The ‘global stone belt’ is not what you think it is. Doctors advise young men to look after their urinary health


SINGAPORE — Whether it is groin discomfort, a burning sensation when urinating or trouble maintaining an erection, there are some below-the-belt symptoms that should not be ignored, even in younger men. 

In conjunction with men’s health awareness month in November, TODAY asked doctors about the most common urological problems that they see in younger male adults, the warning signs of a serious condition and what to know to prevent them.

1. AN INFLAMED PROSTATE

Prostate conditions are often associated with older adults, but younger men can also experience problems with their small, walnut-shaped organ located between the bladder and penis.

Prostatitis, or an inflamed prostate, is among the most common conditions seen among younger men in their 20s to 40s. 

“As with every organ in the body, the prostate can get infected,” Dr Jay Lim said.

The urologist in private practice with PanAsia Surgery Group added that in many cases, it is unclear why it happens but when the source is isolated, it is usually related to a bacterial infection of the urinary tract.

Unlike a urinary tract infection (UTI), he said that the symptoms can be hard to pinpoint and some patients may have difficulty describing their symptoms. 

“They sometimes feel that something is wrong, when they go to the toilet, when they sit or stand. Many of them describe this ‘heavy’ sensation but may not have overt symptoms like fever or blood in the urine when they have prostatitis,” Dr Lim said.

A suspicious symptom would be bloody or painful ejaculation. Some people may report a pulling ache or a vague sensation in the perineal region (the area between the anus and the scrotum).

Symptoms associated with UTI such as blood in the urine and painful urination can also occur with prostatitis.

Most cases are not life-threatening and the immune system will fend it off, but Dr Lim advised men to seek medical attention and get prostatitis treated. 

“Treatment in the form of oral antibiotics for two weeks is usually recommended as it helps with the symptoms and prevent progression,” he said. 

“Without treatment, there will be symptoms and the recovery journey will take longer — months — to resolve.”

In patients with existing conditions such as diabetes, prostatitis can worsen and evolve into a prostatic abscess (a build-up of pus within the prostate), he added.

2. ERECTILE DYSFUNCTION AND LINKS TO STROKE OR HEART DISEASE

For men who have trouble obtaining or sustaining an erection sufficient for sexual intercourse, there is more to worry about other than their sexual performance. It could be a warning sign of a serious medical condition, such as heart disease or stroke.

It is estimated that erectile dysfunction may precede the first cardiovascular event by an average of three years. This is based on a review published in 2021 in the Journal of Clinical Medicine, an international and peer-reviewed journal on clinical and pre-clinical research.

One of the common conditions seen at the department of urology in Sengkang General Hospital is erectile dysfunction and it can happen to men of any age group. 

In Singapore, a past study have shown that about half of the men over the age of 30 have some degree of erectile dysfunction. The condition becomes more prevalent and gets worse with age, particularly after 50. 

Dr Thomas Chan, a consultant with Sengkang General Hospital’s department of urology, said, “Although it is more likely to occur with the advancement of age, it is a common misconception that erectile dysfunction is purely due to ageing.” 

“From our experience (managing this group of patients), erectile dysfunction can be attributed to overt or even undiagnosed metabolic diseases, such as diabetes and cardiovascular diseases.”

That said, not all erectile dysfunction is due to blocked arteries or other underlying medical conditions.

For some younger men, psychological factors such as stress, relationship problems and performance anxiety could affect their ability to achieve adequate erection.

3. URINARY TROUBLES AND LINKS TO SEXUALLY TRANSMITTED DISEASE

There are many reasons why men get UTIs: Diabetes, kidney stones and dehydration, for example. An enlarged prostate due to ageing could also lead to recurrent infections. 

Dr Tan Wei Jie from Dtap Clinic said that in younger men, one of the common causes for UTI is a sexually transmitted infection (STI). 

“At Dtap, due to the nature of our practice, we see young men coming into our clinic with symptoms, and the majority of them will end up being diagnosed with a form of STI.”

Dtap clinics offer a general practitioner’s services with a focus on men and women’s health including sexual health. It also provides screening for STIs and the human immunodeficiency virus (HIV).

Common STIs that can cause urological symptoms are chlamydia, gonorrhoea, trichomoniasis, mycoplasma and ureaplasma — Dr Tan sees around 10 to 20 of such cases each week. 

Some of these infections spread by sexual activity can also cause inflammation of the testicle and epididymis (the coiled tube behind each testis that stores and carries sperm).

Besides painful urination and increased trips to the bathroom, other warning signs may include discharge from the penis, painful sex, blisters and sores around the genitals or anus. 

Dr Tan said: “If any of those symptoms are present, you need to visit your healthcare providers as soon as possible for investigations and treatment.

“STIs that are left untreated can develop complications such as infertility, pelvic inflammatory disease, kidney infection and even cancers affecting the penis, anus, back of the throat, cervix and vagina.”

Untreated STIs can also be transmitted very easily through sexual intercourse. Individuals with symptoms should avoid sexual intercourse until they have been tested and cleared from the infection, Dr Tan added.

He also pointed out that some STIs can have no symptoms, so it is important to undergo regular screening to avoid passing any unwanted diseases to loved ones. 

 4. KIDNEY STONES FROM DEHYDRATION

Kidney stones is a painful urinary disorder that is more common among men and usually among those between 20 and 40 years old, the National Kidney Foundation states.

Living in a tropical climate, excessive caffeine intake from coffee, tea or cola, as well as not drinking enough water, are prime conditions for the body to develop kidney stones, Dr Lim from PanAsia Surgery said. 

He also said that Singapore is situated along the “global stone belt” along with northern Australia, India, the Middle East and the southern part of the United States.

People living in these places are more susceptible to developing kidney stones. These hard deposits made of minerals and salts that form inside the kidneys can affect any part of the urinary tract. 

“Caffeine beverages cause diuresis (increased urine flow or output) and contributes to dehydration of the body. A high-salt diet and high consumption of meat, along with a high oxalate intake, puts one at a greater risk of kidney stones as well as UTI,” Dr Lim explained. 

Foods rich in oxalate include peanuts, soy, almonds, potatoes, tea, cereal grains and beets.

Kidney stones can set off symptoms such as sudden back or flank pain, blood in urine and recurrent UTIs. When stones obstruct urine flow, severe pain or renal colic (sudden, acute pain in the kidney area) is often described as a 10-out-of-10 pain. 

“Without treatment, urine flow is obstructed and the obstructions can affect kidney function,” Dr Lim said. 

Urosepsis, a life-threatening condition, can occur when the obstructed urine becomes infected.

“Even if the infection doesn’t happen, long-term obstruction of the kidney leads to destruction of the obstructed kidney. I’ve encountered patients in their 20s who lose one of their kidneys due to previously undiagnosed stone diseases,” Dr Lim added. 

PREVENTION TIPS

1. STAY HYDRATED, PRACTISE SAFE SEX

Dr Lim said that many urological conditions that occur in younger men are preventable through simple changes to lifestyle and diet. Getting adequate hydration is one way, for example. 

However, how much fluid is considered “adequate” to prevent kidney stones?

International guidelines recommend “producing 2.5L of urine per day”, Dr Lim said.

“To achieve that, one would need around 3L of pH neutral fluids (water) because you lose around 500ml through sweat, skin and saliva,” he added.

“But that may not be feasible. For my patients, I’ll tell them that minimally around 1.5L to 2L (around six to eight cups) of pH-neutral fluids a day is good enough.” 

Dr Lim emphasised that the recommended fluid intake should not include caffeinated drinks such as coffee, tea and soft drinks. 

“Everyone thinks that you’re taking in fluids when you drink caffeinated beverages, but they do not count. They are a diuretic,” he said, meaning that they causes an increase in urine production.  

“To simplify things, I tell my patients to imagine that if you drink a cup of coffee, you’ll have to remember to top it up — with around 1.5 cups of water. While it’s not exactly the amount, it helps my patients remember better.”

Dr Lim said that not holding in urine for long periods of time and voiding after sexual intercourse are other ways that may reduce the risk of urological problems. 

“Bodily fluids are exchanged during sexual intercourse. Voiding after intercourse (which refers to urinating after sex) helps with flushing the urethra and prevents UTIs,” he explained.

The doctors said that there are no specific check-ups or screening programmes for most urological conditions and for younger men. 

“Unless UTIs and stone diseases plague you or you have a family history of urological issues, most men below 50 will not need to see a urologist,” Dr Lim said.

“However, it would be prudent to undergo an annual health screening that includes a urine test and imaging of the kidneys, which can detect early onset of urological problems.”

Protecting against STI is also important. Dr Tan from Dtap advised men to practise safe sex by using a condom, staying in a long-term mutually monogamous relationship, reducing the number of sexual partners and abstaining from high-risk sexual intercourse. 

He also advised staying up-to-date with the latest vaccinations for hepatitis B and the human papilloma virus that can be transmitted via sexual activity.

 2. DO KEGEL EXERCISES

Women are often told to do Kegel exercises as a way to strengthen their pelvic floor muscles and improve bladder and bowel control, especially after pregnancy and childbirth. 

They can benefit men in several ways, too, including alleviating certain urological symptoms.

Dr Chan from Sengkang General Hospital said that Kegel exercises are often recommended to men to prevent stress urinary incontinence — or urine leak — or who are recovering from it. Urine leak is a common side effect in the first few months after a prostatectomy (partial or complete removal of the prostate) for prostate cancer. 

The exercises may help ease symptoms of an overactive bladder. They have also been advocated as a potential treatment method for erectile dysfunction and premature ejaculation, Dr Chan added. 

“The strengthening of the pelvic floor muscles may improve penile rigidity in erectile dysfunction and may help delay premature ejaculation,” he said. 

To reap the benefits, however, the right set of muscles must be engaged during the exercise. 

“The technique of Kegel exercises is often a difficult concept for men to understand and apply. But once it is understood, it can be done anytime, anywhere,” Dr Chan said. 

To locate the pelvic floor muscles, try stopping urination mid-stream or tightening the muscles required to keep from passing out gas. 

Once you have done so, perform two different series of Kegel exercises, with these tips from Dr Chan.

  • The “strong and long” series: Contract the pelvic floor muscles for about three seconds, then relax for three seconds. Repeat this for a total of 10 contractions
  • The “light and short” series: Contract the pelvic floor muscles for one second, then relax for one second. Repeat this for a total of 10 contractions

Consult a urologist or specialist nurse if you want to do the Kegel exercises but still have difficulty locating the pelvic floor muscles.



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