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Urination Problems


Urination problems (LUTS)

What are lower urinary tract symptoms (LUTS)

LUTS (lower urinary tract symptoms) are symptoms related to problems with your bladder, prostate and/or urethra. It can affect both men and women, young or old.

LUTS are broadly grouped into symptoms to do with storing or passing urine. You may have symptoms linked mainly to one or the other, or a combination of both.

What are the symptoms of LUTS?

Symptoms include:

  • Hesitancy – a longer than usual wait for the stream of urine to begin
  • Weak stream
  • Straining to urinate
  • Dribbling after urination has finished
  • A stream that stops and starts
  • Feeling an urgent need to urinate
  • A short period of time between the urges to urinate
  • Waking from sleep to pass urine two or more times a night (Nocturia)
  • A sudden, intense urge to urinate, followed by urinating without control.

How common is LUTS?

LUTS becomes more common as you get older. It can happen when you’re young, but the cause of the problem is likely to be different.

In Singapore, it has been reported than 17% of men aged 40 and above have moderately to severe LUTS.

What causes LUTS?

If it’s painful for you to urinate, your LUTS might be caused by a urinary tract infection, or in men - infection and inflammation of the prostate gland (prostatitis).

Difficulty storing urine causing frequency of urination or urgency, might be because of an overactive bladder. If this is associated with blood in the urine, serious conditions such as bladder cancer or bladder stones need to be ruled out.

An underlying chronic medical condition, such as obesity, diabetes, high blood pressure, or obstructive sleep apnoea can also cause LUTS.

Drinking fluids late at night, having too much alcohol or caffeine, or low levels of physical activity, can make storage symptoms worse.

Symptoms connected to problems with passing urine are usually due to a blockage that makes it more difficult for you to pass urine. This could be caused by an enlarged prostate gland, or scarring of your urethra.

Other causes of LUTS include some medicines, and diseases such as stroke and Parkinson’s disease.

LUTS is also linked with poorer quality of life and depression and erectile dysfunction in men. A local study showed that 10% and 20% of men with LUTS suffered from anxiety and depression respectively.

What can I do?

You can do this questionnaire to check whether you have LUTS and determine its severity. 

LUTS isn’t just a normal part of ageing, so it’s a good idea to see your doctor if you notice any changes to urination - particularly if the symptoms are affecting your quality of life or interfering with normal daily activities. Unfortunately, while LUTS is often easily treatable, many men ignore or choose to live with this bothersome condition. A local survey found that <30% of men with moderate to severe LUTS did not seek medical attention.

Your doctor will evaluate the severity of your symptoms. In men, an examination of the prostate through the anus with a gloved finger is done to evaluate the size of the prostate, check for pain in the prostate which may indicate infection, and the presence of lumps of the prostate which may indicate cancer. Urine tests may be done to rule out infection. The doctor may discuss with you if a blood test called PSA (prostate specific antigen) to look for prostate cancer is appropriate for you.

The doctor may advise on lifestyle changes to help with your symptoms, such as reducing caffeine (from coffee, tea and carbonated soda) and alcohol (these substances can irritate the bladder); avoiding large amounts of fluid before bed; preventing constipation (straining to pass stools can affect pelvic floor muscles, which are important for both bowel and bladder control), and losing weight to improve the symptoms.

Most patients suffering from LUTS from an enlarged prostate (BPH) or overactive bladder will respond to medication. A minority of men with BPH may require minimally invasive surgery to remove part of the obstructing prostate tissue. The is a safe, highly effective surgery, and most patients are highly satisfied after undergoing this.

I heard LUTS can be caused by prostate cancer. Is that true?

The most common cause of LUTS in men is non-cancerous growth of the prostate (BPH). Prostate cancer can sometime be found during the evaluation for LUTS.

Early prostate cancer usually does not cause urinary symptoms as prostate cancer is usually located in the part of the prostate away from the urine passage (urethra), as opposed to BPH which surrounds the urethra. Thus not having LUTS does not mean you do not have prostate cancer. On the other hand, advanced prostate cancer can cause LUTS if it grows large enough to compress the urethra.

There are pros and cons to screening for asymptomatic prostate cancer. The benefit is an improved chance of cure for earlier detected prostate cancer, with reduced chance of prostate cancer related symptoms and death. The drawback is that men may need to undergo more tests, with the associated anxiety and side effects.  Many of the cancers detected may be very slow growing and not harm the man in his lifetime. These men may undergo potentially unnecessary cancer treatment and their associated complications. The urological community is aware of these problems, and have taken steps to reduce overdetection and over-treatment of these slow growing prostate cancers.

Men interested in early prostate cancer detection should only decide on prostate cancer screening, after a discussion with their doctors on whether it is suitable for them.

Dr Lincoln Tan has written an article in Lianhe Zaobao on this topic - 

https://www.zaobao.com.sg/zlifestyle/powerup/story20161202-697008

Don't let your symptoms go unchecked.

Most conditions can be treated effectively if detected early.

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