Getting up 2 or 3 times a night, waiting for the stream to start, feeling like you haven't fully emptied your bladder: all of these are Lower urinary tract symptoms in men (SUB) that many people endure in silence, telling themselves that «it’s just part of getting older.» According to the Canadian Urological Association, up to 70 % of men over the age of 60 experience at least one significant lower urinary tract symptom [1]. However, the majority of these cases have a identifiable cause and a available treatment, which is often simple. This article explains the symptoms to look for, possible causes (including benign prostatic hyperplasia), the evaluation process, and treatment options in Quebec.
On this page
- What is a lower urinary tract symptom?
- What are the most common symptoms?
- What are the possible causes?
- Understanding Benign Prostatic Hyperplasia (BPH)
- How does the medical evaluation work?
- What treatments are available?
- What lifestyle habits help reduce symptoms?
- When should you seek immediate medical attention?
- Myths and Misconceptions
- Frequently asked questions
- Sources
What is a lower urinary tract symptom?
Visit lower urinary tract symptoms (LUTS) encompass all conditions related to the storage and voiding of urine in the bladder, the prostate (in men), and the urethra. The term SUB is neutral: it does not prejudge the cause. Once the symptoms have been described, the medical evaluation seeks to identify their cause in order to recommend an appropriate treatment [2].
Some Key Figures to Keep in Mind
- Up to 70 % for men over 60 have at least one significant SUB [1]
- L’benign prostatic hyperplasia is the most common cause in people over 50
- Visit nocturia (getting up at night to urinate) is the symptom that most severely impairs daily life
- The majority of SUBs respond well to treatment first-line medication
- A small number of cases require a Surgical intervention
What are the most common symptoms?
Visit Lower urinary tract symptoms in men can be divided into two main categories: symptoms obstructive (difficulty emptying the bladder) and symptoms irritating (frequent or urgent urges). Many men experience a combination of the two.
Obstructive symptoms — difficulty emptying the bladder
- Weak spray or intermittent
- Hesitation when starting the engine urination
- Effort to urinate (abdominal push)
- Feeling that the tank isn't completely empty of the bladder
- Final draining at the end of urination
- Extension of the duration urination
Irritative symptoms — frequent urges
- Frequent urination — frequent urination in small amounts
- Urinary Emergencies — a sudden urge that's hard to resist
- Nocturia — getting up at night to urinate (1, 2, 3 times or more)
- Burning sensation during urination or discomfort
- Urge Incontinence in some cases
The Impact on Quality of Life
These symptoms may seem minor on their own, but when they occur together, they have a real impact: fragmented sleep, daytime fatigue, social withdrawal (fear of not being able to find a restroom), loss of productivity, anxiety, and sometimes a reluctance to engage in physical activities or travel. Several studies show that severe SUB affects quality of life as much as other major chronic diseases [3].
What are the possible causes?
Several Causes that may explain lower urinary tract symptoms in men. Accurate identification is essential, as treatment varies depending on the source.
Most Common Causes
- Benign Prostatic Hyperplasia (BPH) — the most common cause in people over 50
- Prostatitis acute or chronic (inflammation/infection of the prostate)
- Urinary tract infection simple or complicated
- Prostate cancer or the bladder (less common but should be ruled out)
- Urethral Stenosis (narrowing of the urethra)
- Urinary stones in the bladder or urinary tract
Neurological and Metabolic Causes
- Stroke Aftereffects, spinal cord injuries, multiple sclerosis
- Diabetic neuropathy affecting bladder control
- Parkinson's disease and other neurodegenerative disorders
- Heart failure (causes nocturia due to nocturnal fluid redistribution)
- Sleep apnea untreated
Medications that may worsen symptoms
- Anticholinergics (antihistamines of 1re (certain generations of medications, such as antidepressants and antispasmodics)
- Sympathomimetics (over-the-counter decongestants)
- Diuretics taken at the end of the day
- Certain psychotropic drugs
- Opioids in the long run
A medication review is always part of the evaluation of a patient with SUB. Never stop taking a prescribed medication without consulting a doctor.
Understanding Benign Prostatic Hyperplasia (BPH)
L’benign prostatic hyperplasia (BPH) is a noncancerous enlargement of the prostate that occurs gradually with age. It is extremely common : It is estimated that more than 50 % of men aged 60 and about 80 % of those aged 80 show histological signs of BPH, even though not all of them have symptoms [1][4]. When the prostate enlarges, it can compress the urethra that runs through it and cause an obstruction of urine flow.
BPH is not the same as cancer
A common misconception: BPH is benign and is not not a direct risk factor for prostate cancer. However, both conditions can coexist in the same man, which justifies a comprehensive medical evaluation, often including a digital rectal exam and, depending on the circumstances, a prostate-specific antigen (PSA) test.
Key Takeaways
- Visit SUBs are very common after age 50, but they are not inevitable
- L’BPH is the most common cause—it's benign, but it should be treated if the symptoms are bothersome
- A nocturia, a persistent weak stream or incomplete flushing should be evaluated
- Several effective treatments exist, ranging from lifestyle habits to medications and modern surgical procedures
- Certain symptoms (blood in the urine, fever, acute urinary retention) require quick consultation
- Visit medication review is an integral part of the process
How does the medical evaluation work?
L’Assessment of lower urinary tract symptoms in men follows a structured approach recommended by the guidelines of the Canadian Urological Association [1].
Standard Steps
- Detailed Medical History and the International Prostate Symptom Questionnaire (IPSS) — a validated tool for quantifying severity and its impact on quality of life
- Physical examination including the rectal exam when applicable (size, shape, and consistency of the prostate)
- Urine Test and culture to test for infection, blood, and blood sugar
- Blood tests : creatinine for kidney function, prostate-specific antigen (APS) depending on the clinical context
- Ultrasound of the urinary tract and measurement of the post-void residual urine
- Flow Measurement urinary function, if necessary (measurement of urine flow rate)
- A Leader in Urology if necessary
The IPSS Questionnaire at a Glance
| IPSS Score | Severity | Standard Approach |
|---|---|---|
| 0 to 7 | Mild symptoms | Monitoring, Lifestyle Habits |
| 8 to 19 | Moderate symptoms | Lifestyle Habits + Medications |
| 20 to 35 | Severe symptoms | Medications, sometimes surgery |
What treatments are available?
Visit Treatments for BPH and SUB range from the simplest to the most complex, always starting with the least invasive options.
1. Changes in lifestyle
- Limit Fluid Intake 2 to 3 hours before bedtime
- Cut back on caffeine (coffee, tea, soft drinks)
- Limit Alcohol Consumption, especially beer in the evening
- Empty your bladder completely, in two stages if necessary («double voiding»)
- Review Medications with the doctor
- Regular physical activity
2. Drug Treatments
- Alpha-blockers (tamsulosin, alfuzosin, silodosin) — rapid relief within a few days to a few weeks
- 5-alpha-reductase inhibitors (finasteride, dutasteride) — for enlarged prostates; effects last for several months
- Combinations alpha-blocker + 5-alpha-reductase inhibitor for certain patient profiles
- Low-dose daily tadalafil — useful if erectile dysfunction is present
- Anticholinergics or beta-3 agonists (mirabegron) if irritative symptoms predominate
3. Procedures and Surgeries
- TURP (transurethral resection of the prostate) — the standard surgical procedure for decades
- Laser vaporization (Greenlight, holmium) — an alternative to TURP with less bleeding
- UroLift — implants that spread the prostate lobes, minimally invasive
- Rezum — water vapor that destroys excess prostate tissue
- Prostate Embolization — radiological option for certain patients
- Prostatectomy open or robotic surgery for very large prostates
The choice depends on the size of the prostate, comorbidities, the patient's preferences, and local availability. A in-depth discussion with the urologist is essential before any proceedings begin.
Are you experiencing lower urinary tract symptoms that interfere with your daily life? Omicron Clinic assesses SUB in men at our locations in Quebec: IPSS questionnaire, clinical examination, ordering of diagnostic tests, initiation of treatment, and referral to a urologist as needed. Make an appointment or view in teleconsultation for a first assessment.
What lifestyle habits help reduce symptoms?
Even before or in addition to medication, several simple adjustments often lead to a measurable improvement in SUBs.
In everyday life
- Distribute the liquids Throughout the day, reduce the volume after 6 p.m.
- Limit caffeine, alcohol, and soft drinks
- Avoid drinking large amounts of beverages just before a trip
- Empty the bladder before going out or going to bed
- Practicing double urination : urinate, wait 30 seconds, urinate again
- Maintaining a Healthy Weight — Obesity exacerbates SUBs
- Regular physical activity — protects against worsening
- Managing Constipation — A full colon can put pressure on the bladder
- Treating Sleep Apnea if present — often reduces nocturia
When should you seek immediate medical attention?
Warning Signs — Seek Medical Attention Immediately
- Blood in the Urine (hematuria) visible or detected on laboratory testing
- Acute urinary retention — Inability to urinate with a full bladder and pain — medical emergency
- Fever and chills with urinary symptoms (suspected acute prostatitis or pyelonephritis)
- Severe pelvic or lower back pain
- Symptoms that appeared suddenly in a young man
- Unexplained weight loss associated with symptoms
- Significant family history prostate cancer with symptoms
Regular checkups are recommended
- Persistent urinary symptoms or have been gradually increasing for more than a few weeks
- Nocturia that regularly disrupts sleep
- Gradual decrease in the strength of the jet
- Feeling that the tank isn't completely empty repeated
- Concern related to a family history of prostate cancer
- Symptoms that appear or worsen after exposure a new drug
Myths and Misconceptions
«It's normal to get up two or three times a night after age 60.»
Nuanced. Occasional nocturia is common, but getting up several times each night is not inevitable. It is a symptom in its own right that warrants evaluation, especially if it affects sleep and quality of life.
«Having an enlarged prostate means you have cancer.»
False. Benign prostatic hyperplasia is, as its name suggests, benign. It does not develop into cancer and is not a direct risk factor. However, the two conditions can coexist, which is why a comprehensive medical evaluation is warranted.
«Finasteride consistently causes sexual problems»
Nuanced. Finasteride and dutasteride may cause a decrease in libido or erectile dysfunction in a small number of users. These effects are usually reversible upon discontinuation. The decision to initiate treatment is made after a thorough discussion of the benefits and risks.
«Natural products (dwarf palm) solve the problem»
Mostly fake. The dwarf palm (saw palmetto) and other natural products have been extensively studied. Rigorous clinical trials have not demonstrated that they are more effective than a placebo in relieving LUTS associated with BPH. This does not mean they are dangerous, but they are not a substitute for proven medical treatment.
«Prostate surgery causes impotence»
Nuanced. Modern surgical procedures (laser, UroLift, Rezum) are designed to preserve erectile and ejaculatory function as much as possible. Certain side effects (retrograde ejaculation) remain common with conventional TURP. A thorough discussion with the urologist will clarify the risks specific to each technique.
Frequently asked questions
At what age should I start worrying about my urinary symptoms?
There is no “magic” age. If your symptoms are affecting your daily life (sleep, social activities, work), if you have difficulty urinating, or if you notice blood in your urine, see a doctor right away. Starting at age 50 (or 45 if you have a family history of prostate cancer), it’s recommended that you have a preventive discussion with your doctor.
Do I always need to have my APS levels tested?
Not routinely. The decision to test for prostate-specific antigen (PSA) is a shared decision between the doctor and the patient, based on age, family history, life expectancy, and personal preferences. Canadian guidelines recommend a structured discussion before offering the test, especially for men between the ages of 50 and 70.
Do alpha-blockers cause dizziness?
This can happen, especially at the start of treatment, due to the drop in blood pressure these medications can cause. Tamsulosin and silodosin are more selective and generally cause less hypotension. Taking the first dose at bedtime and talking to your doctor if you experience significant dizziness will allow for adjustments to your treatment plan.
Can my symptoms improve without treatment?
Yes, in some cases, especially for mild forms (IPSS 0–7). Lifestyle changes, a review of medications, and treatment of associated conditions (sleep apnea, heart failure, constipation, diabetes) may be sufficient. Moderate-to-severe cases generally respond better to additional medication.
Is the initial evaluation covered by RAMQ?
Yes, medical consultations and most basic tests (urinalysis, creatinine, APS when clinically indicated, bladder ultrasound) are covered by the RAMQ for insured individuals. Certain more specialized tests or those performed at private clinics may incur costs, which are sometimes reimbursed by group insurance plans.
How can I tell if I have acute urinary retention?
Acute urinary retention is characterized by a complete inability to urinate despite a full bladder, accompanied by suprapubic pain that can be severe. It is a medical emergency that requires prompt bladder decompression (catheterization). Go to the emergency room or call 911 if the pain is severe.
Sources
- Canadian Urological Association (CUA). Guidelines on Benign Prostatic Hyperplasia.
- European Association of Urology (EAU). Guidelines for the Management of Non-Neurogenic Lower Urinary Tract Symptoms in Men.
- INESSS — National Institute for Excellence in Health and Social Services. Medications in Urology — Clinical Tools.
- Quebec College of Physicians (CMQ). Clinical Approach to Lower Urinary Tract Symptoms in Men.
- Canadian Cancer Society. Screening and Prostate Cancer.
- Quebec Health Insurance Board (RAMQ). Urology Services Covered.
- Ministry of Health and Social Services (MSSS). Men's Health Care in Quebec.
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