Common Male Health Issues

Please click on a health issue below to expand.

Abdominal Aortic Aneurysm

The aorta is the largest artery in the body arising directly from the heart and delivers blood to every part as it courses through the chest and abdomen before dividing to deliver blood to the legs.

After age 60 the wall of the abdominal aorta may weaken and bulge out as an "aneurysm" and eventually burst, suddenly killing about 6,000 men each year in England and Wales.

The enlargement process is silent but easily detectable by a simple, cheap ultrasound scan. Dangerous aneurysms can be repaired successfully with far less risk, before they burst.

It is estimated that about 80,000 men in England have an aneurysm and the NHS AAA Screening Programme operated by Public Health England invites all men as they turn 65 to have a scan; men over 65 not previously scanned may self refer by contacting their local screening centre.

For local advice in N.E.Essex contact CHAPS.

Cancer

Cancers are caused by uncontrolled growth of cells, usually forming solid lumps and then potentially spreading by direct invasion of adjacent organs or to distant sites in the body via the blood or lymphatic circulation. Once such spread has occurred, cure is often impossible.

Cells become cancerous when their controlling genes in the cell nucleus change (mutate) by chance, because they have been born with a genetic mutation, as may occur in prostate cancer, or due to exposure to cancer causing agents (carcinogens) such as smoking, asbestos or radiation.

Men are 14% more likely to get cancer than women and 37% more likely to die from it. This is probably due to a higher risk of exposure to carcinogens, lack of awareness of risks and late presentation when symptoms or signs develop.

It is beyond the capacity of this website to deal with all except the commonest male cancers but men should be aware of the presentation of most cancers; these symptoms and signs always need checking:

  • Any new skin lump or mole, especially if pigmented or changing colour (skin)
  • Any persistent lip tongue or mouth ulcer, especially if bleeding (mouth)
  • Hoarseness, difficulty swallowing, a lump in the neck (oesophagus)
  • Persistent cough, especially if coughing up blood (throat, lung)
  • Unexplained weight loss and indigestion (stomach, pancreas)
  • Vomiting or passing blood in the motions (stomach, bowel)
  • Any abdominal lumps (liver, pancreas, bowel)
  • Lumps in the armpits or groins (any advanced cancer)
  • A poor urinary flow or increased urination, passing blood in the urine or in the semen (kidney, bladder or prostate)
  • Any lump or sore on the penis that doesn't heal within a few weeks or blood coming from under the foreskin (penis)
  • Any new testicular lump, change in size of a testis or persistent pain or aching in a testis (testis)

There is now a national screening programme for bowel cancer using faecal occult blood testing to detect microscopic traces of blood in the stools using a kit sent by post automatically commencing every 2 years from age 60-74 in England. The risk of dying from bowel cancer is reduced by a quarter in screened men.

There are no other national screening programmes for men but many specialists believe, controversially, that there should be a prostate cancer screening programme as the advantages of screening now appear to outweigh the disadvantages (see Prostate Cancer - page 21)

Many of the perceived disadvantages of screening have now been overcome but this is not fully reflected in much of the current information or professional advice.

Depression

We all get depressed sometimes, but when it seems never-ending and is impacting on your ability to carry on your everyday life, it is time to seek help.

Depression affecting men is usually of two types. A reaction to external events, such as bereavement, is "reactive" or "exogenous" depression. But if the depression comes from within for no apparent reason and seems out of all proportion to everyday events, it is termed clinical depression and can be life-threatening.

Seasonal Affective Disorder (SAD) is common and related to short daylight hours in the winter. It usually gets better as summer approaches but if severe, seek medical help. Bipolar Disorder (Manic Depression) causes major mood swings between severe depression and periods of manic, excited overactivity. Professional help is urgently required for both of these states.

Depression is treatable, so get help - don't suffer in silence.

Contact your GP or ring the Samaritans: 0845 790 9090

Diabetes

Diabetes is caused by insufficiency of the hormone insulin to keep the blood sugar level (BSL) normal. A raised BSL causes progressive damage to key organs and sometimes severe medical emergencies including death.

Type I diabetes is uncommon, cannot be avoided and tends to affect the young. Treatment is with insulin injections.

Type II diabetes is very common, comes on with age and is often associated with being overweight. It is treated by exercise, diet, weight control and, if necessary, drugs. It is best avoided by a healthy lifestyle.

If you develop undue thirst, very frequent urination, unexplained increased appetite, weight loss, weakness, impotence, blurred vision or other unexplained symptoms, check for diabetes. This is done most easily by measuring the BSL in a fasting finger prick sample of blood in your local surgery but many pharmacies also offer the test.

NHS page on diabetes

Heart Problems

Angina, Heart Attack and Heart Failure - The heart is basically a specialised muscle that contracts ("systole") and relaxes ("diastole") automatically and regularly at a basic rate known as the "resting pulse rate".

It receives blood from the veins of the body and pumps oxygenated blood from the lungs through arteries to every organ in the body. The basic heart rate ("pulse") will increase automatically in response to increased demand such as exercise.

The heart's own blood supply is through two main coronary arteries, 3-4 mm in diameter. If disease - "arteriosclerosis" - narrows these arteries, starving the heart of oxygen, a "vice-like" chest pain called "angina" occurs.

Angina disappears with rest but if the pain is sudden, severe, does not go and is accompanied by breathlessness, dizziness, nausea and a clammy, pale skin, a heart attack ("myocardial infarction" - MI) due to blockage of an artery may have occurred. Heart attack is the biggest single killer of men and if suspected, emergency treatment (999) is required. If survived, the heart may be permanently damaged and unable to cope with everyday tasks - "heart failure".

The best way to avoid problems that lead to blockage of the coronary arteries is to lead a healthy lifestyle and cut out the risk factors by:

  • Stopping smoking
  • Reducing weight or preventing weight gain by dieting and eating a low cholesterol diet with plenty of fruit and vegetables
  • Exercising
  • Avoiding Type II diabetes through the above measures, or treating it if it already exists
  • Keeping a normal blood pressure
  • If you have a family history of premature heart disease, high cholesterol levels, high blood pressure or diabetes get regular check-ups to ensure problems are not already developing

Remember, a healthy lifestyle should start during childhood so make sure your children lead one! NHS page on heart disease

Impotence

Impotence or "erectile dysfunction" (ED) as it is now often termed, means failure to gain or maintain an erection for satisfactory intercourse. It is extremely common and affects most men at some stage of their lives but its incidence increases with age.

Most cases result from any one of the following problems occurring either singly or in any combination: psychological or damage to the arteries or nerves supplying the penis.

The arteries to the penis are only 1-2mm in diameter and may be the first to be affected by arteriosclerosis. Indeed 20% of impotent men who have had no heart problems actually have underlying coronary artery disease.

The onset of impotence may therefore foretell serious heart problems just around the corner and many men having a first heart attack admit to impotence for the preceding 2-3 years. Consequently any man developing ED should ask for a heart check.

Other problems frequently causing or worsening ED are diabetes (nerve damage), smoking (arterial constriction), multiple sclerosis (nerve damage), depression, stress and excess alcohol.

Once again, avoidance of obesity, diabetes, stress, excess alcohol and smoking are lifestyle changes most likely to enhance sexual performance, so all the usual advice on diet, exercise etc applies.

Fortunately ED is usually treated successfully. Don't be embarrassed and don't waste time and money on quack remedies or buying drugs off the internet - a high proportion are contaminated or fake.

Get checked out and pick from a menu of treatment options the one that most suits you and your partner's lifestyle.

Sympathetic, confidential expert medical advice is easily available, so don't delay!

NHS page on erectile dysfunction

Prostate - Benign

Prostate problems arise in two main forms: benign enlargement (BPH) which affects 50% of men over 65 and Cancer (CaP) which is now the commonest male cancer in the UK and kills over 10,000 men each year.

The gland lies immediately below the bladder encircling the tube (urethra) that carries urine into the penis. It produces fluid (semen) that helps sperm swim and fertilize a female egg. A Digital Rectal Examination (DRE) helps detect problems.

Benign Prostatic Hyperplasia

Normally the size of a walnut, the prostate grows during middle age for unknown reasons and this may block the urethra causing delay, a poor or interrupted stream and dribbling afterwards. It also upsets bladder control leading to increased frequency of voiding by day or at night ("nocturia"), an urgent desire to void or even wetting on the way to the loo ("urge incontinence"). Bed wetting in middle or old age is a serious symptom that demands an urgent medical consultation.

In many men BPH progresses and can cause serious complications such as complete inability to pass urine necessitating emergency treatment. As we don't know what causes BPH, we can't easily prevent it, but there is evidence to show that a diet and lifestyle that are good for the heart are good for the prostate too.

Nowadays a range of drugs can effectively relieve most men's symptoms, may prevent BPH progression and has greatly reduced the need for surgery.

All good reasons for an early check-up.

Prostate - Cancer

Prostate Cancer (CaP)

This is now the commonest male cancer causing 40,000 new cases and over 10,000 deaths each year in the UK or about one death every hour.

Early cancer confined within the prostate ("localised CaP") is usually curable but once it has spread outside the prostate ("advanced CaP") it is often fatal, though it may be possible to suppress it for some years.

We don't know what causes CaP and it may be getting commoner. It is prevalent in North America and Europe, commoner in blacks than whites and rarer in oriental races. About 10% of cases have a genetic family link. We believe smoking, a western diet and obesity predispose to CaP so a heart healthy lifestyle and diet may afford some protection.

CaP may cause the same symptoms as BPH, blood in the urine or blood in the semen, but early, curable CaP is usually silent and can only be detected by screening.

Screening is performed by conducting a DRE and a blood test for Prostate Specific Antigen (PAS). PSA testing does have drawbacks, often being raised when no cancer exists (though usually indicating other problems such as BHP) and occasionally being normal when significant cancers already exist. Overall its is about 80% accurate and the latest research suggests that performing it once in a mans 40s, 50s and 60s could cut the risk of death by half.

Following a suspicion of CaP after PSA testing, further more sophisticated markers (PCA3, hK2) may be used to assess risk or non-invasive MRI imaging used to locate a possible cancer before invasive tissue sampling - "biopsy" - is undertaken.

Recent large population studies in Europe have shown a 20-25% benefit in saving lives in favour of screening. Many men first develop CaP in their 50s and 60s and these are most at risk of premature death. If you are considering screening, we recommend you seek expert advice from a urologist or a dedicated specialist prostate clinic or screening clinic, especially if you have a family history.

It could save your life.

North East Essex Urology Cancer Support Group: 01206 742964

Stroke

A “stroke” ( Cerebro-Vascular Accident – CVA) is caused by an interruption of the blood supply to part of the brain.

There are 2 main types:

  • “Ischaemic”: the commonest type, due to an artery blocking up.
  • “Haemorrhagic”: due to an artery leaking.

Both types deprive an area of brain of blood causing death of brain tissue. Emergency treatment is therefore required so, if suspected, call 999 and request an ambulance.

A third type of problem is called a Transient Ischaemic Attack(TIA) or “mini-stroke”, caused by a temporary blockage, often causing a brief loss of consciousness or disorientation before spontaneously correcting itself. Nevertheless its causes require full investigation.

Strokes occur in about 150,000 people in the UK each year and overall are commoner in men, especially Afro-Caribbean and Asian men. It is the third commonest cause of death. Strokes usually occur suddenly, causing numbness and weakness in one side of the body, facial drooping, sight and speech disturbances.

Headache and loss of consciousness are common. The long term effects of a stroke depend on the area of brain damaged and, as dead brain tissue cannot regenerate, the effects may be permanent.

Weakness, numbness, facial drooping, speech and vision loss and co-ordination of limbs may not recover. Memory may be impaired and tiredness is common.

Ischaemic strokes are caused by arteries blocking due to arterio-sclerosis – “hardening of the arteries” – which can occur in any part of the body and is typically associated with smoking, high blood pressure, high cholesterol levels, obesity and diabetes.

Another common sudden cause is for a blood clot, usually coming from the heart, to impact and block a smaller calibre brain artery. An irregular heartbeat (atrial fibrillation) is the usual cause and requires treatment.

Haemorrhagic strokes occur typically in older men with high blood pressure or less commonly in younger men due to the bursting of a “berry aneurysm”, a congenital weakness of the artery, and sometimes fatal.

Because recovery from stroke is so often only poor or partial, prevention is vital. Control of blood pressure is key as well as control of cholesterol and glucose levels and exclusion of heart and carotid artery disease. A healthy lifestyle with no smoking, limited alcohol intake, plenty of fruit and veg and regular exercise are similarly essential.

For further information, contact the Stroke Association or NHS Choices.

Testicular Cancer

Testicular cancer is uncommon but it affects young men, roughly from 15 to 50. Fortunately its treatment represents one of the great cancer success stories of the last 25 years and only about 1% of sufferers now die. Nevertheless early detection simplifies treatment.

It may be getting commoner for reasons unclear, but it is definitely related to late or failed descent of the testis from the abdominal cavity, where the risk is high. The risk can be reduced by operating early on children with undescended testes to place the testis in the scrotum before the age of 4.

The key to diagnosis and cure is regular self examination. Most cancers develop as a painless lump, so any lump should be checked out.

Other features to get advice on are:

  • Pain, tenderness, heaviness or a dragging sensation in the scrotum or groin
  • A painless swelling of the scrotum
  • One testis becoming larger than the other

Although the vast majority of scrotal and testicular problems are not due to cancer, the message is...

"If in doubt, check it out!"

Weight and Obesity

Being overweight or obese is now reaching epidemic proportions in young and old alike. The more overweight a man, the greater the health risk.

There are three easy ways to assess your weight:

Body Mass Index (BMI): derived from the formula of dividing your weight by the square of your height:

Imperial: wt (Ibs) ÷ height in (inches)2 x 700

Metric: wt (kg) ÷ height in (metres)2

Simple calculators are available on the internet under BMI. BMI's below 18.5 are underweight, 18.5 to 25 is normal, 25 to 30 is overweight and over 30 is obese.

Waist Measurement: because men tend to put on weight by increasing fat within and around the belly, this is a useful simple measure of body fat. Simply measure your girth halfway between the lowest rib and top of your hip bone whilst standing up and after breathing out:

37-40 inches (94-102cm) = overweight; above 40 inches = obese.

If you look down and can't see your "willy", you are almost certainly overweight!

Waist-Hip Ratio: measure your waist as above then measure around your hips at their widest part and divide waist by hip measurements. The healthy ratio should be below 0.95.

Obesity is associated with higher risks of heart disease, high blood pressure, diabetes, arthritis and many other problems leading ultimately to a shorter lifespan. After smoking, obesity is now estimated to be the commonest factor promoting the development of cancer.

Lose weight and you'll feel great!

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