Beyond “Just Getting Older”: When Urinary Woes Signal Something More Serious for Men Over 40
Many men, as they navigate their 40s and beyond, accept a range of urinary and sexual health changes as simply an unavoidable part of ageing. Frequent trips to the toilet at night, a dip in libido, or the onset of erectile dysfunction are often dismissed as inevitable consequences of getting older. However, this common assumption can lead to misdiagnosis, masking potentially serious underlying conditions. Two leading consultant urologists, Gordon Muir and Greg Shaw, shed light on the symptoms that men should never ignore and always discuss with their GP.
The Prostate: A Common Culprit and a Crucial Check
For men aged 40 and over, the prostate gland often becomes a focal point of concern. “Prostate cancer is the most common cancer diagnosed in men over 40,” explains Gordon Muir. “Alongside this, men can develop benign prostatic disease, which typically presents with symptoms like a slow urinary flow, waking up during the night to urinate, and a sense of urgency.”
It’s important to note that prostate cancer rarely manifests symptoms in its early stages. If you are experiencing changes, it’s more likely to be indicative of benign prostatic enlargement – a non-cancerous swelling of the prostate.
However, Greg Shaw stresses that these symptoms should never be brushed aside. Lower urinary tract issues can broadly be categorised into storage problems (increased frequency, urgency, or incontinence) or voiding problems (slow urine stream, incomplete bladder emptying). These can stem from various causes.
“These issues usually relate to an obstruction from the prostate, which can be cancerous or benign,” Greg elaborates. “Alternatively, they can arise from problems within the bladder, such as a cancerous growth or a condition known as overactive bladder syndrome. Lower urinary tract symptoms always warrant investigation because, while most cases are due to benign conditions manageable with medication or sometimes surgery, there are also cancerous conditions that can present with identical symptoms.”
Blood in Urine: A Red Flag That Demands Attention
Greg Shaw is unequivocal: “Blood in the urine is never okay and always needs investigation.” The context in which it appears, however, provides further clues. “If it’s painful, it usually indicates an infection requiring treatment,” he states. “But if it’s painless, whether it’s visible to the naked eye or detected during a dipstick test at the GP’s, that’s never acceptable.” This painless bleeding can be a sign of tumours in the bladder or kidneys, which, if they cause any symptoms at all, often do so through haematuria (blood in the urine).
Prostate Cancer Screening: Who Should Be Asking and When?
While prostate cancer is the most prevalent cancer in men over 40, its early stages are typically asymptomatic. “If prostate cancer starts to cause symptoms, it generally means the cancer has progressed to a stage where a cure is unlikely,” Greg explains. “This is precisely why the PSA (Prostate-Specific Antigen) blood test is so vital. In the UK’s NHS system, any man over 50 is entitled to ask their GP for this test.”
There’s ongoing discussion about whether universal screening for prostate cancer should be implemented for all men above a certain age. Gordon Muir acknowledges, “We know that prostate cancer screening does save lives, but there is also a significant issue with overtreatment of men who have low-grade disease that could be safely monitored.”
Considering this, he advocates for proactive screening for specific groups: “Men with a strong family history of prostate cancer or black men should actively seek out screening, as both groups have a significantly higher risk of developing the disease. The symptoms of prostate cancer are often absent, meaning it needs to be detected through either a PSA blood test or a prostate MRI scan.”
Frequent Urination: Could It Be Diabetes?
Urinary symptoms can sometimes be a pointer towards other health conditions. “Type 2 diabetes, in particular, is extremely common as men age and leads to an increased urine volume, placing pressure on the urinary tract to expel the urine without causing noticeable symptoms,” Greg observes. “I recently saw a patient with this exact issue. We always consider diabetes when a patient presents with lower urinary tract symptoms, and it’s not uncommon to diagnose diabetes in individuals who come in with these complaints.”
Urinary Tract Infections in Men: Rare and Concerning
“Urinary tract infections (UTIs) are frequently treated by GPs, often successfully and appropriately, particularly in women,” says Greg. “However, it’s far less common for a man to contract a UTI.” He attributes this to the longer length of the male urethra, which generally acts as a barrier against infection.
Consequently, Greg states, “Any UTI in a man would be considered unusual and warrants investigation. While we don’t always find an underlying cause, we always investigate. The focus then shifts to preventing future infections rather than solely worrying about the initial cause.” Common UTI symptoms include frequent urination, a burning sensation during urination, and lower abdominal pain. In older men, UTIs can also manifest as delirium or confusion.
Erectile Dysfunction: More Than Just a Sexual Issue
A new onset of impotence in later life is not merely a symptom of ageing, as Gordon Muir clarifies. “Men develop erectile dysfunction (ED) because they have underlying conditions that emerge as they age – typically vascular disease.” This often involves a thickening of the arteries in the penis, which is a strong indicator that arteries elsewhere in the body may also be compromised. “This is why men often experience erectile dysfunction a year or so before their first heart attack,” Gordon notes. ED can also be linked to diabetes, high blood pressure, and being overweight.
The positive aspect, Greg adds, is that “while ED can be a marker for other health issues, if individuals can improve their metabolic health and lifestyle, they can often improve their erectile function. It serves as a barometer for overall health.”
Reduced Sex Drive: A Matter of Personal Preference
“In my experience,” says Greg, “approximately half of 65-year-old men are interested in being sexually active, while the other half are not particularly bothered. If someone isn’t interested, they won’t present with symptoms. It’s always advisable to see a GP if new symptoms arise, rather than assuming everything is fine and simply purchasing over-the-counter remedies.”
When Symptoms Bother You: Seek Professional Advice and Prioritise Basics
“Some men tolerate symptoms that others would find highly distressing, and this is largely how we as urologists determine if treatment is necessary – based on how much the symptoms are impacting the individual,” Gordon Muir explains.
“If men are bothered by their urinary symptoms, whatever they may be, they should consult a urologist. Medications are usually available to help manage these symptoms, and a series of tests can typically identify the cause. Most often, it’s due to benign prostatic enlargement, which is exceedingly common in ageing men.”
In the interim, focusing on fundamental health practices can make a difference. Staying well-hydrated and moderating caffeine intake can significantly reduce the severity of urinary symptoms.
A Final Word of Warning: Ditch the Cigarettes
Gordon Muir has one last, crucial piece of advice. If you have any concerns about your urinary health, quitting smoking is paramount. “Smoking is another common cause of ED, and it’s the single biggest risk factor for bladder cancer. Men should not smoke.”
