Lower Urinary Tract Symptoms (LUTS) - An Overview

Introduction

LUTS stands for lower urinary tract symptoms. It refers to symptoms that can affect the bladder and urethra, such as frequent urination, the urge to urinate, difficulty starting or stopping urination, weak urine flow, and incontinence (involuntary loss of urine).

Various conditions, such as an enlarged prostate, prostate cancer, urinary tract infections, and nerve damage, can cause these symptoms. LUTS can also be caused by certain medications or lifestyle factors. It is essential to consult with a healthcare professional if the patient experiences any of these symptoms to determine the underlying cause and appropriate treatment.

What Are the Lower Urinary Tract Symptoms?

LUTS can be separated into two categories: symptoms related to storing urine and symptoms related to voiding or micturation (urinating).

Storage Symptoms Include:

1) Increased Frequency: The need to urinate more frequently than usual.

• Increased frequency during the day.

• Nocturia (increased night-time frequency).

• Polyuria is defined as passing more urine than usual.

• Diurnal (daytime) polyuria.

• Nocturnal (nighttime) polyuria.

2) Symptoms of Bladder Filling:

• Increased Bladder-Filling Sensation: The sense of having a full bladder happens faster or stronger than usual.

• Urgency: The sudden and difficult need to pass urine.

• Filling Sensation: The sensation of having a full bladder is delayed or weaker than usual.

3) Symptoms of Urinary Incontinence:

• Urinary incontinence or involuntary urine loss or accidents.

• Urgency urinary incontinence is the involuntary leakage of urine that happens with a sense of urgency.

• Stress urinary incontinence is the involuntary loss of urine during effort, exertion, coughing, or sneezing.

• Enuresis is defined as an involuntary loss of urine while sleeping.

• Urine loss after altering posture or body position is called postural urinary incontinence (for example, when moving from sitting to standing).

• Disability-related incontinence is the involuntary loss of urine caused by an inability to reach the bathroom on time owing to physical and/or mental limitations.

4) Voiding Symptoms Include:

• Hesitancy is defined as a delay in starting to urinate when one is ready.

• Paruresis is trouble urinating in the presence of others but not in the absence of others.

• Dysuria is defined as pain during urinating.

• Hematuria is the presence of visible blood in the urine.

• Pneumaturia is the flow of gas or air during or following urine.

• Retention of the urine:
  • Acute urinary retention is sudden onset discomfort or pain from a full bladder caused by an inability to pass urine despite repeated attempts.
  • Chronic urinary retention is the inability to empty the bladder despite regularly passing small volumes of urine.
• Incomplete bladder emptying is the sensation that the bladder is not completely emptied after urinating.

• Need for double voiding is the desire to urinate immediately after urinating.

• Post-micturition urgency is the urgency to urinate after completing urination.

What Are the Most Common Causes of Symptoms in the Lower Urinary Tract?

LUTS is frequently caused by urinary system irritation, infection, or obstruction:

• Bladder (bladder obstruction).

• Kidneys (cysts, stones).

• Ureters (ureteral obstruction).

• Urethra (urethral stricture).

The symptoms could indicate a medical problem, such as:

• Benign prostatic hyperplasia or enlargement of prostate. It is a condition in which an overgrowth of prostate tissue pushes against the urethra and the bladder, blocking the flow of urine

• Infection of the kidneys.

• Multiple sclerosis causes nerve damage, affecting communication between the brain and body.

• Prostate cancer.

• Infection of the urinary tract (UTI).

Lower urinary tract symptoms are also linked to the following:

• Diabetes.

• ED (erectile dysfunction).

• High blood pressure.

• Obesity.

• Dysfunction of the pelvic floor.

• Thyroid condition.

• Using substances that act as irritants to the bladder such as nicotine, coffee, and alcohol.

What Are the Treatment Options for LUTS Patients?

• Medicine: Antibiotics can help cure urinary tract infections, a common cause of LUTS. Depending on the source of the LUTS, other medications can relax the bladder, restrict the bladder, or affect the size of the prostate.

• Lifestyle Changes: People may need to reduce weight, lower their blood pressure, stop smoking, or adjust their drinking habits to help control LUTS. For example, one may need to avoid alcohol or consume no fluids before going to bed. The doctor can assist in making these healthful changes.

• Transurethral Resection of the Prostate (TURP): If a patient has LUTS due to a highly enlarged prostate, the doctor may conduct surgery to remove part of the prostate and relieve pressure on the bladder and urethra. The doctor will put a specialized camera and surgical tool into the urethra during this minimally invasive treatment (the tube which carries urine out of the body). Doctors can use this tool to remove portions of the prostate. The procedure will not leave any scars, although they may be hospitalized for one to two days.

• Holmium Laser Enucleation of the Prostate (Holep): During this procedure, the urologist uses a laser to remove sections of the prostate that obstruct urine flow. They also use a specialized tool to remove sections of the prostate. Like TURP, patients will have no scars and recover quickly with only a day or two in the hospital.

How Does the Doctor Diagnose LUTS?

To diagnose LUTS, the doctor may:

• Ask a series of short questions to assess the existence and severity of LUTS.

• Check urine and perform a physical exam to see if there is any urinary tract infection.

• Ask a patient to record the fluid consumption and urine output to help assess urinary function.

• Suggest tests to evaluate the prostate gland.

What Are Some of the Health Effects of LUTS?

The effects of LUTS can be significant and disruptive to one's life. They can lead to feelings of discomfort and inconvenience, making it difficult to leave the house or socialize.

LUTS can also cause emotional distress, such as anxiety and depression, and affect personal relationships. In some cases, LUTS can also lead to sexual dysfunction in men.

Furthermore, urinary retention can be painful and lead to infections or damage to the urinary tract. It is important to seek medical attention if the patient experiences any urinary symptoms, as they may indicate a severe underlying condition.

Why Is It Important to Seek Treatment Early in LUTS?

It is important to see a doctor if the patient is experiencing symptoms of a lower urinary tract infection to review the symptoms, discuss their impact on the patient's life, and discuss the available treatment options. It's best to seek treatment as early as possible since LUTS can worsen over time without treatment. If a person is experiencing symptoms of acute urinary retention, such as pain, difficulty urinating, or an inability to pass urine, it is crucial to seek medical attention immediately, as a catheter may be necessary to drain the bladder.

Conclusion

Lower urinary tract symptoms (LUTS) refer to symptoms affecting the bladder and urethra, such as frequent urination, an urgency to urinate, difficulty starting or stopping urination, weak urine flow, and incontinence. Various conditions, such as an enlarged prostate, prostate cancer, urinary tract infections, and nerve damage can lead to LUTS. Treatment options include antibiotics for urinary tract infections and other medications depending on the source of LUTS. Lifestyle changes such as reducing weight and limiting the intake of irritants like nicotine, coffee, and alcohol may also be recommended. It is important to consult a healthcare professional to determine the underlying cause of LUTS and the appropriate treatment.