Lower Urinary Tract Symptoms (LUTS)

What are lower urinary tract symptoms?

Lower urinary tract symptoms (LUTS) include various urination problems, such as:

• Feeling like you can’t empty your bladder or that your bladder fills up too quickly.
• Having greater amounts of urine than normal.
• Having sudden urges to pee that are difficult to control.
• Needing to pee frequently, including in the middle of the night.
• Having a urine stream that’s weak or delayed, or that starts and stops (drips).
• Peeing involuntarily, such as leaking when you sneeze, cough, laugh or have sex, leaking while running to the bathroom and leaking when you don’t feel the urge to urinate.
• Straining to pee.

Who gets lower urinary tract symptoms?

LUTS can affect anyone, but symptoms are more common in men and people assigned male at birth (AMAB) and people over age 50.

What are the most common causes of lower urinary tract symptoms?

If you have lower urinary tract symptoms, talk to your primary care provider or a urologist. They’ll diagnose the cause and help you manage the symptoms.

LUTS is often caused by irritation, infection or obstruction in your urinary system:

• Bladder (bladder outlet obstruction).
• Kidneys (cysts, stones).
• Ureters (ureteral obstruction).
• Urethra (urethral stricture).

The symptoms may be signs of a specific medical condition, including:

• Benign prostatic enlargement/hyperplasia.
• Kidney infection.
• Neurological health condition, such as multiple sclerosis.
• Tumors, such as prostate cancer.
• Urinary tract infection (UTI).

Lower urinary tract symptoms can also be associated with:

• Diabetes.
• Erectile dysfunction.
• High blood pressure (hypertension).
• Obesity.
• Pelvic floor dysfunction.
• Sleep apnea.
• Thyroid disease.
• Using products that can irritate the bladder, such as nicotine, caffeine and alcohol.

What tests might I have for lower urinary tract symptoms?

To diagnose the cause of lower urinary tract symptoms, a healthcare provider will perform a physical exam and ask you:

• What symptoms do you have?
• How long have you had them?
• How much do they interfere with your life?
• Does anything make them worse or better?
• How much fluid do you drink each day? At what time of the day?
• Do you have a family history of LUTS?
• Do you have any medical conditions?
• What medications and substances do you use, including prescriptions, over-the-counter drugs, supplements, nicotine, caffeine and alcohol?

Your healthcare provider may order tests, such as:

• Blood tests to check various things, including prostate-specific antigens in men.
• Urinalysis (urine test) to look for signs of infection.
• Rectal exam (for men and people AMAB), when a healthcare provider inserts a gloved finger into your rectum to feel your prostate gland.
• Imaging tests, usually an ultrasound test, to look at your bladder, kidneys and prostate. Post-void residual volume (amount of pee left on your bladder after urination) can be calculated with most imaging tests.
• Urodynamic test, where bladder volume, pressure and strength can be assessed.
• Cystoscopy, which uses a thin tube and tiny camera to examine the bladder and urethra.

How are LUTS treated?

Treatment options for lower urinary tract symptoms depend on the cause and how the symptoms affect your life.

Your healthcare provider may recommend lifestyle changes such as:

• Adjusting the amount of fluids you drink or the times of day you consume liquids.
• Changing certain medications you take.
• Going to the bathroom at scheduled intervals throughout the day.
• Limiting or eliminating nicotine, caffeine and alcohol.
• Losing weight.
• Strengthening your pelvic floor muscles with Kegel exercises.

Various medications may be used to treat LUTS, including:

• 5-alpha reductase inhibitors, such as finasteride and dutasteride.
• Antibiotics to treat infections.
• Alpha-blockers that can relax your bladder, such as alfuzosin or tamsulosin.
• Antihypertensives to relax the blood vessels, such as doxazosin and terazosin.
• Bladder antispasmodics, such as oxybutynin and mirabegron.

Other causes of LUTS may be treated surgically. For example, if there’s an obstruction, you may need an operation to remove whatever’s causing the blockage. If your prostate is enlarged, your healthcare provider might recommend a procedure to remove part of it.

When should I seek medical treatment for LUTS?

It’s important to talk to a healthcare provider if you have any lower urinary tract symptoms. Even if the symptoms are mild, they may be signs of a developing health problem. And treatment can be more effective if started early.

It’s especially important to seek medical attention if LUTS are:

• Accompanied by blood in your pee.
• Causing discomfort or pain.
• Frequently interrupting your sleep patterns.
• Leading to anxiety or depression.
• Affecting your relationships, such as making you avoid social situations, intimacy or sex.
• Preventing you from doing the things you enjoy or leaving your house.

A note from Cleveland Clinic

Lower urinary tract symptoms (LUTS) include a wide variety of problems with urination. Examples include involuntarily leaking urine or having sudden and strong urges to pee. LUTS may be signs of a health problem, so it’s important to talk to a healthcare provider.

• Agency for Healthcare Research and Quality. Newer Medications for Lower Urinary Tract Symptoms (LUTS) Associated with Benign Prostatic Hyperplasia (BPH). Accessed 10/3/2022.
• Australian Government Department of Health. What are LUTS? Accessed 10/3/2022.
• Lepor H. Pathophysiology of Lower Urinary Tract Symptoms in the Aging Male Population. Rev Urol. 2005;7(Suppl 7): S3-11. Accessed 10/3/2022.