BPH symptoms and the IPSS questionnaire

Benign prostatic hyperplasia produces a recognisable pattern of lower urinary tract symptoms (LUTS). The International Prostate Symptom Score (IPSS) is a validated questionnaire that quantifies the symptoms and is used to monitor change with treatment.

Voiding (obstructive) symptoms

  • Weak stream. A thinner, slower flow is the classic sign of outflow obstruction.
  • Hesitancy. A delay between relaxing and actually starting to pass urine.
  • Intermittency. The flow stops and starts.
  • Straining. Needing abdominal effort to empty.
  • Incomplete emptying. A sense that the bladder is never properly empty.
  • Terminal dribble. Continued small-volume leakage at the end.

Storage (irritative) symptoms

  • Frequency. Passing urine more often than usual during the day.
  • Urgency. A sudden compelling need to pass urine.
  • Nocturia. Getting up at night to pass urine, often twice or more.
  • Urge incontinence. Leaking on the way to the toilet when the bladder outlet relaxes before the sphincter is ready.

Storage symptoms are usually the result of the bladder becoming overactive in response to long-standing outflow obstruction, and often improve over months following successful prostate surgery as the bladder muscle recovers.

The International Prostate Symptom Score (IPSS)

The IPSS is a 7-question symptom questionnaire plus one quality-of-life question. Each symptom item is scored out of 5. The total ranges from 0 to 35:

  • 0-7 - mild symptoms.
  • 8-19 - moderate symptoms.
  • 20-35 - severe symptoms.

A copy of the questionnaire (plus scoring instructions) is available for download:

IPSS questionnaire (PDF) ipss.pdf Male LUTS - BAUS patient information male-luts.pdf

Symptoms that need prompt review

Book an earlier appointment or see your GP promptly if you experience any of the following:

  • Complete inability to pass urine (acute urinary retention).
  • Visible blood in the urine.
  • Recurrent urinary tract infections.
  • Severe pain passing urine.
  • New onset flank or loin pain with fever.

These features can indicate retention, infection, stones, haematuria requiring investigation, or upper-tract involvement - all of which warrant prompt assessment.

Considering laser surgery for an enlarged prostate?

You can ask for a second opinion on your symptoms, flow studies and prostate size before deciding between medication, HoLEP, GreenLight, TURP, UroLift, Rezum or iTind.

Request a second opinion Call 02 8382 6980