Lower urinary tract symptoms are very common in older men. These symptoms may include slowing of the urine stream and needing to get up to pass urine at night. There are different causes of LUTS and the treatment will depend on the cause. Some men even choose not to have treatment if their symptoms are not too bothersome and the cause is not serious.
What are lower urinary tract symptoms?
The urine production system can be divided into the upper tract (kidneys and ureters) and lower tract (bladder and urethra). Lower urinary tract symptoms (LUTS) are a very common problem, especially in men over the age of 65 years. They can be caused by various conditions.
LUTS are usually divided into storage of urine (also called irritative) and voiding (also called obstructive) symptom groups.
- Voiding symptoms include: poor stream, hesitancy, intermittent flow and straining when passing urine.
- Storage symptoms include: increased frequency and urgency of passing urine, urge incontinence and needing to get up to pass urine at night.
Other symptoms may include feeling the need to pass urine again after you have just emptied your bladder and dribbling of urine after you have been to the toilet.
What are the causes of lower urinary tract symptoms?
There are various causes of LUTS. The more common causes include:
- An enlarged prostate gland. The prostate gland (referred to from now on here as the prostate) is situated around the neck of your bladder. When this gets bigger it can cause voiding symptoms. See the separate leaflet called Prostate Gland Enlargement for more details.
- Overactive bladder. As men (and women) get older, it is more common to develop bladder control problems. Your bladder may also be less able to store urine. This leads to you needing to pass urine more frequently and can even lead to leakage of urine at times (incontinence). See the separate leaflet called Overactive Bladder Syndrome for more details.
- Water balance problems. As people get older, it becomes harder for the body to reduce the amount of urine that they pass at night. This leads to the need to pass urine more often at night. Therefore, at the age of 65 and over it can be normal to pass urine at least once a night.
What tests are commonly performed?
The tests you may have will vary depending on your symptoms.
Your doctor may examine your prostate to see how big it is. This is done by inserting a gloved finger through the anus into your rectum to feel the back of your prostate. The size of your bladder may be assessed by examining your tummy (abdomen).
The most common tests performed include:
- A urine dipstick test to exclude an infection in your urine or any blood in your urine.
- A blood test for glucose to exclude diabetes.
You may be asked to complete a urinary frequency volume chart on which you will be asked to document the times that you pass urine and also the amount of urine you have passed each time.
What self-help treatments are available?
The following, which you may find help your symptoms, you can do yourself:
- Reduce the amount of fluid you drink. There is no correct amount of fluid for you to drink but, if you are drinking too much, you can often improve your symptoms by reducing your fluid intake.
- Reduce drinking in the evening. You should try to drink as little as possible after 4 pm if you are having night-time symptoms.
- Try to anticipate times when urinary frequency and urgency are likely to be most inconvenient and reduce the amount that you drink beforehand. For example, when you go out, don't drink much for 2-3 hours before you go out. However, do not reduce the total amount of fluid to less than 1.5 litres each day.
- Consider changing what you are drinking. Alcoholic, fizzy and caffeine-containing drinks can all make LUTS worse. You should stop drinking these to see if this improves your symptoms.
- If you are a smoker then stopping smoking may significantly improve your symptoms, as nicotine irritates the bladder.
- Try to train your bladder. This means you should try to hold on to urine for longer if you are experiencing a frequent desire to pass urine. If you can, you should try to gradually increase the time between visits to the toilet and also increase the amount of urine that you pass each time. The bladder muscle can be trained to expand more in this way.
- If hesitancy is a problem - try to relax when standing to pass urine.
- If urgency is a problem - try some distraction techniques such as breathing exercises and mental tricks (for example, counting) to take your mind off the bladder.
- Pelvic floor exercises. These can help you to hold on to urine for longer and also without having accidents. You use your pelvic floor muscles if you try to interrupt your flow of urine. You should try to tighten these muscles for around 10 seconds, at least 10 times each day.
What other treatments are available?
The treatment for your LUTS will depend upon:
- The underlying cause.
- How much your symptoms are bothering you and interfering with the quality of your life.
For example, if you have an enlarged prostate then you may be offered a medicine to shrink your prostate or an operation to remove some of your prostate. Different operations can also be performed for men with other symptoms.
Medicines can also be effective to improve symptoms of an overactive bladder and storage symptoms. They can also improve symptoms of passing urine in the night.
If you are experiencing problems with continence of your urine then you may benefit from using a small tube (a catheter) to drain the urine from your bladder. Many men use catheters just to empty their bladders so they do not have a catheter in all the time. However, some men may need to have long-term catheters. This will be discussed with you in more detail by your doctor if you are likely to benefit from this.
You may be referred to a specialist, especially if your symptoms have not improved with some of the self-help measures or with some medication. You may also be referred if you need further tests.
Further reading and references
Lower urinary tract symptoms in men: assessment and management; NICE Guidelines (June 2015)
Guidelines on the Management of Non-Neurogenic Male Lower Urinary Tract symptoms (LUTS), incl. Benign Prostatic Obstruction (BPO); European Association of Urology (2018)
LUTS in men; NICE CKS, February 2015 (UK access only)
Pelvic floor muscle exercises for men; Prostate Cancer UK.
Aikawa K, Yamaguchi O, Oguro T, et al; New classification for men with lower urinary tract symptoms: cluster analysis using the International Prostate Symptom Score. BJU Int. 2012 Aug110(3):408-12. doi: 10.1111/j.1464-410X.2011.10771.x. Epub 2011 Nov 17.
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