Lower Urinary Tract Symptoms in Young People

Lower urinary tract symptoms (LUTS) are often associated with aging, but they can significantly impact the lives of younger individuals as well. This is an often-overlooked topic. These symptoms, which may include changes in frequency, urgency, hesitancy, or flow, along with a range of other lower urinary tract problems, are typically dismissed in this group. They may even be dismissed as unimportant or embarrassing. However, LUTS in young people may signal underlying medical conditions that require investigation and management. This article explores the causes, diagnostic approaches, and importance of early intervention for LUTS in this population. A thorough evaluation can help.

Recognizing the Symptoms: More Than Just "Normal"

LUTS encompasses a range of symptoms affecting bladder storage and emptying. These can include:

• Storage Symptoms:
• Voiding Symptoms:

In young people, these symptoms might be dismissed as "normal" variations in development, attributed to stress or anxiety, or even go unreported due to embarrassment or lack of awareness. This may make it harder to fully diagnose these conditions.

Possible Causes:

While prostate issues are a common cause of LUTS in older men, the causes in young people are much more diverse and include:

• Urinary Tract Infections (UTIs): These are particularly common in young females, often creating secondary issues, and can lead to frequency, urgency, and painful urination.
• Overactive Bladder (OAB): Characterized by involuntary bladder contractions, often resulting in frequency, urgency, and urge incontinence. It can be a debilitating and embarrassing issue for those who are struggling with this condition.
• Bladder Outlet Obstruction (BOO): Though more common in older individuals, it is also seen in younger patients and should always be ruled out as a diagnosis in younger patients presenting with the condition. BOO can occur in young people due to congenital anomalies, urethral strictures, or neurological conditions.
• Neurogenic Bladder: Conditions affecting the nerves that control the bladder (e.g., spina bifida, spinal cord injury, multiple sclerosis) can cause various LUTS.
• Psychological Factors: Stress, anxiety, and other emotional issues may play a contributing role in the development of LUTS for those in this demographic.
• Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS): A chronic condition causing bladder pain, pressure, and discomfort, often accompanied by frequency and urgency.

Diagnostic Approaches: A Thorough Evaluation

Diagnosing LUTS in young people requires a thorough evaluation, including:

• Detailed History: A comprehensive medical history, including the nature and onset of symptoms, their severity, fluid intake patterns, medication use, and any relevant family history of urinary tract problems or relevant conditions.
• Physical Examination: A focused physical examination should include abdominal, genital, and neurological assessments as applicable.
• Urinalysis and Urine Culture: To rule out urinary tract infections.
• Voiding Diary: Patients may be asked to keep a diary, recording fluid intake, voiding frequency, volumes, and any episodes of urgency or incontinence. This helps the physician get a clearer idea of habits and frequency to track down any specific patterns that may indicate what condition is responsible for the LUTS symptoms.
• Urodynamic Studies: These tests assess bladder function and can help identify issues like overactive bladder or bladder outlet obstruction. These studies are typically reserved for patients in which conservative measures are not helping their condition, or for when surgery is being considered.
• Cystoscopy: A visual examination of the bladder and urethra using a thin, flexible scope. It is not usually ordered for all patients with LUTS symptoms, especially if they are not severe and the patient has not experienced trauma. It can assist in evaluating more complex cases and ruling out other causes or conditions when symptoms are severe, not improving, or additional information would aid the assessment process.

Imaging Studies: Ultrasound or other imaging may be used to assess the kidneys, bladder, and other relevant structures as appropriate, although this is also not frequently required as a standard step.

Pharmacologic Interventions for LUTS in Young People

When lifestyle modifications and non-pharmacological approaches are insufficient to manage LUTS in young people, medication may be considered. The choice of medication depends on the underlying cause and the specific symptoms. Pharmacological options include:

• Anticholinergics/Antimuscarinics: These drugs (e.g., oxybutynin, tolterodine, solifenacin) are often the first-line treatment for overactive bladder (OAB). They work by blocking the action of acetylcholine, a neurotransmitter that stimulates bladder contractions. This can help reduce frequency, urgency, and urge incontinence. These are most commonly prescribed for overactive bladder and can be very effective, depending on patient factors.
• Beta-3 Adrenergic Agonists: Mirabegron is a beta-3 agonist that relaxes the detrusor muscle of the bladder, increasing bladder capacity and reducing OAB symptoms. This is generally well-tolerated by patients but is not usually a first-line treatment compared to other options. It may offer a useful alternative if anticholinergics/antimuscarinics are not tolerated or are contraindicated in the patient.
• Alpha-Blockers: These drugs (e.g., tamsulosin, alfuzosin, doxazosin) can be used to treat bladder outlet obstruction (BOO) by relaxing the muscles in the bladder neck and prostate (if present), thus facilitating complete bladder emptying. These drugs do not come without potential side effects, however, so it is important to use them under the advice and direction of a doctor. They can be prescribed alongside other medications for a more robust approach, and a more effective result may be achieved if these drugs are correctly prescribed and used.
• Antibiotics: If a urinary tract infection (UTI) is the underlying cause of LUTS, appropriate antibiotic treatment is essential to properly managing this condition and treating any associated pain, discomfort, and the various physical and physiological symptoms. Recurrent infections require appropriate diagnosis and care and may require further interventions.
• Other medications: Depending on specific cause, other relevant options for treating various issues and reducing symptom severity might be available under appropriate direction from a physician. In some cases, surgical interventions might be necessary to remove an obstruction, depending on its type or severity, or its cause.

Early Intervention is Key

LUTS in young people can have a significant impact on quality of life, affecting social interactions, academic performance, and emotional well-being. Prompt evaluation and appropriate management are crucial for achieving proper health. It also helps to ensure any potential complications from not treating any underlying or related conditions are identified early. Early intervention can help improve symptoms, prevent complications, and address underlying medical conditions. Addressing LUTS in young people should include education and creating open communication and providing ongoing support as needed, while helping young patients and families manage this condition. If you or someone you know is experiencing LUTS, seek help from a medical professional. These are not normal physiological conditions, nor are they normal in day to day life for people within this age range.