• Christina Hellmann

Back pain and men's health

Following on from my women’s health blog earlier this week where I discussed common gynaecological issues, I wanted to also blog about back pain and its link to men’s health. My information for this blog comes from my notes taken during a lecture which I attended last week delivered by Maidstone and Tunbridge Wells based urologist Alastair Henderson. In his lecture he discussed three conditions that can disguise themselves as back pain. They are:

  • Kidney stones

  • Testicular tumours

  • Prostate cancer

Like my previous blog, I want to share my notes taken from this lecture in the hope that some of the information may be of use to you. If you or anyone you know is experiencing symptoms associated with any of the three conditions discussed in this blog, I encourage you to see your GP as the early detection of these conditions often results in the best outcome.

What is an urologist?

An urologist is a specialist who treats problems of the male and female urinary tract as well as problems that are associated with the male reproductive organs. This includes problems with the kidneys, ureters, bladder, prostate and testicles.

Kidney stones

Whilst kidney stones are not only experienced by men, they are more common in men than they are in women with 3 in 20 men and 2 in 20 women developing them at some stage in their lives. Kidney stones are caused by a build up of crystal-like stones that collect inside the kidney. When enough of these crystals have built up, they come together to form a hard ‘stone’. These crystals are usually caused by a build up of certain chemicals in the blood such as calcium and uric acid. Certain foods and medications can cause higher levels of these chemicals to be in the blood – increasing the risk of developing the stones. Not drinking enough fluid also increases the risk of developing stones.

Kidney stones can vary in size and with smaller stones, you may not even notice you have them as they can pass out unnoticed through urine when going to the toilet. If the stone is bigger, it may not be able to pass through the urinary system. In these cases the stone may become lodged in the kidney or the ureter (the tube connecting the kidney to the bladder) and cause a blockage. When this happens, severe pain (known as renal colic) can occur.

Other symptoms of kidney stones include:

  • Pain in the back, abdomen or side

  • Pain when peeing

  • Blood in the urine

  • Cloudy or smelly urine

  • Nausea/vomiting

  • Fever/chills

Treatment of kidney stones:

  • If the stone is small enough, it may just be passed in urine and no treatment other than painkillers is needed

  • If the stone is larger, it can be broken up using ultrasound or laser energy before being passed

  • If breaking the stone up is not an option, key hole surgery may be necessary to remove it directly

Unfortunately, suffering from kidney stones increases the risk of suffering from them again in the future by 50% - therefore adopting certain habits to prevent this from happening is recommended. These include:

  • Drinking more water – note: whilst drinking more water is a great way to prevent the build up of kidney stones, it’s not advised to drink more water to try and clear an already existing stone unless advised by a consultant. This is because if one kidney becomes blocked by a stone, the kidney will try to go into ‘shut down’ mode to protect itself. When this happens, the other kidney will end up working harder to compensate so any extra fluid consumed will be directed straight to the normal working kidney rather than the dysfunctional one – this will add extra stress onto the urinary system.

  • Reduce salt intake – a high salt diet increases the risk of calcium kidney stones. This is because when there is too much salt in the urine, it prevents calcium from being reabsorbed from the urine into the blood.

  • Vegetarian diet – foods that contain animal protein may increase the acidity of urine which can cause uric acid and calcium stones.

  • Eat lots of fruit and vegetables

  • Keep dairy in the diet – even though the most common type of kidney stone is a calcium stone, it’s actually a low calcium diet that can increase these types of stones from forming. Good calcium options in the diet include milk, cheese and yoghurt.

Testicular tumour

Testicular tumours are one of the less common cancers in men with around 1 in 500 men being affected. The risk increases to 1 in 100 men for those that suffered from an undescended testicle as a child. For reasons unknown, white men have a higher risk of developing testicular cancer than other ethnic groups.

The main symptoms of a testicular tumour include:

  • A painless swelling or lump in one of the testicles

  • A change in the shape or texture of the testicles

  • Back pain – this is usually the result of advanced cancer caused by the spread of the cancer to the lymph nodes around the aorta in the abdomen

Testicles vary in shape and size from man to man so it’s important to know what is ‘normal’ for you. Checking your testicles regularly is the best way to pick up any changes and if anything feels different, it’s important to see your GP. Ultrasound is a very easy way to look for the early stages of testicular cancer.

Treatment of testicular cancer:

  • In nearly all cases of testicular cancer, the affected testicle will be surgically removed – this doesn’t affect your fertility or ability to have sex.

  • Radiotherapy and chemotherapy may also be used on their own or alongside having the affected testicle removed.

Testicular cancer is one of the most treatable types of cancer and the outlook is good. Once the affected testicle is removed, it’s rare for the condition to return in the other testicle.

Prostate cancer

The prostate is a small gland that only men have. It’s about the size of satsuma and is located between the penis and the bladder. It surrounds the urethra (the tube in which urine passes from the bladder to be passed out of the body). The main function of the prostate is to produce a thick white fluid that creates semen when mixed with sperm by the testicles.

Prostate cancer is the most common male cancer but death is usually the result of advanced cancer that tends to occur in men in their 70s-80s. Prostate cancer is not the same as benign prostate enlargement (BPE). BPE is where the prostate enlarges and is thought to occur as a man ages and hormones change. Because of its position, an enlarged prostate can put extra pressure on the bladder and the urethra which can cause symptoms such as:

  • Difficulty starting to pee

  • Needing to pee more often

  • Difficulty fully emptying the bladder

Having an enlarged prostate does not mean that there is a higher risk of developing prostate cancer but as the symptoms are very similar to each other, it’s important to be assessed for both.

Having a prostate screening is not mandatory in the NHS however it is recommended that you see your GP if you notice any change in toilet habits such as the symptoms described above particularly if you are aged between 50 and 70. Back pain is another symptom of prostate cancer but this, like testicular cancer, is usually the result of advanced cancer which has caused the cancer to spread to other areas of the body.

Testing for prostate cancer may involve:

  • A blood test – a blood test will look at your PSA reading (prostate specific antigen). PSA is a protein produced by normal cells in the prostate and prostate cancer cells. It’s normal to have a small amount of PSA in the blood. PSA levels normally rise with age as the prostate enlarges. Having a raised PSA may indicate a problem with your prostate but it doesn’t necessarily have to be cancer. A PSA blood test is often done alongside other tests because the test on its own can sometimes be unreliable.

  • The general rules for PSA readings are:

  • PSA score of 3 and under = a very good sign indicating a perfectly normal working prostate

  • PSA score of above 3 = may warrant some investigation

  • PSA score of above 20 = normally indicative of advanced prostate cancer

  • MRI scan – if your PSA level is raised, MRI scans are usually the next step to see whether any abnormal signs can be seen on a scan

  • Biopsies – there are a few types of biopsy for the prostate. During the biopsy, a needle will be inserted into the prostate to extract a sample of tissue to be studied. If cancerous cells are found during the biopsy, they will be studied further to determine how aggressive the cancer is and what treatment will be best – this is called ‘grading and staging’

  • DRE – digital rectal examination – this involves a quick examination in which a doctor or nurse uses their finger to check the prostate inside the bottom

Treatment for prostate cancer may include:

  • Watchful waiting – for many men with prostate cancer, treatment is not immediately necessary especially if the cancer is at an early stage or causes no symptoms

  • Radiotherapy – either used on its own or alongside hormone therapy

  • Surgery – to remove the prostate completely

  • If the cancer is already at an advanced stage and has spread to other parts of the body when it is diagnosed, the treatment is focused on prolonging life and relieving symptoms

Unfortunately having the prostate removed can carry significant side effects such as erectile dysfunction and bladder incontinence. Because of this, some men choose the watchful waiting option of treatment until there’s a risk of the cancer spreading. Prostate cancer usually progresses very slowly and men can live for decades without needing treatment. However it can affect life in other ways such as feeling anxious or depressed. It’s encouraged that men affected have a good network of friends and family around them to discuss any worries or concerns.


I hope this information has been useful. It’s been proven that early detection of kidney stones, testicular tumours and prostate cancer can often give the best outcome. Therefore, once again, if you or someone you know has started to experience any changes or symptoms that are unusual, I strongly recommend you see your GP. I said in my last blog of the importance of normalising talking about these sort of things as being aware of what’s ‘normal’ and what isn’t can help to save lives. Please help me to spread the word by sharing this blog and stay tuned for some fresh blogging next week!