There are a number of common health issues that men can find embarrassing. These types of issues are likely to be suffered in silence or ignored by men. Occasionally they are brought up at the end of the consultation: ‘Any cure for piles, doc?’ More often though, men suffer in silence, sometimes with nasty consequences. At times as a doctor you are more likely to be confronted with these issues at a hurling match or even the supermarket.
This chapter discusses a number of common men’s health problems that men can find embarrassing, and also a number of conditions which, while not embarrassing, are certainly common in men.
Piles (Haemorrhoids)
Piles are small blood-filled swellings of the veins of the back passage area (lower rectum and anus). They are very common and affect up to 50 per cent of men at some stage. They may be present for years and cause no symptoms until bleeding occurs. They may be located at the beginning of the anal canal (internal piles) or at the anal opening (external piles). Piles are not dangerous.
What Causes Piles?
Anything that increases the pressure in the back passage area can cause piles. Constipation and straining at the toilet during bowel movements may cause piles by increasing the pressure in the anal or rectal veins. Other factors include cigarette smoking, a low-fibre diet, heavy lifting, prolonged sitting or standing, obesity, anal intercourse, and loss of muscle tone due to old age or rectal surgery. A family history of piles also plays an important role.
What Are the Symptoms of Piles?
Symptoms can vary depending on the severity or extent of the piles and can include the following:
Piles are usually not painful unless they get blocked over or ‘thrombosed’, in which case they can be very painful.
If I Think I Have Symptoms of Piles, What Should I Do?
If you think you have symptoms that could indicate piles the best thing to do is have yourself checked out by your GP. By taking a history and conducting an examination your GP will be able to determine the best course of action, including the necessity or otherwise of further investigations.
Rapid assessment is essential if you have bleeding and/or a change in bowel habit as these symptoms may indicate early colorectal cancer, which is a potentially curable condition if caught early.
What Is a Perianal Hematoma?
This is an external pile, where a small bump is found on the outside part of the anus. It often has no symptoms, but if a blood clot forms inside it, it can become extremely painful and bleed for a few days. Eventually it shrinks away, forming a small skin tag.
Treatment of Piles
Piles can often be treated by simple measures like a high-fibre diet and plenty of fluids. Laxative drugs may be prescribed to prevent constipation and soften the stools. There are various creams, ointments and suppositories available to help the symptoms of piles. Preparations containing a steroid can help with swelling or inflammation while preparations containing an anaesthetic can help with pain. These preparations should only be used when they are clinically indicated and for not longer than five to seven days at a stretch. Sometimes these topical anaesthetic creams can sensitise the skin around the anus and actually cause an itchy bottom.
More troublesome piles may require specialist referral to a surgeon. There are several treatment options, including banding. This is a procedure with a high success rate where a rubber band is placed at the bottom of the pile, cutting off its blood supply and causing the pile to ‘die’ and fall off after a few days. Other options include injecting the piles, causing them to shrivel, and in some cases the pile can be removed surgically under general anaesthetic.
How Can Piles Be Prevented?
Prevention is better than cure and this applies to piles also. Keeping the bowel motions regular and soft, thereby avoiding constipation and straining on the toilet, is the key. The following will help in this regard:
Itchy Bottom
Many men who suffer from the symptoms of an itchy bottom feel embarrassed and are reluctant to seek medical advice. Itchy bottom is a common problem for men. The condition is known medically as pruritus ani. The underlying causes are rarely serious and treatment is usually highly successful. Symptoms include an ongoing chronic feeling of itchiness around the back passage area. The sensation of itching is often worse after going to the toilet or just before sleep at bedtime. However it can occur at any time. It can be aggravated by stress, anxiety, heat, moisture or various allergies.
What Are the Causes?
Sometimes the cause of pruritus ani is never found. However, there are many recognised causes. These include the following:
It is important to remember that if you have symptoms such as bleeding, altered bowel habit – including persistent constipation or diarrhoea or a mixture of both – mucus discharge or lumps around the back passage then you need to see your doctor quickly. This will allow for any potential bowel cancer to be promptly diagnosed and treatment started.
What Should I Do If I Have Symptoms of Pruritus Ani?
The best thing to do is see your GP and have these symptoms evaluated medically, especially if the itch is troublesome or persistent and definitely if it is associated with any other worrying symptoms as described above.
The treatment will depend on the underlying cause. For example, piles or an anal fissure may need specific surgical treatment, thrush may respond very well to antifungal creams, threadworms to specific worm medication and so on. If there is evidence of inflammation, eczema or dermatitis around the anal area then a short course of a steroid cream may help.
There are also several specific self-help measures that can help stop itchy bottom:
Medical Options
Sometimes doctors will prescribe a steroid cream to be used topically for a few days to settle down any inflamed areas. These do not work on infected skin, which requires an antibiotic. Antihistamine medication taken at night-time may have some benefit in reducing the sensation of itch in the skin. In more persistent cases you may need to be referred to a skin specialist for specialised testing, including skin patch testing.
Bad Breath
Bad breath, known medically as halitosis (pronounced hal-it-oas-is), is common and embarrassing for many men. The best way to know if you have bad breath is to ask your partner or a close friend.
What Causes Bad Breath?
There are many varied causes of bad breath. Gum disease and poor oral hygiene are common causes of bad breath. Naturally it is important to brush your teeth regularly. However, even regular brushing of your teeth may not prevent gum disease. Symptoms of gum disease include bad breath and gums that bleed easily when brushing. Gum disease is usually painless but if the gums become acutely infected and swollen then the gums can become painful as well. Gum disease is caused by plaque, which is a sticky bacteria that forms on the teeth everyday and can lodge between the teeth in the area where the teeth meets the gums. This plaque eventually causes a foul stale odour. Regular flossing of your teeth has an important role to play in keeping plaque levels down.
Sinus problems or allergies often cause a post nasal drip, where mucus runs from the back of the nose down into the mouth. This can cause bacteria and bugs to accumulate on the back of the tongue, which can cause bad breath.
Foods commonly associated with bad breath include:
These foods are a common cause of bad breath for two reasons. Firstly, the odour from some foodstuffs can remain in the mouth. Secondly, some of these foods release gases as they are broken down in the stomach. This gas can come back up to the mouth and contribute to bad breath. Similarly, alcohol can also cause bad breath.
Any condition that causes drying of the mouth can lead to bad breath. This is often why we have bad breath first thing in the morning, which is almost universal because when we are sleeping we do not produce saliva, which helps keep the mouth clean. Smoking also causes bad breath by reducing the flow of saliva; this is known as ‘smokers’ breath’. Dry mouth can also be caused by other medical conditions such as heartburn and belching or by medication, particularly drugs that are used to treat depression and bladder disorders.
Not eating regular meals can cause bad breath. When we are hungry our bodies start to break down fat. Ketones – a by-product of fat breakdown – are exhaled in the breath and can cause bad breath.
How Do I Treat Bad Breath?
Obviously being aware of it and being aware of the potential causes listed above is the first step. The following steps will also help:
Using a mouthwash can also help disguise bad breath. Some mouthwashes contain antibacterial properties and they tend to be most effective if they are used at night before bedtime. However, some mouthwashes are acidic, which can potentially damage tooth enamel, and others can temporarily stain and darken teeth. While mouthwashes can be a very useful part of an integrated approach to the problem of bad breath, they are not a cure. It is much better to determine what the underlying causes are and treat those properly rather than just blindly using a mouthwash as a sticking plaster solution.
Finally, there is some evidence now that gum disease may be associated with heart disease. So looking after your oral health and teeth may not be good just for your breath, it may help your heart as well!
Jock Itch
Jock itch, sometimes known as sweat rash, is an itchy rash that occurs on the scrotum and groin area of men. It is caused by a fungus or yeast infection known as tinea cruris. Fungi such as tinea cruris tend to grow and thrive in warm moist areas. It is a common but under-reported condition, as men are often shy or embarrassed about presenting with these types of problems unless they become very bothersome.
What Are the Symptoms?
The symptom of jock itch is usually itching associated with a red rash. This rash often has a little bit of scaling around the edges, and occurs in the groin and scrotum areas. It is commonly seen in sports people because the associated body heat and sweating provides an ideal medium for fungus infections to grow and thrive. It is also common in men who are overweight or obese.
How Is It Treated?
This condition is usually effectively treated by applying an antifungal cream topically twice daily for a couple of weeks. In more severe cases antifungal medication can be taken orally. It is important to try to minimise scratching as this can lead to bacterial infection of the skin, which may need treatment with antibiotics. In this regard keeping the fingernails short and clean is essential. As a condition it is not contagious and it is fine to continue with all athletic activities. It is also helpful to wear cotton underwear and avoid tight-fitting trousers so that the area can breathe.
What Can I Do to Avoid Getting It?
Athlete’s Foot
This is a yeast or fungus infection that affects the feet. Again it is very common, particularly in feet that are warm and sweaty.
What Are the Symptoms?
Athlete’s foot often presents with foot odour. It can also cause itching, classically between the fourth and fifth toes, with the space between these toes being red and scaly. As the infection spreads it can cause itching and scaling on other areas of the foot. Anybody can get athlete’s foot but it is particularly common in people who play sport, who suffer from sweaty feet or who spend large amounts of time wearing plastic shoes or runners, which can cause the feet to get warm and sweaty.
Sometimes the infection can spread and involve the nails of the feet. This can result in discoloration of the nail, which can look yellowish, brownish or green, with the nail becoming thickened and sometimes more crumbly in appearance.
The diagnosis of a fungal nail infection can be confirmed by getting your doctor to send a nail clipping to the laboratory to have it analysed for the presence of fungus.
Treatment
Athlete’s foot usually responds quite well to the use of antifungal creams. The foot must also be allowed to ‘breathe’ as much as possible by avoiding wearing runners and tight shoes and by wearing flip flops in the evenings. Fungal nail infection, when confirmed, generally requires treatment with antifungal medication for at least three months.
Snoring and Sleep Apnoea
Snoring is basically caused by wind turbulence when you are breathing in through either your nose or mouth. It occurs when air flows past relaxed tissues in your throat, causing the tissues to vibrate as you breathe and creating hoarse or harsh sounds. As you doze off and progress from a lighter sleep to a deep sleep, the muscles in the roof of your mouth (soft palate), tongue and throat relax. The tissues in your throat can relax enough that they vibrate and may partially obstruct your airway. The narrower your airway, the more forceful the airflow becomes. Tissue vibration increases and your snoring grows louder. Snoring may be an occasional problem or it may be habitual. Snoring is common, especially in men; about half of all men snore at some stage and about 25 per cent of men snore regularly.
The main health consequence of snoring is disturbed sleep of the spouse and/or household and it is a recognised cause of marital disharmony. However, snoring can also be a serious health issue for men.
Sleep Apnoea Syndrome
Sleep apnoea syndrome is a potentially serious condition that is seen in some men who snore. This is where the throat tissues block the airway and prevent you from breathing momentarily. When this happens the blood oxygen level falls and carbon dioxide level rises, which causes arousal, making the person suddenly snort or grunt, heralding the return of breathing. Sleep apnoea syndrome is characterised by these spells of loud snoring followed by episodes of silence. The problem is that this mechanism prevents somebody from getting deep refreshing sleep and they suffer from the clinical effects of sleep deprivation, including daytime drowsiness or sleepiness, poor concentration, headaches and irritability. In addition, sleep apnoea syndrome has adverse effects on the heart and blood pressure, leading to an increased risk of heart arrhythmia, heart attack and stroke.
Clues to Sleep Apnoea
Nearly all men who suffer from sleep apnoea syndrome are snorers; however many snorers do not have sleep apnoea syndrome. Feeling tired, drowsy or sleepy during the day is a major clue to the existence of sleep apnoea syndrome. Ask your spouse or partner if there are any periods during snoring when your breathing tapers off or stops, with silence for a few seconds or more, followed by a grunt or a gasp. The presence of this is highly suggestive of sleep apnoea syndrome. Other symptoms include poor concentration, irritability and reduced daytime performance. Sleep deprivation can also produce a whole range of other symptoms, from sexual dysfunction to sleep walking.
What Contributes to Snoring?
A variety of factors can lead to snoring, including:
Other known risk factors include allergies, using sedative drugs and rare conditions, including an overactive thyroid gland.
Tips to Prevent or Reduce Snoring
Appropriate lifestyle changes are important in the treatment of snoring and sleep apnoea syndrome:
Diagnosis
If you snore you should consult your doctor, especially if you have symptoms of sleep apnoea. A diagnosis of sleep apnoea syndrome is confirmed by a specialist in the area who will perform sleep studies, which requires you to spend a night in a specially designed sleep lab that measures the amount of oxygen in your blood during the night, amongst other parameters. Other causes of snoring, including nasal obstruction, may benefit from an opinion from an ENT (ear, nose and throat) specialist.
Treatment Options
If lifestyle changes don’t sort out the snoring problem other options can be considered. Mouthpieces that help advance the position of your tongue and soft palate to keep your air passage open can be used. Surgical options include tightening the loose tissues in the back of the throat. Laser surgery on the soft palate can now also be an option in some cases.
The treatment of sleep apnoea syndrome has been revolutionised by the delivery of continuous positive airway pressure (CPAP). This delivers air continuously through your airway while you are sleeping. The most common form of CPAP involves wearing nasal prongs or a pressurised mask on the nose while you are sleeping. The mask is attached to a small pump that forces air through the airway, keeping it open. CPAP is extremely effective and can prevent all complications of sleep apnoea syndrome. However, like many medications or medical devices, it is only as good as the willingness or ability of the person to use it regularly.
Haemochromatosis – The Celtic Storage Disease
Iron is a valuable mineral that helps make the blood rich in oxygen, helps the blood to carry oxygen to the muscles and also helps the brain and immune systems. However, while a certain amount of iron is good for us, more certainly isn’t better. Haemochromatosis is an inherited condition in which the body tends to absorb too much iron so that iron leaks out of the blood and into the joints and body organs such as the liver, heart and pancreas. This excess iron can damage the normal functioning of these organs.
Until a few years ago haemochromatosis was thought to be a fairly rare condition. Now we know it as one of the most common inherited disorders. Up to one in every five Irish men may be carriers of the gene for this condition. Men are five times more likely than women to develop iron overload, and they usually experience symptoms at an earlier age. Women tend to store less iron than men as they lose it through menstruation and pregnancy.
What Are the Symptoms?
Haemochromatosis generally causes no symptoms before the age of 30 in men. Even then it can be a silent condition for many years. However, eventually when the iron leaks out of the blood and into the organs around the body, symptoms will start to occur. These symptoms are varied and may include the following:
How Is this Condition Inherited?
We all have about 30,000 genes in our bodies, which are tiny information and control centres in the cells of the body that control how the body works and grows. A mutation in just one gene can drastically alter the way your body works. To inherit haemochromatosis you need to inherit a defective gene from both of your parents. Therefore it is not necessary for either of your parents to have had haemochromatosis for you to get the condition. If you simply inherit the gene from one parent then you will be a carrier; this means you are not likely to develop haemochromatosis yourself, but you can pass on this defective gene to your own children. If you inherit the gene from both parents you will develop the condition yourself.
Relatives of patients with haemochromatosis should be tested to see if they are carrying the defective gene. This includes brothers, sisters, parents, partners and children from the age of 18 years upwards.
What Tests Can Be Done To Diagnose Haemochromatosis?
Iron overload can be detected with two blood tests even if there are no symptoms:
Genetic testing can be carried out by taking a blood test to see if you have the genes for haemochromatosis.
Remember, knowledge is power; by being aware of the possible symptoms of haemochromatosis you can raise this possibility with your own doctor if you have concerns.
How Is This Condition Treated?
Treatment for haemochromatosis is incredibly simple: it involves regularly removing blood, just as if you were donating it. Removing a pint of blood from the body removes about a quarter of a gram of iron. The frequency of blood letting required varies from person to person. Some people need to have this procedure carried out at weekly intervals. For others, monthly or less frequently will suffice. The target with treatment is to get the serum ferritin level below fifty. This treatment can be very effective at bringing the amount of iron in the body down. However, it cannot reverse complications of haemochromatosis such as cirrhosis or diabetes. Therefore, early detection is better than cure. The goal with haemochromatosis is to detect it at an early stage before the complications have set in. Medical professionals are increasingly aware of this important condition, particularly as it is now recognised as being so common. The challenge, as with all things relating to health, is for men to educate themselves about these conditions so they can then make appropriate health choices.
What About a Low-Iron Diet?
Unfortunately dietary changes are really of no benefit in haemochromatosis. This is because a normal diet contains about ten times as much iron as we need, so normally only 10 per cent of the iron that we eat is absorbed into our body. However, the following dietary suggestions are recommended:
Coeliac Disease
Coeliac disease is a genetic bowel disorder caused by an allergy to gluten, a protein that is found in wheat, rye and barley. Most people with coeliac disease can eat oats, although some people with a more severe sensitivity to gluten cannot.
How Common Is It and What Are the Symptoms?
Coeliac disease affects about 3 per cent of the Irish population. It can present in early childhood with frequent smelly stools, lack of growth, anaemia, failure to thrive and weight loss. However, in many adults the condition is not diagnosed until middle age and people often present with very vague and non-specific bowel or stomach complaints such as wind, gas, constipation, bloating and sometimes pale smelly stools that are difficult to flush. Coeliac disease may also be a cause of tiredness, including chronic fatigue.
How Is the Condition Diagnosed?
Blood tests may show anaemia, which can be due to a combination of a lack of iron and a lack of folic acid. Specific coeliac blood tests can check for the presence of antigluten and other antibodies. The diagnosis is confirmed by carrying out biopsies of a part of the bowel known as the jejunum. This test will be carried out by a hospital specialist.
How Is Coeliac Disease Treated?
The cornerstone of the management of coeliac disease is simply to avoid gluten and to strictly follow a gluten-free diet. This means no wheat, no barley and no rye, and avoiding any food containing these ingredients, including bread, cakes and pies. Gluten-free biscuits, flour, bread and pasta are available. Rice, maize, soy, potatoes, sugar, jam, syrup and treacle are allowed, along with moderate quantities of oats. People with coeliac disease are at risk of developing several complications; this is largely due to a lack of compliance with a gluten-free diet. Human nature and a dislike of restrictions mean that people may be inclined to not follow medical advice when they don’t feel sick. However, sufferers who do not comply properly with a strict gluten-free diet have an increased risk of osteoporosis and of both iron and folate deficiency anaemias. There is some evidence that patients with coeliac disease are at increased risk of some bowel cancers, including one known as intestinal lymphoma. It is thought that adherence to a strict gluten-free diet decreases this risk.
Gout
Gout can be an extremely painful condition that mainly affects men. In fact gout is the most common cause of pain, redness and tenderness (painful arthritis) in men over the age of 40. Gout is caused by a build-up in the body of a chemical called uric acid.
What Is Uric Acid?
Uric acid is naturally produced by the body as a result of the breakdown of purines as part of the body’s normal ongoing daily wear, tear and repair process. Purines are substances found in all of the body’s cells, and in many foods. This is a normal and healthy process. Uric acid from this process is generally cleared by the kidneys. Imagine the kidneys as being like a sieve which filters all the bad stuff from the body, keeping the good stuff in. With gout the kidneys become less efficient at filtering (the holes in the sieve become smaller) so more uric acid is retained in the body. This is what happens when you drink alcohol and is why many heavy drinkers get gout. When the uric acid reaches a certain level it can then escape into the bloodstream and enter the joints, causing pain.
Some people can just produce too much uric acid (one reason why some men who don’t drink alcohol can still get gout). Uric acid can also be found in our diets, particularly in purine-rich foods like red meat (especially offal), duck, seafood (especially sardines and anchovies), gravy, kidney beans, peas and lentils. Other culprits can include shellfish, spinach, asparagus, cauliflower, mushrooms, beer and other forms of alcohol.
Binge drinking and extreme fasting can also cause uric acid levels to rise, as can certain medications, such as thiazide diuretics and niacin (Vitamin B3), which is often taken to boost HDL (good) cholesterol (see Chapter 6). Sometimes there are genetic factors involved that cause the uric acid level to be too high.
It is the build-up of high uric acid over a long period of time that tends to cause gout. The higher the uric acid level the higher the chance of developing gout. When uric acid leaks out of the blood it enters the joints, most commonly the big toe. Occasionally it can affect other joints, including the hands. The attack usually comes on suddenly, causing pain, and within a few hours the affected joint can become red, hot, swollen and painful.
Diagnosis of Gout
The diagnosis of gout is often straightforward. Certainly any man who has suffered recurring attacks of gout will know immediately when they have been struck down by it. However, sometimes other forms of arthritis or infection can mimic gout. A high uric acid level supports the diagnosis of gout, but it is not as black and white as it seems: some people can have a high uric acid level for many years without developing gout. If the diagnosis is uncertain the doctor may remove a small amount of fluid from the joint; the presence of uric acid crystals in the joint fluid confirms the diagnosis beyond doubt.
Complications of Gout
Recurrent attacks of gout can lead to chronic gout, which can cause a form of arthritis in the joints and permanent joint damage. Swellings, called tophi, can occur in the joints due to a build-up of large amounts of uric acid crystals. These uric acid crystals can also deposit in the kidneys, causing kidney stones.
Treatment of Gout
Acute attacks of gout can be effectively treated by taking anti-inflammatory medication. Caution is needed with anti-inflammatories, however, as they can affect the stomach and kidneys. Other options include colchicine (although this can cause vomiting and diarrhoea) or short courses of steroids.
If someone is suffering from recurrent attacks of gout they can be prescribed medication, known as allopurinol, to lower the uric acid level. However, while allopurinol is very effective at preventing attacks of gout, it must be stopped if someone suffers an attack while taking it as it can make an acute episode of gout worse.
Tips to Prevent Gout
Drinking lots of water is important to flush out the kidneys and help to remove uric acid from the body. While only about 10 per cent of uric acid comes from our diet, making some dietary changes can be worthwhile. It is recommended to cut back on purine-rich foods (see page 311) and keep your alcohol consumption within safe limits, particularly avoiding binge drinking. Keep your weight healthy (BMI 20–25). If you are overweight this puts extra strain and pressure on your joints as well as increasing the risk of high uric acid levels and gout. Avoid crash diets as they can increase uric acid levels in the blood, and also low-carbohydrate diets that are high in protein and fat, which can increase uric acid levels.
Kidney Stones
Kidney stones are small bits of mineral and acid salts inside the kidneys. They are caused by the urine flowing through the kidneys becoming rich or heavy in minerals that form into crystals, which in time can stick together, solidify and develop into tiny bits of gravel and eventually stones. Normally these substances are diluted in the urine. The main mineral found in most kidney stones is calcium, while others less commonly found include oxalate or phosphate. About 10 per cent of kidney stones are due to excess uric acid.
How Common Are Kidney Stones?
Kidney stones mainly occur in men. An Irish man has about a 10 per cent chance of getting a kidney stone at some stage during his life, most commonly between the ages of 20 and 50. They also have a nasty habit of recurring. Up to 50 per cent of men will suffer a reoccurrence within ten years of getting a kidney stone.
What Are the Symptoms of Kidney Stones?
Sometimes kidney stones can remain dormant, or silent, for years if they occupy a wide part of the ureter (the tube connecting the kidneys and bladder), so you may not even know you have one. If your urine is tested by your doctor at this stage, traces of blood may be detected. However, once the gravel or stone moves into a narrower part of the ureter, blocking it, symptoms develop.
The main symptom of a kidney stone is pain, also known as renal colic. The pain of kidney stones is often very severe. It can start suddenly in the lower back and often radiates around to the groin and down into the testicles or scrotum. The pain can vary in intensity with episodes of severe pain lasting from 20 to 60 minutes. It is usually impossible to get into a comfortable position when you have this pain. The excruciating pain is often associated with:
Kidney stones that don’t cause these symptoms may show up on X-rays when you seek medical care for other problems, such as blood in your urine or recurring urinary tract infections.
What Are Kidney Stones Made Of?
Most kidney stones contain crystals of more than one type. However, it can be easier to figure out the underlying cause of the kidney stone if the makeup of the stone is known.
Risk Factors for Kidney Stones
Kidney stones usually don’t have one single identifiable cause. However, these factors may increase your risk of developing kidney stones:
Other risk factors include high blood pressure, obesity and prolonged immobility, for example, being bed-bound with a broken leg. In addition, any bowel disorder that reduces your ability to absorb calcium will lead to more oxalates in the urine, which can lead to stone formation. These can include gastric bypass surgery, inflammatory bowel disease and chronic diarrhoea.
Tests and Diagnosis
If your doctor suspects you have kidney stones, you’re likely to have blood tests to look for excess calcium or uric acid and a 24-hour collection of urine to analyse its content. You may also need a scan of the urinary tract. However, nothing beats hard evidence and if you can recover a stone you have passed, perhaps by peeing through a strainer, then it can be analysed.
Treatment
The treatment of kidney stones depends on the type of stone as well as the underlying cause. Sometimes the stones will pass on their own and drinking large amounts of liquid can help this process. Sometimes larger stones can be treated with lithotripsy, which is a form of ultrasonic shock therapy, causing the stone to break into tiny fragments that are then passed in the urine. Occasionally surgery is needed to remove kidney stones. Kidney stones may remain silent and cause no long-term problems. However, there is the risk of long-term kidney damage as well as kidney infection.
Prevention
Lifestyle changes can prevent kidney stones in many cases. The best way to prevent kidney stones is to drink lots of fluids and avoid dehydration. This means drinking enough fluid to keep the urine pale or clear in colour. Urine that is yellowish in colour means dehydration. For most men this means drinking several extra glasses of water a day on top of their usual fluid intake. If you have already had a kidney stone you will have to drink even more fluid (up to 3 litres a day) to keep the urine very dilute, thereby preventing crystals from forming in the urine. The best fluid to drink is good old-fashioned water. A glass of lemonade made with real lemons is also thought to be good as lemons increase the amount of citrates in the urine, which can help prevent stone formation.
If you have a history of calcium-based kidney stones you should certainly avoid calcium or Vitamin D supplements. However, for many men a low-calcium diet doesn’t appear to reduce the chances of getting kidney stones. A diet low in salt and animal protein is thought to be helpful in preventing kidney stones.
It may be advisable to avoid foods with high amounts of oxalate as this is the substance that can bind calcium in the urine, thereby helping to form calcium oxalate stones. Foods that are high in oxalate include rhubarb, parsley, nuts (especially almonds), spinach, beets, instant coffee and chocolate. As with all other dietary recommendations, moderation is the key.
Uric acid stones are a complication of gout. To prevent these you need to keep your uric acid levels low through a combination of high fluid intake and a low-protein diet, staying away from red meat and shellfish in particular.
Osteoporosis
Osteoporosis is a disease that causes the skeleton to weaken and the bones to break. A useful analogy is that of a big thick coffee mug turning into a dainty china cup that eventually cracks and crumbles. It poses a significant threat to many Irish men, as up to one in every five men will be affected by it at some stage. Yet, despite the large number of men affected, osteoporosis in men remains under-diagnosed and under-reported. Many Irish men view osteoporosis solely as a ‘woman’s disease’. Osteoporosis is called a silent disease because it usually progresses without symptoms until a fracture occurs.
Fractures resulting from osteoporosis most commonly occur in the hip, spine and wrist. Hip fractures are especially dangerous and men can die from their complications or be left permanently disabled.
What Causes Osteoporosis?
Bone is constantly being built up and broken down in the body. Generally, peak bone mass is reached at about the age of 35, which is when our bones are at their strongest. After this age we start to lose more calcium from our bones slowly over time, causing our bones to gradually weaken. In some people the bones become fragile more quickly than in others. Once bones lose a certain amount of calcium they are more likely to break from a fall – this weakening of the bones is known as osteoporosis.
Men in their fifties do not experience the rapid loss of bone mass that women do in the years following menopause. By age 65 or 70, however, men and women are losing bone mass at the same rate, and the absorption of calcium, an essential nutrient for bone health throughout life, decreases in both sexes.
What Are the Symptoms?
Symptoms of osteoporosis in men may include a fracture occurring after a relatively minor trauma, loss of height or sudden back pain (the latter two symptoms caused by a vertebral bone in the back breaking). In many cases there are no symptoms until the later stages. Untreated osteoporosis can lead to progressive pain, loss of height, loss of independence, premature disability and even death.
Risk Factors for Osteoporosis in Men
Several risk factors have been linked to osteoporosis in men:
Steroids are medications used to treat diseases such as asthma and rheumatoid arthritis. Bone loss is a very common side affect of these medications. Therefore, men taking these medications should talk to their doctor about having a bone mineral density (BMD) test. Abnormally low levels of sex hormones cause osteoporosis in women after the menopause. Similarly, lowered testosterone levels can also cause osteoporosis in men. Immobilisation during illness or after a fracture or surgery can result in significant bone loss. Therefore a good diet and a proactive rehabilitation programme are essential to help counteract this. Even astronauts in space are prone to osteoporosis because they are in a gravity-free environment.
How Is Osteoporosis Diagnosed?
Osteoporosis can be effectively treated if it is detected before significant bone loss has occurred. The gold standard test for osteoporosis is a type of bone mineral density (BMD) test known as a DEXA scan. This test can identify osteoporosis, determine your risk of fractures (broken bones) and measure your response to osteoporosis treatment. It is a painless test, like having an x-ray, but with much less exposure to radiation. It can measure bone density at your hip and spine.
How Can Osteoporosis Be Prevented?
Men should take the following steps to preserve their bone health:
What Treatments Are Available?
Once a man has been diagnosed with osteoporosis his doctor may prescribe one of several medications available to strengthen the bone density. A healthy lifestyle, including plenty of weight-bearing exercise and calcium and/or Vitamin D supplements can help. If there is an identifiable underlying cause for the osteoporosis, such as testosterone deficiency, a specific treatment plan may address the underlying cause.
There are several drug treatment options available at present. The best known of these is a group of drugs known as bisphosphonates, which can be taken just once weekly. They can help prevent further calcium loss from the bones and sometimes can help strengthen the bone. Side effects can include inflammation of the food pipe and a possible effect on the jaw known as osteonecrosis. There is a lot of research in this area at present and newer treatments will be available in time. Keep informed about developments in this area.
Key Points
