Management of urinary symptoms
Lower urinary symptoms in men
Lower urinary tract symptoms in men are categorised into voiding (weak or intermittent urinary stream, hesitancy, straining, terminal dribbling, incomplete bladder emptying) and storage (frequency, urgency, urge incontinence and nocturia (need to wake up during the night to urinate) symptoms to help define the source of the problem.
Possible causes of these symptoms are related to abnormalities of the prostate, urethra and bladder.
The most common cause in men is benign prostate enlargement (BPE), which obstructs the bladder outlet. Other conditions that can cause urinary tract symptoms in men include weakness or overactivity of the bladder muscle, urinary tract infection (prostatitis), prostate cancer, urethral srictures, tight bladder neck and neurological diseases.
Age is an important risk factor for lower urinary tract symptoms and the prevalence of urinary tract symptoms in men increases as men get older.
Lifestyle measures - avoid caffeine, fizzy or acidic drinks, alcohol. Drink around 2 litres per day to keep urine dilute, and avoid evening fluids if night time waking is a problem.
Do not drink before you go to bed - if you need to wake up many times during the night to pass urine
Only have a few sips of water at night - if you wake up needing a drink
Allow your bladder time to empty properly - wait a few seconds, then try to empty more.
You may be referred to a specialist Urologist if your symptoms do not improve after life style measures for further investigation and treatment of your lower urinary tract symptoms
Lower urinary symptoms in women
Lower urinary tract symptoms (LUTS) are common in women of all ages, especially between the ages of 30-60.
The symptoms may include wetting yourself (incontinence), needing to pass urine frequently, urgency to pass urine or discomfort passing urine.
Your doctor may recommend tests to look for an underlying cause such as an ultrasound of your kidneys and bladder, flexible cystoscopy or urodynamic investigations. Often, no specific underlying cause is found. Treatment may help to relieve symptoms.
What self-help treatments are available?
The following may help your symptoms:
- Avoid drinking too many drinks containing caffeine. Caffeine can make symptoms worse.
- For a dry, sore vagina after the menopause, vaginal lubricants may be useful.
- For an overactive bladder there are bladder training exercises. Try to empty your bladder at a set time before you are desperate to go . Gradually increase the interval until you can hold your urine for longer.
- For stress incontinence, practise pelvic floor exercises
- Try to lose weight if you are overweight.
- Stop smoking if you are a smoker.
- If you have UTIs frequently after having sex, it may help to get up and pass urine straight after having sex. If it keeps happening, your doctor may prescribe you an antibiotic to take each time after the intercourse.
What other treatments are available?
The treatment will depend on the underlying cause. Often, no specific cause is found and so there is no specific treatment.
Medicines can be effective in helping symptoms of an overactive bladder if there is not enough improvement with bladder training alone. These medications are called antimuscarinics or anticholinergics.
An operation may be required to repair or boost your pelvic floor in some cases.
You may be referred to a specialist if your symptoms do not improve after self-help measures