Storage, voiding and post-micturition lower urinary tract symptoms
Lower urinary tract symptoms (LUTS, urinary complaints from the bladder, prostate or urethra) are grouped by when they occur: filling, emptying or just after passing urine.
Remember
Sort each lower urinary tract symptom by timing: storage symptoms happen while the bladder fills, voiding symptoms while it empties, and post-micturition symptoms just after the stream has finished.
Memory aid
the bladder's three jobs: fill (storage), empty (voiding) and finish (post-micturition)
Ask which job is going wrong: filling, emptying or finishing.
Doctors sort lower urinary tract symptoms by the phase of the bladder cycle in which each one happens. Think of the bladder's three jobs: fill, empty and finish.
Storage symptoms arise while the bladder is filling and holding urine. Urgency is a sudden, compelling need to pass urine that is difficult to defer (to put off). Daytime frequency means needing to go more often than before, usually passing only small amounts. Nocturia means waking at night to pass urine. Urinary incontinence, such as urge incontinence (leakage with a sudden urge to pass urine), belongs in this group too.
Voiding symptoms belong to the act of emptying. They include hesitancy (a delay before the stream starts), a weak stream, straining, intermittency (the stream stops and starts) and terminal dribbling (a trickle as the stream tails off). They usually come from bladder outlet obstruction, meaning resistance to flow out of the bladder, most often from benign prostatic enlargement in men (an enlarged prostate narrowing the urethra). Less commonly, voiding symptoms come from the detrusor (the bladder wall muscle) contracting weakly.
Post-micturition symptoms come once the stream has finished, and micturition simply means passing urine. The classic example is post-micturition dribbling, a small leak just after finishing. A sensation of incomplete emptying is classed here as well.
Grouping tells you when a symptom occurs, not which disease is causing it. Storage symptoms were once believed to relate only to prostatic enlargement, but there are many different causes of both voiding and storage symptoms.
Key facts
- Storage symptoms
- urgency, frequency, nocturia and urinary incontinence occur while the bladder fills.
- Voiding symptoms
- hesitancy, a weak stream, straining, intermittency and terminal dribbling occur while urine is being passed.
- Post-micturition symptoms
- post-micturition dribble and a sensation of incomplete emptying occur after the stream has finished.
- Usual cause of voiding symptoms
- bladder outlet obstruction, most often from benign prostatic enlargement in men.
- Urgency versus urge incontinence
- urgency is a sudden, compelling desire to pass urine that is difficult to defer, whereas urge incontinence is leakage that comes with that urge or soon afterwards.
- Terminal dribbling versus post-micturition dribble
- terminal dribbling tails off while urine is still being passed, whereas post-micturition dribble is leakage after urination has completely finished.
- Nocturia
- it has many bladder, urine-volume and sleep causes, so it does not mean prostate disease on its own.
Exam traps
- A slow trickle at the end of the stream is not a post-micturition symptom, even though it is dribbling: it happens while urine is still being passed, so it is a voiding symptom.
- Dribbling after finishing is neither a storage nor a voiding symptom, because it forms its own post-micturition group.
- Leakage with a sudden urge is urge incontinence, not urgency, because urgency is the desire itself and does not require leakage.
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