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The Link Between LUTS and Incontinence: Stronger Than You Thought


LUTS (lower urinary tract symptoms) is a common urologic condition affecting both men and women, and it becomes more prevalent with age. Approximately 50 percent of men in the U.S. will develop some form of LUTS, while studies show only 1 in 10 men will seek treatment. Although BPH is the most common cause behind LUTS for men, there are a number of other medical conditions resulting in urologic symptoms. Women most often experience stress incontinence as a result of their LUTS, whereas men typically endure urge incontinence.


Although incontinence has always been a common symptom of LUTS, it hasn’t always been included in its initial symptom assessments. According to recent studies, the prevalence of incontinence in LUTS patients is much higher than previously thought, which highlights the need for a new symptom assessment.


What is LUTS?


Lower urinary tract symptoms (LUTS) is the general term used to describe a variety of urination symptoms. They are categorized into three groups: Storage, otherwise known as irritative, and voiding, previously known as obstructive, and post micturition. The International Continence Society constructed this terminology based on the corresponding conditions of each symptom, and the terms were updated to their current status in 2002.


Common storage symptoms include frequent urination, Nocturia, urgency, incontinence, and OAB. Voiding symptoms consist of any difficulties when voiding the bladder, such as straining, intermittency, slow or uncontrollable stream, and urinary retention. Post micturition symptoms were added to the list in 2002 and are experienced after voiding symptoms.


Study Finds a High Occurrence of Incontinence


A team lead by Dr. Brian Helfand, chief of urology and professor at University of Chicago Pritzker School of Medicine, examined the prevalence of incontinence in men seeking treatment for LUTS. The participants consisted of 477 men with an average age of 60, who were pursuing treatment for a variety of lower urinary tract symptoms, bowel symptoms, sexual dysfunction symptoms, and psychological symptoms. Detailed questionnaires were used to determine the existence and severity of the symptoms.


51 percent of these men reported occurrence of urinary incontinence, more specifically urge incontinence and post-void incontinence. This percentage is dramatically higher than findings from previous studies, which reported a 5-12 percent occurrence. The research also shows that patients with incontinence are at a higher risk for psychological and bowel issues than those without incontinence.


Results Indicate a Need for New Assessment  


The drastically different findings of past and present research highlight a big problem in classifying LUTS. It is concerning to urologists because the current primary methods for assessing LUTS do not include questions about incontinence. There is currently a symptom index questionnaire, “this questionnaire, however, is largely insufficient, as it does not capture the frequency, severity and/or bother of urinary incontinence,” says Dr. Helfand.


Physicians need a better way of evaluating LUTS that includes an updated, comprehensive symptom assessment, like the one used in this study. An extensive questionnaire that covers all lower urinary tract symptoms including incontinence, would help provide more accurate treatment and overall improve patient care.


LUTS in Pregnant Women


Despite the focus of most studies, men are not the only ones who struggle with lower urinary tract symptoms. Around half of all women over 40 have reported some form of LUTS in their life. Pregnant women in particular battle LUTS due to the hardships involved with pregnancy and delivery. Pregnant women experience hormonal changes and drastic anatomical alterations of the uterus and pelvic region, which exert a great deal of stress on the bladder and urethra. These biological changes can lead to many urological issues during and after pregnancy.


One study showed the most common lower urinary tract symptoms present in pregnant women include frequency, Nocturia and stress incontinence. 270 women at different trimesters of their pregnancy were given symptom questionnaires about their LUTS; 77 percent reported frequency, 75.6 percent reported Nocturia and 51 percent reported stress incontinence. A more recent study examining LUTS among pregnant women also found stress incontinence to be the most prevalent symptom. Stress incontinence is so commonplace because the pressure of childbirth weakens muscles and nerves in the bladder.


When it comes to understanding and treating LUTS, the same conditions apply to women as to men. 80 percent of pregnant women report some form of LUTS, thus a more comprehensive symptom assessment is needed for each trimester to better evaluate and diagnose their condition. Most questionnaires do not account for the changes in symptoms at each trimester, nor do they include questions about non-incontinence symptoms, so physicians need a better way to assess these factors in order to provide more accurate information and better care.


Seeking Treatment for LUTS


If you are experiencing any lower urinary tract symptoms, it is important to speak with a gynecologist or urologist who can help diagnose a potential underlying condition. If you do visit a doctor, he or she will ask if you have LUTS, classify the symptoms as either storage or voiding, determine their severity, and then present you with treatment options. If you have been experiencing storage symptoms, such as frequent urination or urgency, you may receive a diagnosis of OAB or incontinence. Voiding symptoms like straining to urinate or abnormal urine streams may indicate prostatitis or bladder stones. LUTS is also an important prerequisite when diagnosing BPH, as this condition presents with a combination of storage and voiding symptoms.


Although extremely common in men and women over 40, LUTS is still embarrassing to discuss for those who have it. Even though researchers are still trying to fully understand its origins and effects, they have established certain risk factors, which include: Age, weight, surgery or childbirth, hormonal changes, and neurological disorders. Fortunately, there are many treatment options available, including home remedies, medication and surgery, that can help improve a patient’s overall quality of life.