NICE gives doctors guidance on treating peeing problems

The first-ever guidance to doctors on treating men with urine problems has been published by NICE.

The new guidelines from the National Institute for Health and Clinical Excellence aim to set a national standard so that all men with so-called LUTS (lower urinary tract symptoms) receive the same quality treatments wherever they go.

LUTS includes needing to pee urgently or frequently, retention of urine, hesitancy when peeing and incontinence. The symptoms themselves, esitmated to affect around 1 in 4 men over 40, can impact on a man’s physical, mental and social wellbeing. They can be also be the sign of an underlying health problem such as a urinary tract infection or prostate cancer.

The NICE recommendations advise that:

• a new patient should be asked about his general medical history, given an examination of his abdomen and genitals, asked to record his symptoms in a “bladder diary” and offered a urine test and a digital rectal examination (manual examination of the prostate gland);
• if the prostate gland feels abnormal or enlarged, or if the patient is concerned about cancer, he should be referred for a PSA test which can help diagnose prostate cancer
• in less serious cases, doctors should advise patients about 'temporary containment products' (eg. pads or urine collecting devices), bladder training, and lifestyle interventions (such as reducing caffeine intake).
• Men should only be offered drug treatments if their symptoms are bothersome or if conservative management options have been unsuccessful or are inappropriate. Surgery should be considered if medication has been unsuccessful or is inappropriate.

There was previously no national guidance for diagnosing and treating these symptoms in adult men, which meant that healthcare professionals were not always using the most effective treatments.

'Waterworks problems' still a taboo issue

Roy, a 75 year old man who has experienced urine symptoms said: 'For over twenty years I experienced some dribbling after going to the toilet, which caused me great embarrassment if visible spots appeared on my trousers. Instead of going to see my doctor straightaway, I thought I could hide the problem by using makeshift pads, or by not drinking as much water, which only made me feel dehydrated and still very much concerned that there was something physically wrong with me.

'I am very encouraged by this new guideline from NICE, which will hopefully benefit many men in a similar position to mine or who have any symptoms of "waterworks problems". In particular I hope that it encourages younger men to come forward at an early stage as many may feel inhibited by the social taboos that surround these issues.'

GP Julian Spinks who helped draft the gudiance encouraged men to come forward. 'There really is no need for men to feel reluctant about visiting their GP or other healthcare professional if they have any concerns about urine problems, or for them to suffer in silence.

'The symptoms can be treated in a variety of different ways depending on the patient’s medical requirements and choice, from self-help methods to medications or surgical procedures.

'I hope that this guideline will prove to be a useful resource for the NHS and the potentially large group of patients that may require treatment.'