Lower urinary tract symptoms (LUTS) affect as many as a fifth of adults, and it should not be ignored.

LUTS are a range of symptoms related to problems of the lower urinary tract (bladder, prostate, and urethra). LUTS can be caused by a variety of factors, including benign prostatic hyperplasia (BPH).

Approximately one in five adults reports moderate to severe LUTS conditions. It has been shown that LUTS substantially affect sleep, reduce the quality of life, and are associated with various health conditions, including depression.

PREVALENCE

BPH becomes more common in men as they get older. The diagnosed BPH increases from 8% in men aged 31-40 years, and 50% in men aged 51-60 years, to over 80% in men older than 80 years.

31-40 Years Old

51-60 Years Old

80+ Years Old

LUTS MECHANISM OF ACTION

LUTS are divided into two symptoms types: storage and voiding. Enlargement of the prostate gland can lead to both storage and voiding symptoms.

Diagnosis of the symptoms in advance is crucial for further assessment of the condition and the subsequent treatment.
Mostly, the symptoms are measured by validated questionnaires, such as the International Prostate Symptom Score (IPSS), it is important not only to look at the total symptom score but also at the breakdown of the storage and voiding subscores.

STORAGE SYMPTOMS

Storage symptoms are characterized by bladder dysfunction.
May be caused by chronic medical conditions such as obesity, diabetes or high blood pressure. There may also be external factors such as smoking, drinking fluids late at night or too much alcohol or caffeine.

Other causes can include weak pelvic floor muscles and hormonal imbalance.

VOIDING SYMPTOMS

Are usually due to a blockage of the outlet at the base of the bladder, making it more difficult to pass urine. The blockage may be caused by an enlarged prostate gland and thus cause bladder hypersensitivity and involuntary bladder contractions.

Voiding symptoms of the lower urinary tract include hesitancy, slow stream, splitting or spraying of the stream, straining and terminal dribble.

BPH is the most common cause of LUTS and in this condition, the prostate gland is situated around the neck of the bladder. When it gets bigger it can cause voiding symptoms such as:

URINARY HESITANCY

Not being able to pass urine immediately

URINARY INCONTINENCE

Leakage of urine during physical activity, coughing, sneezing or straining

POOR STREAM

A condition where the flow of urine is weaker and it takes longer to empty the bladder

POST-VOID DRIBBLING

Involuntary release of a few drops of urine from the urethra after urinating

INCOMPLETE EMPTYING

A feeling of not quite emptying the bladder

OVERFLOW INCONTINENCE

Urinary incontinence that occurs when the bladder is too full that it continually leaks

Storage symptoms are characterized by an altered bladder sensation, increased daytime frequency, nocturia, urgency or urge incontinence.

The incidence of storage symptoms increases with age among men (15.7% in the youngest to 29.7% in the oldest age groups).

URGENCY

The need to pass urine without much warning

FREQUENCY

The need to pass urine very often

URGE INCONTINENCE

Urgency resulting in leakage of urine which cannot be controlled

NOCTURIA

The need to pass urine frequently at night

What is Benign Prostatic Hyperplasia (BPH)?

As we get older, our bodies change, often in ways we cannot control.
Some men undergo a change in the size of their prostates. This is a natural phenomenon caused by aging, but it can lead to obstruction during an attempt to pass urine.

According to the Urology Care Foundation, BPH affects every second man between the ages of 51 and 60 and up to 90% of men over the age of 80. It can have a significant impact on the quality of life.
In men with BPH, the prostate is larger than usual, the urethra is narrowed and the bladder can be blocked. Eventually, there can be lower urinary tract symptoms such as voiding difficulties or bladder storage.
In men presenting with mild to moderate symptoms and limited discomfort, BPH is not normally actively treated but instead monitored by yearly examination. During this phase, the use of phytotherapeutics to support functions such as voiding is of great interest.

What is Nocturia?

The technical term for nocturia is “excessive nighttime urination”. It means you wake up twice or more during the night for urinate.
Multiple factors can cause nocturia. In men, nocturia is often directly attributed to BPH. Additional factors that can contribute to nocturia include taking in too much fluid, caffeine, or alcohol before bed or an overactive bladder condition. As we get older, we produce less of a hormone that causes our bodies to retain fluid, so we manufacture more urine. Additionally, our bladder loses its ability to store urine with age.
Waking up twice or more a night to empty your bladder is not normal – it is a condition that can and should be treated. At best it is a nuisance and at worst it can seriously affect your health.
This is because the less sleep we get, the more tired we are the next day, affecting our ability to perform daily tasks and be our best selves.