. This complex process, which scientists increasingly point to as the root cause of many disparate medical conditions, can result from poor nutrition. The connection to one another via the nervous system means that inflammatory events in one part of the pelvis can impact the function in another — for instance, irritable bowel syndrome (IBS) can be associated with urinary incontinence and vulnerability to urinary tract infections (UTIs).

When it strikes, inflammation disturbs the balance of microbial colonies that normally populate the genital-urinary and lower gastrointestinal tracts. These outlets are close together, so microbial disturbances easily migrate from one to another. Often the result is the emergence of a significant underlying infection, typically due to fungus such as Candida albicans.  Antibiotic use can spark or stoke this problem by indiscriminately suppressing, often killing, good bacteria along with the bad, which opens the door to fungal overgrowth. The resulting imbalance affects not only the community of beneficial organisms in the large intestine, but those in the urinary tract as well.

Conventional physicians typically prescribe drugs such as tamsulosin (Flomax), terazosin (Hytrin), alfuzosin (UroXatral) and doxazosin (Cardura) to improve urination in men whose problems stem from an enlarged prostate. These “alpha blockers” work by relaxing prostate and bladder muscles so urine can pass more easily. Yet Dr. Rubman warns that an enlarged prostate is often only part of the problem. These drugs may be helpful in the short term, but he points out that they fail to resolve the microbial disturbance and inflammation at root. Another issue: Alpha blockers potentially have significant, occasionally serious side effects, such as dizziness and low blood pressure.


For patients with difficulty or discomfort with urination, bowel movements or ejaculation, Dr. Rubman may prescribe the following, in addition to treating any underlying candidiasis problem…

  • Kegel exercises. Contrary to popular opinion, Kegel exercises are not just for women. To enhance pelvic muscle control and prevent dribbling, Dr. Rubman recommends incorporating daily Kegel exercises to strengthen the pubococcygeus muscles (PC) muscles, which help control urine and semen release.

How to perform Kegel exercises: Isolate PC muscles by purposely interrupting urine flow at your next bathroom visit. This helps you understand where and what these muscles are. Clench and then relax them five to 10 seconds… relax for one full deep breath… and repeat. A similar movement strengthens the area around the rectum, drawing the muscle back up toward the colon and releasing. You can do these exercises as you sit in your car or office — no one will be the wiser.

  • Proper regulation of blood glucose levels. Glucose and other sugars and polysaccharides can pass into the urinary tract, which can in turn lead to inflammation and infection.
  • An anti-inflammatory diet. Cut back on refined carbs (white bread, sugary desserts) that lead to glucose peaks and valleys… decrease your intake of grain glutens, dairy proteins, homogenized fats (which are most commonly found in homogenized dairy products), trans fats and fried foods… and eat protein and healthy fats at every meal to slow the rate at which glucose enters the bloodstream.
  • Cold-water fish such as salmon or tuna. Incorporate fish into your menu two to three times a week. These are rich in inflammation-fighting omega-3 fatty acids. If you don’t eat fish, your health care provider may prescribe a fish oil supplement.
  • Dietary supplements. In his practice, Dr. Rubman often prescribes saw palmetto for men with urinary problems and/or an enlarged prostate. Numerous studies show that saw palmetto improves symptoms such as nighttime urination, urinary flow and overall quality of life.

More beneficial supplements: Depending on his assessment of an individual’s nutritional deficiencies, Dr. Rubman may prescribe additional supplements such as selenium, germanium, anthocyanidin antioxidants, vitamin E and zinc. To bring microbial colonies back into balance, he prescribes probiotics such as Lactobacillus and Bifidobacterium. Caution: Once more, don’t take these on your own. Supplements should be used only with your ND’s prescription.

  • When you need to go, go! This holds true with both urination and bowel movements. If you fail to respond promptly, over time your body gradually loses its ability to generate and recognize critical biological urges, and problems will worsen.

By carefully customizing these treatments, Dr. Rubman said he often hears reports from his middle-aged patients that they’re feeling like teenagers again — at least when it comes to urination. Next month we will explore pelvic-abdominal health problems for women. There are obvious differences, both in structure and chemistry, but surprising similarities, too. Though you may feel very alone with problems like these, you aren’t — and though the solutions aren’t unisex, there are plenty, for both genders.