LUTS

What are Lower Urinary Tract Symptoms? 

Lower urinary tract symptoms are a common problem in men and the incidence of these symptoms increases with age. Lower urinary tract symptoms may be divided into voiding and storage, and men may present with a combination of the two symptom groups. Voiding symptoms include:

  • Weak stream
  • Hesitancy 
  • Incomplete emptying or straining

Storage symptoms include:

  • Urinary Frequency
  • Urinary Urgency
  • Nocturia

In elderly men who present with lower urinary tract symptoms, indications for early referral to a urologist include haematuria, recurrent infections, bladder stones, urinary retention and renal impairment. In uncomplicated cases, medical therapy can be instituted in the primary care setting. Options for medical therapy include alpha blockers to relax the smooth muscle of the prostate, 5 alpha reductase inhibitors to shrink the prostate, and antimuscarinics to relax the bladder. 

What Causes Lower Urinary Tract Symptoms?

Where lower urinary tract symptoms are present, particularly if the individual has pain on urination (dysuria), there may be an acute problem such as a urinary tract infection, in inflammation of the prostate gland (prostatitis) or less commonly, bladder stones.

Storage symptoms or overactive bladder (OAB – defined as urgency, with or without urge incontinence, usually with frequency and nocturia) may indicate an underlying chronic medical condition such as obesity, diabetes (high glucose levels in the blood), high blood pressure or obstructive sleep apnoea, or be due to the effects of smoking. Lifestyle factors including drinking fluids late at night, too much alcohol or caffeine, or low levels of physical activity can make storage symptoms worse.

Voiding symptoms are usually due to a blockage of the outlet of the bladder making it more difficult to pass urine. The blockage may be caused by an enlarged prostate gland or a urethral stricture (scarring of the urethra). Enlargement of the prostate gland can lead to both storage and voiding symptoms.

Other causes of LUTS include some medicines and neurological diseases such as stroke and Parkinson’s disease. There are also links between LUTS and depression and erectile dysfunction. It is common for there to be several factors at the same time to cause LUTS and the exact cause is not always easy to find.