From reduced sex drive to UTIs – these are some of the warning signs men should watch out for as they age
A lot of the urinary problems men face are attributed simply, to “ageing”. Whether that’s increased frequency during the night, an onset of erectile dysfunction or a reduced sex drive – most of this is seen as inevitable when you pass 40. But often when writing off symptoms as just “getting older”, mid-life men can be misdiagnosed.
Here, two consultant urologists, Gordon Muir and Greg Shaw, explain the symptoms that should always warrant a trip to the GP.
If you’re getting up to wee in the night, it’s probably a benign issue – but see your doctor
The key concern for men aged 40 onwards is the prostate, says Gordon. “Prostate cancer is the most common cancer diagnosed in men over 40, and men can also develop benign prostatic disease which will tend to cause symptoms such as slow urinary flow, waking up at night, rushing to the loo.”
New FeatureIn ShortQuick Stories. Same trusted journalism.
Prostate cancer rarely causes symptoms unless it’s very advanced, so if you’re noticing a change it’s not likely to be cancer, he says. “It’s almost always benign prostatic growth symptoms.” This means the prostate is enlarged but not cancerous.
However that doesn’t mean symptoms should be ignored, Greg says. Lower urinary tract issues can either relate to storage (needing to wee more frequently or incontinence) or voiding (the urine flow is very slow or the bladder doesn’t feel like it properly empties) and can have various different causes.
“These usually relate to either obstruction from the prostate (which can be cancerous or benign) or it relates to problems in the bladder which might be a cancerous growth, or a bladder has become irritable called overactive bladder syndrome,” Greg explains. “Lower urinary tract symptoms warrant investigation because whilst most cases are due to benign conditions and can be managed with medication or sometimes surgery, there are cancerous conditions that can cause the same symptoms.”
Blood in urine is never acceptable but whether it hurts matters even more
Blood in the urine, as Greg puts it, “is never OK and always needs investigation.” But the reason why you notice it matters too. “If it’s painful, it usually means it’s due to an infection that needs treatment. But if it’s painless, whether it’s seen by the eye or picked up on a urine dipstick test with the GP, that’s never OK.” This could indicate the presence of tumours in the bladder or kidney which, if they present symptoms at all, will present as blood in the urine.
If you’re over 50 and black, or have a family history, ask for a prostate cancer test
Prostate cancer is the most common cancer diagnosed in men over 40, but is largely asymptomatic in the early stages. “If it starts to cause symptoms that generally means the cancer’s gone so far as to be unlikely to be curable,” Greg says. “This is why the PSA blood test is so important. Any man over the age of 50 is entitled to ask their GP for that within the NHS system.”
There is currently debate ongoing about whether all men over a certain age should be screened for prostate cancer, adds Gordon. “We know that prostate cancer screening does save lives, but there is quite a lot of overtreatment of men who have low level disease which can be safely watched.”
With that in mind, he recommends actively seeking out screening “for men with a strong family history or black men because both are much more at risk of the disease. The symptoms of prostate cancer are none, so it needs to be picked up by either a PSA blood test or an MRI scan of the prostate.”
Frequent urination often indicates diabetes
Often urinary symptoms can be a sign of other conditions.
“Type 2 diabetes in particular is extremely common as one gets older and results in increased urine volume, putting pressure on the urinary tract to get the urine out without causing symptoms,” Greg says. “I saw a patient in the clinic yesterday with this problem. We always think about diabetes if someone’s got lower urinary tract symptoms, and it’s not unusual to identify diabetes in someone who presents that way.”
UTIs in men are rare and therefore concerning
“Urinary tract infections are often treated by the GP, successfully and appropriately, particularly in women,” Greg says, but “it’s far less common for a man to get a urinary tract infection”. This, he says, is because the length of the male urethra largely stops the infection from taking hold.
As such, he says, “any urinary tract infection in a man would be considered strange and require investigation. We don’t always find something wrong, but we always check. Then it’s about stopping the patient from getting further infections, rather than worrying about the cause for it”. Symptoms of a UTI include urinating frequently, a burning sensation when urinating, and lower abdominal pain. In older men, it can also present with delirium or confusion.
Don’t ignore erectile dysfunction
A new onset of impotence in later life, Gordon explains, “is not a facet of ageing. Men get ED because they have conditions that develop as they age – usually a vascular disease”. The problem is often due to thickening of the arteries in the penis – meaning arteries elsewhere in the body are in poor condition too. “This is why men will often develop erectile dysfunction a year or so before they have their first heart attack,” says Gordon. It can also be associated with diabetes, being hypertensive or being overweight.
The good news, Greg adds, is that “while erectile dysfunction can be an indicator of failing health in other ways, often if people are able to improve their metabolic situation, their lifestyle, they’re able to improve their erectile function. It’s kind of a barometer for general health.”
But a reduced sex drive is normal
“In my experience, about half of 65-year-olds will want to be sexually active, the others are not that bothered about it,” says Greg. “So of course if someone’s not bothered about it they won’t present their symptoms. Always consider seeing a GP if new symptoms arise, rather than just assuming all is well and purchasing tablets over the counter.”
If it bothers you, get it investigated – and take care of the basics
“Some men tolerate symptoms which other men wouldn’t and that’s really the basis that we as urologists use to decide if someone needs treatment – how upset they are by their lot.
Your next read
“If men are bothered by their urinary symptoms, whatever it might be, they should see a urologist. There are usually medications that can be used to help with these symptoms and a series of tests will usually elucidate the cause. It’s usually down to benign prostatic enlargement, which is extremely common in ageing men.”
In the meantime, take care of the basics – staying hydrated and reducing caffeine can work wonders to reduce the severity of urinary symptoms.
And seriously, don’t smoke
Gordon has one final, simple message. If you have any concern about your urinary health, quit the cigs. “Another common cause of ED is smoking, and smoking is the biggest single factor in bladder cancer. Men should not smoke.”