31 Older Men’s Health It can sometimes be difficult for men to find information and advice about health issues which affect them, particularly as they get older. This information sheet aims to look at some of the health problems experienced by men, where to get more information and how to stay well. Contents Health services page 2 Conditions page 2 – Prostate and bladder conditions page 3 – Problems with testicles page 5 – Impotence page 6 – Incontinence page 7 – Depression page 8 Staying fit and healthy page 9 Useful contacts page 11 Health services Men are about half as likely to visit their doctor as women, despite the fact that they are more prone to illness. Surveys have shown that there are a number of reasons for this: * Men tend to be less familiar with the services that are available. * Some men feel that they should be able to manage their illness on their own without going to the doctor. * Some men are uncomfortable or embarrassed at having to discuss personal health issues with a doctor or nurse. However, it is very important that you are registered with a local doctor, even if you don’t have any health problems at the moment. This is in case you need to call a doctor out in an emergency. Or you might want to be referred to another service, for example, chiropody. If you think that you might have a health problem, you should not ignore your symptoms or try to get through it on your own. If you feel uncomfortable about going to the doctor you could consider: * arranging to see the practice nurse instead of the doctor; * seeing a different doctor at the same surgery; * finding out if your surgery runs clinics for men, sometimes called ‘Health MOTs’, ‘Modern Man Clinics’ or ‘Well Man Clinics’; * going to a different doctor at a new surgery; or * taking up the offer of an ‘over-75s check’, if your practice offers one, where you can discuss your health with a practice nurse. For more information on getting a doctor and other health services, see our free information sheet no. 30, Your Health Services: where to start. Conditions Obviously, men experience a range of illnesses. But in this information sheet we will focus on conditions which particularly affect older men and which are harder to find information about. We will look at how to recognise these illnesses and where to get more help and advice. Prostate and bladder conditions The prostate is a small gland, about the size of a walnut, that sits just below the bladder and fits round the urethra like a collar. (The urethra is the tube which carries urine and semen outside the body.) There are three main conditions that can affect the prostate. Benign prostatic hyperplasia Benign prostatic hyperplasia (BPH) is an enlargement of the prostate gland. This is quite common in older men: over half of men over 60 could have BPH, rising to eight out of ten men over 80. If your prostate is enlarged it might put pressure on your urethra. This will mean you might have to urinate more often, especially at night, with less notice. Your stream will slow down, and sometimes there will be dribbling afterwards. The condition can sometimes lead to a sudden inability to urinate at all. You should see your doctor immediately if this happens as this is a surgical emergency. The common symptoms of BPH are: * needing to urinate frequently, especially at night * difficulty starting to urinate * pain when passing urine * taking a long time to urinate * a feeling that you have not emptied your bladder * dribbling afterwards. If you have any of these symptoms you should visit your doctor, who will carry out an examination to check if your prostate is enlarged and probably run some tests. BPH can be treated by reducing the size of the prostate. This is now often done with drugs and with surgery. (Your doctor may just wish to monitor the enlargement.) Prostatitis Prostatitis is inflammation or infection of the prostate gland. It is more often found in men under 50 but can affect men of all ages. Symptoms of prostatitis include pain when ejaculating or passing urine and pain deep between the buttocks, in the lower abdomen or lower back. If you have any of these symptoms you should make an appointment to see your doctor. Prostatitis can be treated with antibiotics, anti-inflammatory drugs or pain killers. If you have pain and discharge from the penis, you can go to your nearest genitourinary medicine (GUM) clinic. You do not need a doctor’s letter as you can refer yourself to a GUM clinic and your doctor need not know you have been. Alternatively you may wish to consult your doctor. You can find your nearest GUM clinic by phoning NHS Direct on 0845 46 47 in England or Wales (or NHS 24 in Scotland on 08454 24 24 24) or by looking in the phone book. Prostate cancer Prostate cancer is diagnosed in about 27,000 men in the UK each year. Most of the men diagnosed will be over 60 but men from the age of 40 can be affected –the risk of getting prostate cancer increases with age. Prostate cancer is a slow-growing, abnormal growth that starts within the prostate gland. In some men it can remain undetected because it never causes problems; some men with prostate cancer may never get any symptoms at all. At first there are no outward signs that anything is wrong and not all men get the same symptoms. But as the disease develops you may get similar symptoms to BPH. You may also get: * lower back pain * pain in your pelvis, hips or thighs * difficulty in getting, or keeping, an erection * unexplained weight loss * blood in your urine or semen. If you experience any of these symptoms you should go to see your doctor straight away. Having the symptoms does not necessarily mean that you’ve got prostate cancer; it is possible that it is a sign of something like BPH. Either way, you should go to the doctor and get it checked out. Your doctor may give you a PSA (prostate-specific antigen) test. This is a blood test which helps to diagnose prostate cancer but does not always give a clear-cut answer. Treatment for prostate cancer depends on the type and size of your cancer as well as your age and general health. It can vary from careful monitoring (many prostate cancers grow so slowly that they do not cause problems) to radiotherapy, hormonal therapy or surgery. With lengthening life expectancies, most cancers will need treatment. The Prostate Cancer Charity produces a range of leaflets including one called The Works. See page 11 for the charity’s address and other organisations which can offer more information and advice on conditions which affect the prostate. Bladder cancer Bladder cancer is caused by abnormal cell growth in the wall of the bladder. It mostly affects people over 50 and is much more common in men. It causes bladder pain and blood in the urine. If you notice blood in your urine, visit your doctor straight away. It does not necessarily mean that you have bladder cancer, but it is important to get it checked. If your doctor suspects that you have bladder cancer they will usually refer you for a cystoscopy examination. This is where the surgeon passes a tube into the bladder. Bladder cancer can also be treated using cystoscopy depending on the type and size of the cancer. Problems with testicles Hydrocele A hydrocele is a swelling caused by a build-up of fluid around a testicle and usually in the ducts connected to the testicle. They normally only occur on one testicle but sometimes you can get them on both. Hydroceles vary in size but can get as large as a grapefruit if left untreated. If you think you may have a hydrocele, or any other kind of swelling, you should visit your doctor to get it checked. Hydroceles can be treated by draining the fluid with a syringe but it is most likely it will be treated with simple surgery. Alternatively, if the symptoms are not causing you any problems your doctor may suggest that you simply leave it alone. Testicular self-examination It is best to carry out a self-examination during or after a bath or shower, as the scrotum will be more relaxed, making it easier to examine the testes. Hold your scrotum in the palm of your hand with your thumb over the top of your testicles. Feel the difference between the testicles. It is normal to have one that is larger and lying lower. Examine each testicle individually and use both hands and gently roll each testicle between thumb and forefinger, checking for any swellings or lumps or tenderness, as your testicles should be smooth. Remember that the tube carrying sperm to the penis (the epididymis) normally feels bumpy. It lies along the top and back of each testicle. Compare your testicles with each other and at the same time check your penis for any rashes or sores. Impotence Impotence, or erectile dysfunction (ED), happens when a man has problems getting or keeping a good enough erection to have sex. It can get more common as you get older. It is now known that in about three-quarters of cases impotence is the result of physical causes. Conditions such as diabetes, cardiovascular disease, Parkinson’s disease, nerve damage as a result of prostate surgery or side-effects from some medicines can all cause impotence. Psychological problems such as anxiety, stress, depression, guilt and sexual boredom can also result in problems maintaining an erection. However, for many men impotence is caused by a combination of both physical and psychological problems. Although a lot of older men experience impotence, many do not seek help, despite the fact that it can be successfully treated in many cases. If you are having problems getting or maintaining erections you should visit your doctor, but there are lifestyle changes that you can try which may help. * Cut down on the amount of alcohol you drink. Too much alcohol can cause ‘brewer’s droop’ and in the long term reduce your desire to have sex. * Stop smoking. Nicotine damages the circulation, which can affect the blood-flow to the penis. * Take exercise, such as brisk walks or going to the gym. This will improve your general fitness and circulation, and may help you to relax. * Think about any areas of stress or worry which may be contributing to your impotence. Make time to do things you find relaxing or learn new ways to relax such as deep-breathing techniques. * Talk to your partner. Most people find that talking about a problem makes it easier to deal with. Both of you will probably be relieved to have things out in the open. You and your partner can reassure each other that it is no one’s fault and find ways round the problem. * Think about what you and your partner want from sex. Older couples often find that they need to adapt their sex lives to physical and emotional changes. For example, after menopause some women feel discomfort during sex. So you both may need, and enjoy, more foreplay than when you were younger. Indeed, you can have a full and happy sex life that doesn’t involve full intercourse at all. Although these lifestyle changes are likely to improve your general health and protect you from other conditions, they will not help everyone who experiences impotence. If you are still having problems you should see your doctor. You may feel embarrassed to talk to your doctor about impotence, but it is a common problem and there is effective treatment available. There is much more awareness of the condition these days and your doctor will be used to treating patients with impotence. Some doctors have impotence clinics, while others may send you to a specialist. There are different ways of treating impotence depending on the causes. These range from lifestyle changes to highly effective and safe oral medicines. These medicines are available on NHS prescription only if your impotence is caused by certain conditions. Private prescriptions can be expensive, but there are other kinds of treatment your doctor can discuss with you. For more information on impotence and the treatments available visit your doctor or contact the Sexual Dysfunction Association. See page 11 for its contact details. Incontinence Urinary incontinence is very common. Up to six million people in the UK cannot control their bladder as they would like to. Men who have prostate complaints or have had prostate surgery are more susceptible to urinary incontinence. Diabetes, urine infections and constipation can also contribute. Symptoms of bladder incontinence include leaking urine, experiencing an urgent, sudden need to urinate, and not always reaching a toilet in time. If you find that you have to get up to go to the toilet in the night, it might be a good idea to sit down to urinate, as standing can cause older men to faint. Don’t be self-conscious about sitting down to urinate; it makes you more relaxed, is safer and will help you to empty your bladder more easily. You may also experience bowel incontinence. Symptoms include difficulty in controlling your bowels and leaking from the back passage. There is a lot that can be done to improve or even cure incontinence. So if you have symptoms of bladder or bowel incontinence, you don’t have to live with it; make an appointment to see your doctor, who may refer you to a local continence adviser for help and advice, or to a surgeon. For more information on the different types of incontinence, treatments and self-help, see our free advice leaflet, Bladder and Bowel Weakness. Organisations that can offer advice and support are listed on page 11. Depression As we get older we experience lots of changes which can affect our mood: for example, stopping work and being at home during the day, getting a physical illness which is difficult to cope with or losing friends and family members. It is natural to feel sad about things like this. Sometimes however, this sadness is very intense and can’t be shaken off. You might feel that you haven’t got the energy to find a way out of it. This can be a sign that you are experiencing depression. Common symptoms of depression include loss of appetite, changes in your sleep pattern, concentration problems and poor memory, lack of interest in sex and low energy levels. Unfortunately, older men have one of the highest suicide rates in the UK, so it is very important that you look after your mental health. Although depression is quite common, it is not an inevitable part of getting older. Treatment is available, so if you think you might be suffering from depression, visit your doctor, talk to someone you trust or contact your local branch of Mind. See page 11 for its details. If you are experiencing emotional distress or suicidal thoughts and want to talk to someone, you can contact the Samaritans at any hour of the day or night, on 08457 90 90 90. For more information on the symptoms of depression and how to deal with them, see our free information sheet no. 11, Beating the Blues. For organisations that can provide more advice and support on depression, see page 11. Staying fit and healthy As we get older it becomes ever more important to look after our physical and mental health. We are living longer and deserve to enjoy our retirement. Unfortunately, men tend to be less healthy than women, experiencing higher rates of heart disease, stroke, cancer, fatal accidents and suicide. They also die younger. It is never too late to start improving your health. In fact, you can reap the benefits of a healthier lifestyle relatively quickly. You probably know what you should be doing, but it is worth recapping. Stop smoking Giving up smoking is the single most effective thing you can do to improve your health. Giving up can promote health benefits within days. Studies have shown that you are more likely to be successful in quitting if you get professional help and nowadays there is a lot available. In fact, treatment on the NHS is free. Visit your doctor or contact one of the organisations listed on page 11. Eat healthily To stay fit and well we need a healthy diet to help protect us from disorders such as heart disease and some cancers. Eating well means enjoying your food and having plenty of variety. Try to eat more fibre, fruit and vegetables and less fat, sugar and salt. For more information on eating well see our free advice leaflet, Healthy Eating. Cut down on alcohol A drink now and then is a good way to relax and socialise. But as with most things you shouldn’t go overboard. Regular drinking above the recommended limits can contribute to heart disease, strokes, impotence, cancer, liver and digestive problems and accidents. The Government recommends that men drink no more than three to four units of alcohol a day. A unit is roughly about half a pint of ordinary strength beer, lager or cider, a pub measure of spirits or a small glass of wine. For more information about sensible drinking or advice on alcohol misuse contact the organisations on page 11 or visit your doctor. Take exercise Whatever your age, regular, safe and enjoyable exercise is vital to maintaining a healthy way of life. It will protect your heart and bones, help you to maintain a sensible weight and aid relaxation. If you’re not as fit as you used to be it is a good idea to start with gentle exercise and gradually build up the amount you do. If you have a medical condition, talk to your doctor before getting started. For example, if you have problems with your knees, you can do non-weight-bearing exercise such as swimming. For more information on staying fit and healthy see our free advice leaflet Keeping Mobile. Help the Aged also produces a free information sheet, no. 25, Leisure Ideas, which offers suggestions and contact details for different types of exercise, to do either on your own or at a class or club. Help the Aged also produces two exercise videos: Be Strong, Be Steady, which demonstrates chair-based and standing exercises, and Step to the Future, a new exercise programme that progresses through standing, chair-based and floor exercises. To buy a copy , visit our online shop or call 0870 770 0441; both videos cost £12.00. Be Strong, Be Steady (reference number N2601) is also available in Punjabi, Bengali and Cantonese and Step to the Future (reference number N2701) is available on VHS in English with subtitles and on DVD in English with Hindi or English subtitles. Avoid accidents Statistics show that men are more likely to be injured or killed in accidents and more likely to take risks than women. Changes as we get older, such as worsening sight, slower reaction times and being less agile, can make everyday activities more hazardous. We don’t always notice these changes in ourselves and sometimes don’t like to admit that we could have an accident. However, once you have had an accident you will find it harder to recover from it than when you were younger. To avoid accidents it is a good idea to know where risks lie and plan ways of steering clear of them. For example, getting up too quickly from a bed or chair can cause giddiness or fainting, so remember to take your time and keep obstacles out of your path. For more information see our free advice leaflets Fire, Your Safety and Staying Steady. Look after your mental health Being physically fit will help you stay mentally healthy and alert. The reverse is also true: feeling well emotionally will help you cope with any physical worries that you have. You can help to keep your spirits high by getting out and about, even if it is just for a short walk to the post office. Make time to do things you find relaxing, listening to music, gardening, dancing, watching or taking part in sport, or socialising. If you have mobility problems which make it difficult for you to leave home there are still things you can do to stay active and occupied. If you are feeling low or sad, talk to a friend or relative. If you think you might be depressed, don’t struggle on your own; see your doctor. For more information see our free information sheet no. 11, Beating the Blues. For suggestions for leisure and relaxation activities see information sheet no. 25, Leisure Ideas. Useful contacts Men’s Health Forum Web: www.malehealth.co.uk Men’s Health Forum runs Malehealth.co.uk, which provides essential, accurate and easy-to-understand information about the key health problems that affect men. It offers tips and expert advice as well as details of how men can check their own health and use health professionals more effectively. Cancer Cancerbackup 3 Bath Place Rivington Street London EC2A 3JR Helpline: 0808 800 1234 Web: www.cancerbackup.org.uk Cancer Research UK PO Box 123 61 Lincoln’s Inn Fields London WC2A 3PX Tel: 020 7242 0200 Web: www.cancerresearchuk.org Depression Depression Alliance Suite 212, Spitfire Studios 63–71 Collier Street London N1 9BE Tel: 0845 123 2320 Web: www.depressionalliance.org Mind (infoline) PO Box 277 Manchester M60 3XN Helpline: 0845 766 0163 Web: www.mind.org.uk Drinking Alcoholics Anonymous PO Box 1, 10 Toft Green York YO1 7NJ Helpline: 0845 769 7555 www.alcoholics-anonymous.org.uk Drinkline The National Alcohol Helpline Helpline: 0800 917 8282 (24 hours) Impotence Sexual Dysfunction Association London Bridge Hospital Suite 301, Emblam House 27 Tooley Street London SE1 2PR Tel: 0870 774 3571 Web: www.sda.uk.net Incontinence Continence Foundation 307 Hatton Square 16 Baldwins Gardens London EC1N 7RJ Helpline: 0845 345 0165 www.continence-foundation.org.uk Incontact United House North Road London N7 9DP Tel: 0870 770 3246 Web: www.incontact.org Prostate The Prostate Cancer Charity 3 Angel Walk London W6 9HX Confidential Helpline: 0800 074 8383 Web: www.prostate-cancer.org.uk Prostate Research Campaign UK 10 Northfields Prospect Putney Bridge Road London SW18 1PE Tel: 020 8877 5840 Web: www.prostate-research.org.uk Smoking NHS Smoking Helpline Tel: 0800 169 0169 Web: www.gosmokefree.co.uk QUIT Tel: 0800 00 22 00 Web: www.quit.org.uk If you need information on an illness or condition which we have not covered in this information sheet, please feel free to contact us. Although we are not medical experts we may be able to find the information you need or point you to a more specialist organisation which can advise. See page 14 for our address. For further information contact: Information Resources Team Help the Aged 207–221 Pentonville Road London N1 9UZ Tel: 020 7278 1114 If you have access to the Internet you can download our information sheets and advice leaflets by logging on to www.helptheaged.org.uk SeniorLine is the free welfare rights advice and information service run by Help the Aged for older people and their carers. Trained advice workers offer free, confidential and impartial advice about: * welfare and disability benefits * care at home * residential care * housing options and adaptations * access to health and community services. Freephone: 0808 800 6565 Textphone: 0800 26 96 26 9am to 4pm, Monday to Friday If you are in Northern Ireland, contact SeniorLine on 0808 808 7575. We would like to thank Dr Chris Hindley for his assistance in writing this information sheet. IS(NO)31 February 2004 (TH) Last updated: February 2007 (LWB) Next update due: August 2007 Help the Aged is a registered charity No. 272786 registered in England at the above address. 15