MEN'S HEALTH MATTERS/THOMAS LYNCH:Your health questions answered
QI am a 55-year-old male and have recently noticed a lack of energy, some weight loss (around 8kg) and a tend- ency for my bowel motions to be poorly formed. My GP says I may have coeliac disease. What exactly is this and how is it diagnosed?
A Coeliac disease is caused by inflammation in the upper intestine - called the small intestine. Some 65 years ago, a Dutch doctor, Wilhelm Dicke, realised that the trigger of this inflammation was a common component of the diet, found in wheat and some other cereals.
This cereal component is called "gluten". Dicke discovered that by removing wheat or gluten from the diet, symptoms improved dramatically. This discovery led to a completely effective dietary method of treating coeliac disease, referred to as the gluten-free diet.
There has been much research into coeliac disease in recent decades. Originally, it was thought to be a relatively rare disorder and that it primarily affected children.
It is now appreciated that as many as one in 100 are affected and that the condition can be diagnosed in any age group. Whereas in Dicke's time, patients usually had very dramatic symptoms - with marked diarrhoea, tummy pain, weight loss - nowadays many patients often have mild symptoms, such as poor energy, and are found to have a low blood count (called anaemia).
The inflammation in the small intestine causes damage to the lining layer of the bowel. The small intestine has a fundamental role in absorbing nutrients from the diet and when the lining layer is damaged, these nutrients are poorly absorbed.
These include iron and the vitamin folic acid, both of which are essential for manufacturing red blood cells. In the absence of iron or folic acid, a patient will develop anaemia. Patients may also not absorb calcium properly and develop osteoporosis. Fats in the diet are also poorly absorbed, which is responsible for the diarrhoea that patients complain of.
If your doctor suspects coeliac disease, certain blood tests can give very useful information as to the likely presence of this condition. These blood tests are based on a patient developing an antibody to a particular enzyme found in the small intestine: this enzyme is called tissue transglutaminase. The other critical test in diagnosing the disease is a biopsy.
When a patient is diagnosed with coeliac disease, excluding all gluten containing foods from their diet can cure them.
Q I am 39 years old and recently noticed blood in my semen. It was rather alarming but do I need to worry about it?
A Blood in the semen (hematospermia) can be very alarming, however, bloody semen is almost never a sign of a serious underlying medical problem. In most cases, bleeding follows damage to small blood vessels in the urinary tract or prostate gland.
This may come from minor trauma or irritation, or growth of normal blood vessels. Small amounts of blood may linger in the semen for weeks, but most cases resolve on their own.
It's very rare for bleeding to come from a serious cause such as cancer, particularly in men under 40. Young men who have a single episode of bleeding that goes away on its own generally need no evaluation other than an examination by their doctor and a urine specimen.
A more thorough work-up may be worthwhile in older men, or in men who have persistent or recurring episodes of bleeding. Such a work-up might include cystoscopy, which is an inspection of the bladder, an ultrasound of the bladder and prostate. However, most of these evaluations will be entirely normal. In fact, even after extensive testing, it's unusual for a specific cause of the bleeding to be identified.
Possible rarer causes of blood in the semen include: urinary tract infections; prostatitis (inflammation of the prostate); sexually transmitted diseases such as gonorrhea or chlamydia; benign prostate hyperplasia (benign non- cancerous enlargement of the prostate); surgical procedures such as prostate biopsy or bladder catheterisation; trauma to the testicles or prostate; or cancer of the prostate, bladder or reproductive organs.
• This column is edited by Thomas Lynch, consultant urological surgeon, St James's Hospital, Dublin with contributions from Prof Conleth Feighery, consultant immunologist. Please send your questions to healthsupplement@irish-times.ie