Lower Urinary Tract Symptoms – Female

  • Is very common and increases in incidence as a woman increases in age
  • Has a wide variety of causes. The most common causes would include:
    • Lifestyle factors: caffeine & alcohol intake, smoking, obesity
    • Constipation
    • Overactive (or even underactive) bladder
    • Urine infection
    • Pelvic floor dysfunction
    • Neurological disorders
      • History of stroke, multiple sclerosis, other
    • Underlying bladder pathology
    • Other
Lower Urinary Tract Symptoms – Female
What Are Some Common Symptoms?
  • Symptoms are usually divided into voiding and storage symptoms
    • Voiding: hesitancy (slow to initiate urination), slow stream, intermittent stream of urine, end dribbling, straining to void, incomplete emptying
    • Storage: urinary frequency, urgency (the need to rush to the toilet with minimal warning), urge associated incontinence
  • Many women will have a mixture of both
  • These are often referred to as LUTS – Lower Urinary Tract Symptoms
  • Incontinence – involuntary leakage of urine
    • Can be due to
      • a weakened pelvic floor (‘stress urinary incontinence’)
      • an over-active bladder (‘urge urinary incontinence’)
    • Commonly the cause of incontinence is a mixture of both
How Might My Urologist Assess My Symptoms?

Apart from a general medical and surgical history, your Urologist will focus their questioning on the following issues:

  • Urological history
  • Lifestyle
    • Fluid intake: volume and type (specifically coffee, tea & alcohol)
    • Smoking
  • Blood in urine
  • Incontinence – severity; obstetric & gynaecological history
  • Investigations
    • Bladder diary
    • 24 hour pad weighs (if incontinence is an issue)
    • Urine test: to exclude an infection and check for blood in urine
    • Blood test: in particular a kidney function check
  • Imaging
    • Ultrasound
      • Post void residual – volume of urine left in the bladder after voiding
    • CT – occasionally required if there is suspicion of an anatomical abnormality or other suspected pathology such as a stone or a growth in the urinary tract
    • MRI (rarely needed)
      • Of the brain and spinal cord: required only if a neurological cause for your bladder symptoms are suspected
  • Sub-specialised tests
    • Urodynamics
  • Procedure
    • Cystoscopy – an internal camera inspection of the urethra and bladder
What Are My Treatment Options?

How your LUTS will be treated ultimately depends on the underlying cause.

The treatment plan may be simple or a little more complex: your Urologist will be able to guide you through this.

Treatment typically involves a step-wise progression starting at life style measures, pelvic floor physiotherapy, medications, minimally invasive procedures and finally more complex procedures. Some of the treatment options are outlined below – some may not be relevant to yourself.

  • Lifestyle measures
    • Reduction in caffeinated and alcoholic drinks
    • Maintain healthy bowel habit
    • Quit smoking
    • Weight loss
    • Reduction of evening fluid intake if excessive night time voiding is a problem
  • Pelvic floor physiotherapy and bladder training
  • Medication
    • If your symptoms are largely storage symptoms, medications that may be helpful include
      • Mirabegron
      • Solifenacin
      • Oxybutynin
    • Surgical
      • If the symptoms are due to an overactive bladder:
        • Botox – injected into the bladder wall
        • Sacral Neuromodulation
        • Other (rare): cystoplasty, urinary diversion
      • If the main problem is stress urinary incontinence, the surgical management is usually performed by a Urological sub-specialist
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