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lower urinary tract symptoms

  • Benign prostatic hyperplasia (BPH) is a common enlargement of the prostate gland as a man ages. Though the prostate continues to grow during most of a man’s life, the enlargement doesn’t usually cause symptoms before age 40, but more than half of men in their sixties, and as many as 90 percent in their seventies and eighties have some symptoms of BPH. These are typically referred to as lower urinary tract symptoms (LUTS), and include incomplete bladder emptying, frequent urges to urinate during the day and at night. However, it should be understood that LUTS and BPH are not equivalent. While all BPH includes LUTS, not all LUTS are reflective of BPH.

    Lifestyle and LUTS

    This is comprehensively explained in a peer-review article from Current Opinion in Urology.1 The authors of the article explain that LUTS has also been associated with many factors, including diet—which is unrelated to the prostate directly but which is reflective of various lifestyle factors. The article indicates that:

    • Increased total calorie intake has been associated with LUTS;
    • Red meat, fat, cereals, bread, poultry and starch have been associated with increased risks of symptomatic LUTS;
    • Total protein, dairy, vegetables, fruits, polyunsaturated fatty acids, linoleic acid, carotenoids, vitamins A, C and D have been associated with decreased LUTS;
    • Lower vitamin D status and caffeine intake were associated with a greater prevalence of LUTS;
    • Higher serum levels of vitamin E, lycopene, selenium and carotene have been associated with reduced LUTS.

    Vitamin D and LUTS
    This relationship between vitamin D and LUTS was demonstrated in the National Health and Nutrition Examination Survey, where a majority of men with LUTS (89 percent) had insufficient vitamin D levels. In fact, 55 percent had deficient vitamin D levels. Among the 1388 men (58 percent) with LUTS data and vitamin D levels, 48 percent had at least one LUTS. The researchers concluded, “Vitamin D insufficiency and deficiency are highly prevalent among adult men in the U.S., and vitamin D deficiency is associated with moderate-severe UI and the presence of at least one LUTS.”2

    Additional non-BPH disease states and LUTS Additional research has similarly demonstrated that other non- BPH, non-disease states are associated with LUTS:

    Non-disease state Study description

    Stool / Bowel Movement3

    Less LUTS in the adult male were independently associated with low stool frequency, hard stool type and loose stool type. These data suggest causality of lower urinary tract functions and abnormalities of bowel

    habits.

    Mobility4

    Prospective study of 1740 elderly men > 65 years in the U.S. untreated for LUTS, to determine non-urological lifestyle and health factors independently associated with LUTS.

    • 345 men with progressing LUTS were more likely to have mobility limitations.
    • Men with mobility limitations or back pain may perceive their symptoms as becoming more severe over time, if difficulty with ambulation alone, or because of pain, interferes with their ability get to or use a toilet.

    Poor Diet5

    Cohort consisted of 1385 men aged .40 years, of which 279 (21.1%) reported LUTS. Poor diet quality was independently associated with patient-reported LUTS.
    Higher prevalence of LUTS:

    • among men with poor dietary intake of dairy (22.4% vs 16.4%, P =.013)
    • among men with poor intake of protein (24.6% vs 17.9%, P = .012)
    • among men with overall poor diet (25.8 vs 17.8%, P = .018)
    • among men with little dietary variety (26.1 vs 17.6%, P = .001).

    Physical Activity
    Inverse Association
    LUTS not assoc. with
    changes in prostate size
    (volume)6

    Cross-sectional analysis study included 405 men without prostate cancer or prostatic intraepithelial neoplasia.
    Higher leisure-time physical activity energy expenditure and light housework activities were significantly associated with lower LUTS.
    Although, higher LUTS was not mediated through changes in prostate size.
    Alcohol7

    This study analyzed the longitudinal association of alcohol consumption with LUTS in a longitudinal study of 9,712 healthy men 30 years or older who visited the institution multiple times for routine comprehensive health evaluations, with an average follow-up period of 27.9 months.

    • Light-moderate alcohol consumption (0.1 to 29 g/d) was associated with decreased likelihood of pronounced LUTS.
    • Heavy alcohol consumption (.30 g/d) was associated with increased likelihood of pronounced LUTS.
    Risk Factors–
    Age
    Alcohol
    Smoking8

    708 African-American men aged 40–79 years in Flint, Michigan, studied between 1996 and 1998.

    • Men aged 70–79 years experienced more than a twofold increase in the odds of pronounced LUTS.
    • Both current and former smokers were at increased odds of having pronounced LUTS in comparison with never smokers.
    • Former alcohol drinkers, when compared with never drinkers, had an approximately twofold increase in the odds of pronounced LUTS.
    • Current heavy drinkers (>72 g/day) had a nearly threefold increase in the odds of pronounced LUTS increase.
    • There was no consistent pattern of association between increasing body mass index and LUTS, but engaging in vigorous physical activity was inversely associated with the odds of pronounced LUTS.

    While many men who experience LUTS symptoms do have BPH, those same symptoms may occur as the result of lifestyle factors, independently of BPH. Consequently, it makes sense to get a proper diagnosis of your symptoms. Also, assuring adequate vitamin D intake (2,000 IU daily recommended), while eating a good diet and exercising, while avoiding constipation, smoking and the overconsumption of alcohol, may also help you to avoid LUTS or even help reduce those symptoms in some instances. Of course if you do have BPH, there are nutraceuticals, which can help. Refer to “Naturally Improving Prostate Health” in the May 2016 issue of Total Health.

    References:

    1. Lin PH, Freedland SJ. Lifestyle and lower urinary tract symptoms: what is the correlation in men? Curr Opin Urol. 2015 Jan;25(1):1-5.
    2. Vaughan CP, Johnson TM 2nd, Goode PS, et al. Vitamin D and lower urinary tract symptoms among US men: results from the 2005–2006 National Health and Nutrition Examination Survey. Urology. 2011; 78(6):1292–7.
    3. Thurmon KL, Breyer BN, Erickson BA. Association of bowel habits with lower urinary tract symptoms in men: findings from the 2005-2006 and 2007-2008 National Health and Nutrition Examination Survey. J Urol. 2013 Apr;189(4):1409-14.
    4. Marshall LM, Holton KF, Parsons JK, Lapidus JA, Ramsey K, Barrett-Connor E; Osteoporotic Fractures in Men (MrOS) Study Group. Lifestyle and health factors associated with progressing and remitting trajectories of untreated lower urinary tract symptoms among elderly men. Prostate Cancer Prostatic Dis. 2014 Sep;17(3):265-72.
    5. Erickson BA, Vaughan-Sarrazin M, Liu X, Breyer BN, Kreder KJ, Cram P. Lower urinary tract symptoms and diet quality: findings from the 2000-2001 National Health and Nutrition Examination Survey. Urology. 2012 Jun;79(6):1262-7.
    6. Fowke JH, Phillips S, Koyama T, Byerly S, Concepcion R, Motley SS, Clark PE. Association between physical activity, lower urinary tract symptoms (LUTS) and prostate volume. BJU Int. 2013 Jan;111(1):122-8. BJU Int. 2013 Jan;111(1):122-8.
    7. Suh B, Shin DW, Hwang SS, Choi HC, Kwon H, Cho B, Park JH. Alcohol is longitudinally associated with lower urinary tract symptoms partially via high-density lipoprotein. Alcohol Clin Exp Res. 2014 Nov;38(11):2878-83.
    8. Joseph MA, Harlow SD, Wei JT, Sarma AV, Dunn RL, Taylor JM, James SA, Cooney KA, Doerr KM, Montie JE, Schottenfeld D. Risk factors for lower urinary tract symptoms in a population-based sample of African-American men. Am J Epidemiol. 2003 May 15;157(10):906-14.