Men’s health is important throughout the lifespan. It becomes increasingly important though as you age to undergo regular screening for common health issues to maintain optimal health. We know that spinal cord injury can impact how men access these tests.
Spinal cord injury can mean a greater risk for many common men’s health issues, such as cardiovascular disease. For some, SCI may make it harder to detect symptoms of health issues and make screening tests more difficult or harder to access. This chapter briefly covers screening tests that are recommended for men generally, and those that are important to know about for men with SCI.
What Can I Do About It?
Become aware of the unique issues related to your spinal cord injury and the recommended screening tests to help you stay healthy and avoid common health issues throughout your life.
Guidelines for Screenings: When and Why
Cardiovascular disease & metabolic syndrome
Persons with SCI are at a greater risk for cardiovascular disease and metabolic syndrome. Your risk increases with age, level of injury and severity of injury.
Metabolic syndrome: A cluster of conditions that occur together increasing your risk for cardiovascular disease, type 2 diabetes and stroke. Metabolic syndrome is defined as having 3 or more of the following traits:
- a waistline that measures more than 40 inches (102 centimeters) for men
- high triglyceride level (a type of fat in your blood),
- low “good“ cholesterol, called HDL cholesterol,
- increased blood pressure, and
- increased blood sugar.
These can be measured by your doctor. Testing should start earlier for people with spinal cord injury even without obvious signs. Speak with your doctor about when testing should start for you.
Low testosterone (hypogonadism) is quite common (about 40%) in men with spinal cord injury. The most common causes for low testosterone are: obstructive sleep apnea, multiple concussions or brain injury, and/or opioid use. It is also commonly seen with cardiovascular disease, diabetes, metabolic syndrome and other chronic illnesses.
Common symptoms in men with SCI are: low sexual drive, fatigue, foggy brain/ low mood, poor strength and low sexual drive.
Testosterone levels can be acquired through blood testing. Speak to your doctor if this is a concern for you. Typically we suggest looking at total and bioavailable testosterone levels along with FSH, LH, TSH, prolactin. Testosterone levels can be replaced to normal by taking testosterone, but if you wish to be a biological father, other medications need to be used instead to increase your blood level of testosterone without affecting your fertility.
Spinal cord injury puts you at higher risk for osteoporosis. Please talk to your doctor about when testing bone density might be right for you. You can read more about the Dual-energy X-ray absorptiometry (DXA) bone density test and how to prepare for the BMD test.
Colon cancer risk is higher among men as they age, and men with SCI may have difficulty detecting the warning signs of colon cancer because of neurogenic bowel and bowel programs. Colonoscopy is a test used to screen for colon cancer that is strongly recommended for men over 50, or for people who are in higher risk groups.
Colonoscopy requires your bowel to be completely empty using a bowel prep solution that moves your bowels repeatedly over a short period of time. It requires a lot of time spent on the toilet which can pose a risk to your skin, and may increase symptoms of AD due to repeated bowel movements. It’s a good idea to talk to your physiatrist or outpatient rehab nurse before you undergo bowel prep to know how to do so in a manageable way.
After SCI, you may not have sensation in your genital areas, which can result in pinching or injury due to constant sitting. It’s important to do skin checks frequently, for example, once a day or every other day, to know whether your skin on these delicate areas is healthy. Pinching of the genitals can be a potential trigger for Autonomic Dysreflexia in males, so keep in mind when you transfer to and from your wheelchair if AD is a concern for you.
Lack of air circulation over the skin of your groin area due to a seated position can lead to skin irritation or rashes such as “Jock Itch” or groin rash. This can be prevented by keeping the skin clean and dry – drying completely after bathing, and keeping clothes dry and free of moisture. There are some cushions that promote air circulations which can also be helpful. Rashes themselves can be cleared up with anti fungal ointments prescribed by your family doctor.
Routine Men’s Health Screening
Screening for men with SCI is an important part of your overall health and can help to identify health risks early enough to treat or intervene. As a person with SCI, it’s important to talk to your doctor about screening tests if your doctor hasn’t recommended them already.
- Prostate Cancer Screening: Screening typically begins at age 40 if there are family risk factors, or age 50 otherwise. It’s important to learn about the basics of screening, causes and prevention.
- Digital rectal exams (DRE): A DRE is typically done as part of your annual physical exam. The purpose is to check for prostate enlargement or other abnormalities. A DRE is done as a baseline typically with PSA blood work prior to the initiation of Testosterone replacement therapy.
- Prostate specific antigen (PSA) blood work: check at age 40 for a base-line level or prior to starting on testosterone replacement therapy. Please note: ejaculation, digital stimulation for bowel care should be avoided for at least 3 days prior to the test.
- Breast Screening: Although the numbers are significantly less in men than females, men can also be at risk for developing breast cancer. The risk increases with age. Please see this link for further description of your risk factors and the symptoms.
- Testicular screening: Testicle self-exams are recommended to be done monthly, preferable after a warm shower or bath. These simple exams can help you detect lumps or abnormalities of your testicles early and reduce your risk of testicular cancer. If you have lower hand function from quadriplegia, a partner or family doctor can help with testicular exams.
Inform yourself about how you can best look after your health. Know how your risks are higher for common medical conditions and discuss them with your physician. Many family physicians may not be aware of SCI-specific concerns about screening tests, or risks that are higher for SCI than the average. You can use this chapter as a guide to talk with your physician about how to stay healthy and what screening you should consider and when.
Many screening tests require preparation or mobility that you may not have – your role is to ask a trusted healthcare professional for help. Physiatrists, outpatient rehab nurses and your family doctor may be ideal partners to assist you with an exam, or to help direct you to a screening facility that is accessible. If in doubt, ask!
Who Can Help Me?
Your family doctor
SCI BC’s Infoline is a wealth of information on how peers have dealt with common health issues and medical tests. You can reach the Infoline Monday-Friday 9am-5pm, at 1-800-689-2477 or firstname.lastname@example.org.
Accessing these routine screening assessments are essential for optimal health for any male. We understand that accessibility can oftentimes make these tests feel like a huge hassle when you are living with a spinal cord injury. We hope that the information provided here can help you prepare and feel proactive in your health.
Men's Health Resources
Heads Up Guys- managing and preventing depression in men - University of BC
About the DXA Bone Density Test - Prohealth Vancouver
Bone Density After A Spinal Cord Injury - Spinal Cord.com
Breast Cancer in Men - Canadian Cancer Society
Early Identification of Cardiovascular Diseases in People With Spinal Cord Injury - Archives of Physical Medicine and Rehabilitation (PDF)
Health Considerations in Spinal Cord Injury: A Handbook for People with SCI - University of Louisville
How to do a Testicular Self-Exam (Slideshow) - Kids Health.org
Men's Cancer: Prostate - BC Cancer
Monthly Testicular Self-Exams - Testicular Cancer Awareness Foundation
Preparing for the BMD Test - Prohealth Vancouver
Tests and Procedures: Digital Rectum Exam (DRE) - Canadian Cancer Society
Check out the Video Playlist for this chapter!
Check out the video playlist for this chapter!