Blocked Urinary Track ? Ungonjwa ya wazee

What are lower urinary tract symptoms (LUTS)?

LUTS (lower urinary tract symptoms) is a term used to describe a range of symptoms related to problems of the lower urinary tract (bladder, prostate and urethra). LUTS are broadly grouped into voiding (obstructive) symptoms or storage (irritative) symptoms. A man may have mainly voiding symptoms, mainly storage symptoms, or a combination of both.

Voiding or obstructive symptoms

Storage or irritative symptoms

Hesitancy – a longer than usual wait for the stream of urine to begin Weak and poorly directed stream of urine Straining to urinate Dribbling after urination has finished or an irregular stream Chronic urinary retention – not all the urine is passed from the bladder causing a need to urinate more often Overflow or paradoxical incontinence – urine overflows from a full bladder uncontrollably even though normal urination can be difficult to start

These are also symptoms typical of OAB (overactive bladder) Urgency – an urgent feeling of needing to urinate Frequency – a short time between needing to urinate Nocturia – a need to pass urine two or more times during the night. Urge incontinence – a sudden, intense urge to urinate followed by an uncontrolled loss of urine

How common are LUTS?

LUTS are common in men and are more likely as men get older; however, LUTS can also happen in young men, although the cause of the symptoms may be different. A large Australian study has shown that about one in fourteen (7%) men in their 40s, increasing to nearly one in three (29%) men over the age of 70, reports moderate to severe LUTS. A smaller Australian study of men 35 to 80 years old found that storage symptoms were twice as common as voiding symptoms (28% versus 13%).

What causes LUTS?

LUTS, especially if pain on urination (dysuria) is also present, may be caused by an acute problem such as a urinary tract infection, inflammation of the prostate gland (prostatitis) or less commonly, bladder stones.

Storage symptoms or overactive bladder (OAB – defined as urgency, with or without urge incontinence, usually with frequency and nocturia) may indicate an underlying chronic medical condition such as obesity, diabetes (high glucose levels in the blood), high blood pressure or obstructive sleep apnoea, or be due to the effects of smoking. Lifestyle factors including drinking fluids late at night, too much alcohol or caffeine, or low levels of physical activity can make storage symptoms worse.

Voiding symptoms are usually due to a blockage of the outlet of the bladder making it more difficult to pass urine. The blockage may be caused by an enlarged prostate gland or a urethral stricture (scarring of the urethra). Enlargement of the prostate gland can lead to both storage and voiding symptoms.

Other causes of LUTS include some medicines and neurological diseases such as stroke and Parkinson’s disease. There are also links between LUTS and depression and erectile dysfunction.

It is common for there to be several factors acting at the same time to cause LUTS and the exact cause is not always easy to find.