MALE LOWER URINARY TRACT SYMPTOMS

The bladder is part of the urinary system, it fills and stores urine. A normal healthy bladder stores 400-600ml of urine, it is normal to pass urine 4-6 times a day. The prostate gland produces the fluid which nourishes and transports sperm. The prostate is located at the base of the bladder in front of the rectum, when you pass urine, urine must pass through the prostate and urethra (pee tube). Thinking simply, when you are ready to go to the toilet, your bladder contracts, sphincters relax, and you empty your bladder.

A healthy bladder will fill urine and store urine. Generally, you won’t think about your bladder until it ‘triggers’ you that it is time to go to the toilet. When your bladder is ‘full’ you are signalled to go to the toilet, but you can wait until it is socially appropriate and there is a toilet before you empty your bladder. When you pass urine, you should empty to completion without having to strain. You should not leak urine between voids.

As men get older, their prostate enlarges which can constrict the flow of urine and cause urinary symptoms. Thinking simply, as a little boy you can pee up a wall, as you get older, the flow diminishes!

These urinary symptoms can include nocturia (passing urine at night), poor flow, dribbling, intermittency, frequency and urgency. Some men also complain of leakage of urine or a ‘post pee drip’. These symptoms can impact quality of life and tend to slowly worsen over time.

Assessment of these symptoms include questionnaires to assess symptoms, a urine flow test and post void ultrasound. Physical examination may be required, occasionally specific blood tests and imaging is needed, and, in some cases, we will refer you for a flexible cystoscopy with one of the urologists we work with.

Management often involves conservative management such as lifestyle interventions, fluid modification and pelvic floor physiotherapy. Management can also involve pharmacological intervention (tablet medications) and with severe symptoms referral to a urologist for surgical intervention.

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