Lower urinary tract symptoms (LUTS): causes, assessment and GP guidance

Lower urinary tract symptoms, often shortened to LUTS, describe a group of urinary symptoms that are common in men, particularly with increasing age. While many men worry these symptoms mean prostate cancer, most LUTS are caused by benign and treatable conditions.

This page explains the different types of urinary symptoms, common causes, how GPs assess them, which tests may be needed, and when further review is important.

These articles are intended as educational sources, not diagnostic nor taking place of a proper medical assessment. If you need help, please book an appointment with one of our GP’s.

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What are lower urinary tract symptoms?

LUTS are usually grouped into three categories:

Voiding symptoms

These relate to passing urine and may include:

Weak or slow urine stream
Difficulty starting urination
Straining to pass urine
Stopping and starting during urination

Storage symptoms

These relate to bladder storage and include:

Needing to urinate frequently
Urgency
Waking at night to pass urine (nocturia)
Difficulty holding urine

Post-void symptoms

These occur after passing urine and may include:

Feeling the bladder has not fully emptied
Dribbling after finishing

Many men experience a mixture of symptoms.

Common causes of LUTS in men

Benign prostate enlargement

An enlarged prostate, also known as benign prostatic hyperplasia (BPH), is the most common cause of LUTS in older men.

It is not cancer
It develops gradually
Symptoms vary widely

Bladder-related causes

These include:

Overactive bladder
Reduced bladder capacity
Bladder muscle changes with age

Urinary tract infection

Less common in men, but may cause:

Burning or pain when urinating
Sudden onset frequency or urgency
Cloudy or smelly urine

Medications and lifestyle factors

Symptoms may be worsened by:

Diuretics
Alcohol and caffeine
Decongestants
Poor fluid timing

Less common causes

These include:

Prostate inflammation (prostatitis)
Bladder stones
Neurological conditions

LUTS and prostate cancer: an important distinction

Most urinary symptoms in men are not caused by prostate cancer.

Prostate cancer often causes no urinary symptoms at all in early stages

LUTS alone does not automatically indicate cancer, which is why assessment focuses on the overall picture rather than symptoms in isolation.

If you have any concerns, you must seek a GP review to discuss your symptoms.

Seek urgent medical advice if you develop:

Inability to pass urine
Severe lower abdominal pain
Blood in the urine
Fever with urinary symptoms
New back pain with urinary changes

How GPs assess LUTS

Assessment usually includes:

Detailed symptom history and pattern
Impact on quality of life
Fluid intake and timing
Medication review
Examination where appropriate

Validated symptom questionnaires may be used to assess severity and monitor response to treatment.

Tests that may be considered

Not all men with LUTS need tests.

A GP may consider:

Urine testing to rule out infection or blood
Blood tests to assess kidney function
PSA testing, after discussion of risks and benefits

PSA blood test explained.

Imaging

Imaging may be considered if symptoms are severe or complicated.

Bladder ultrasound can assess residual urine after voiding
Prostate size may be assessed if relevant

Ultrasound scans explained.

Managing LUTS

Management depends on symptom severity and impact.

Lifestyle measures

These may help mild symptoms:

Reducing evening fluid intake
Limiting caffeine and alcohol
Timed voiding
Reviewing medications

Medications

Medication may be considered if symptoms affect daily life.

Choice depends on symptom type
Benefits and side effects are discussed
Regular review is important

Referral and surgery

Referral may be considered if:

Symptoms are severe or worsening
There are complications such as urinary retention
Medical treatment is not effective

LUTS and sleep

Nocturia can significantly disrupt sleep and contribute to fatigue and low energy. Treating underlying urinary symptoms often improves sleep quality without separate sleep treatment.

Fatigue and low energy in men.