Lower urinary tract symptoms

Introduction

Lower urinary tract symptoms (LUTS) are common in men – an estimated 50% of all men over 65 years old experience LUTS. Symptoms of LUTS can be obstructive (voiding symptoms e.g. hesitancy and poor stream) or irritative (storage symptoms e.g. frequency and urgency). Treatment usually involves a stepwise approach beginning with watchful waiting and self-management interventions, and then escalating to drugs followed by surgical interventions.

Precautions

Need to rule out other causes, e.g. infection

Adverse effects

The interventions do not have significant health risks.

Availability

Interventions are mostly readily available. Bladder retraining may require more patient education. Behavioural changes require goal setting, monitoring, and frequent symptom review.

Description

Self-management interventions can achieve a clinically important reduction in symptom severity compared with usual/standard care (moderate quality evidence). Self-management interventions are as effective as drug treatment in reducing symptoms. The benefits of self management were seen early and sustained at 12 months.

The components of self-management interventions are as follows:

1. Education and reassurance: Explain the causes of LUTS and the natural history of benign prostatic hyperplasia. Reassure that no evidence of prostate cancer has been found.
2. Fluid management: Advise on appropriate volume of fluid intake, and on fluid restriction when symptoms are inconvenient (e.g. long journeys or going out), and on evening fluid restriction for control of nocturia.
3. Reducing caffeine and alcohol consumption: Substitute coffee with decaffeinated drinks, or large volumes of alcohol with smaller volumes of alcohol. Avoid alcohol in the evening to control nocturia.
4. Managing concurrent medication: Time medication-taking to have the most symptom improvement at certain times (e.g. long journeys or going out). If possible, replace antihypertensive diuretics with suitable options with less urinary effects.
5. Toileting practices: Advise to double void (void, then void again within a few minutes) and urethral milking to prevent post-void dribbling.
6. Bladder retraining: Aim to increase the minimum time between voids to 3 hours and/or the minimum volume to 200–400 mL. Use distraction techniques such as a predetermined mind exercise or pelvic floor exercises to suppress the urge to void. Gradually increase the time interval between voiding, and chart progress using a bladder diary.
7. Patients should be advised on avoiding constipation.

Tips and Challenges

• Considerations for individuals’ health literacy levels
• Ability and willingness to self-monitor progress

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