Bladder Problems

Frequent symptoms of a urinary problem include:

  • Burning with urination – the most common symptom of a urinary tract infection.
  • Frequent urge to urinate without the ability to pass a desired amount of urine (frequency).
  • Urgent need to urinate (urgency).
  • Feeling of incompletely emptying of your bladder.
  • Blood in the urine (hematuria). Your urine may look red, brown, or pink. Blood in the urine may occur after exercise, such as running or bicycling.
  • Leaking urine (incontinence)

Urinary Tract Infections

Urinary tract infection (UTI) is a common infection that usually occurs when bacteria enter the opening of the urethra and multiply in the urinary tract. The urinary tract includes the kidneys, the tubes that carry urine from the kidneys to the bladder (ureters), bladder, and the tube that carries urine from the bladder (urethra). The special connection of the ureters at the bladder help prevent urine from backing up into the kidneys, and the flow of urine through the urethra helps to eliminate bacteria. Men, women, and children develop UTIs.

Urinary tract infections usually develop first in the lower urinary tract (urethra, bladder) and, if not treated, progress to the upper urinary tract (ureters, kidneys). Bladder infection (cystitis) is by far the most common UTI. Infection of the urethra is called urethritis. Kidney infection (pyelonephritis) requires urgent treatment and can lead to reduced kidney function and possibly even death in untreated, severe cases.

Approximately 8 to 10 million people in the United States develop a UTI each year. Women develop the condition much more often than men, for reasons that are not fully known, although the much shorter female urethra is suspected. The condition is rare in boys and young men.

Twenty percent of women in the United States develop a UTI and 20% of those have a recurrence. Urinary tract infections in children are more common in those under the age of 2.

Urinary Tract Infections usually occur when bacteria enter the urinary tract through the urethra and multiply in the bladder. Infection-fighting assets are found in the urinary system and help inhibit the growth of bacteria. Unfortunately, certain factors boost the chances that bacteria will enter the urinary tract and develop into an infection.

Sexual intercourse may lead to UTI’s in women. And due to the fact that the anus is so close to the female urethra, even women who aren’t sexually active may contract lower urinary tract infections. Most cases of cystitis are caused by E. coli, a type of bacteria usually found in the gastrointestinal tract. When men suffer from a UTI it is typically acquired from sexual contact. Some sexually transmitted diseases, like herpes or chlamydia, also are possible causes.

Cystitis

Cystitis is a general term that includes any inflammation or infection of the bladder. Cystitis is generally caused by a bacterial infection, but it can also be caused by yeast or viruses. A unique type of cystitis known as interstitial cystitis is not caused by an infection, but it is more like an inflammation that involves the bladder lining and muscle.

For a detailed discussion of the diagnosis and management of interstitial cystitis, click here for the American Urological Association’s clinical guidelines.

Symptoms may be varied and range from severe and intensely painful to simply annoying. These include burning with urination, bladder pressure and pain, blood in the urine, and increased frequency and urgency of urination. Some patients even experience leakage of urine, also known as incontinence. Some patient likewise may experience the inability to urinate, known as urinary retention.

Treatment depends on the cause. Bacterial and yeast cystitis is treated with appropriate medicines. Viral cystitis, although rare, is generally self-limiting and requires no treatment except symptomatic. Interstitial cystitis treatment depends on the severity and duration of the symptoms and it can be very complex.

Prevention can be difficult, but obviously, patients should drink plenty of fluids and maintain good urinary tract hygiene.
How will I know if I have true cystitis and not just some irritation of the bladder causing symptoms? The only real way to know is for a urologist to take a thorough history, examine the patient and most importantly, do an analysis of the urine.

Frequent Urination

This urinary problem can be a characteristic sign of a urinary tract infection. Because irritation and swelling reduces the bladder’s ability to hold urine, even small amounts of urine cause discomfort. Pregnancy, diabetes and prostate problems are other common causes of frequency.

Other possible causes include:

  • Interstitial cystitis, described as a constant irritation of the bladder that is more common in women than men and typically hard to diagnose and treat.
  • Diuretics and many other medications
  • Radiation therapy
  • Dysfunction of the bladder
  • Bladder cancer

Urgent Urination

This condition can occur due to a variety of different causes. There are certain to be other possible sources of urinary urgency, so talk with your doctor about symptoms you experience. Possible causes of urgency include:

  • Alcohol, caffeine and artificial sweeteners
  • Bladder conditions and stones
  • Bladder irritation
  • Interstitial cystitis
  • Urge incontinence
  • Urinary tract infection
  • Blocked urine flow
  • Urinary Retention
  • Hematuria
  • Urinary Incontinence

Urinary Retention

This problem may happen unexpectedly (acute), causing discomfort or pain, or may take place long term (chronic). As with most urinary problems there are many possible causes, including:

  • Blockages in the urinary system due to urinary tract stones or birth defects
  • Narrowing of the urethra due to scarring from injury or infection
  • Benign enlargement of the prostate gland
  • Nerve or bladder muscle problems
  • Prostate cancer or kidney stones
  • Side effects from some medications, such as antihistamines

Bladder Cancer

The bladder is an organ located in the pelvic cavity that stores and discharges urine. Urine is produced by the kidneys, carried to the bladder by the ureters, and discharged from the bladder through the urethra. Bladder cancer accounts for approximately 90% of cancers of the urinary tract (renal pelvis, ureters, bladder, urethra).

Bladder cancer usually originates in the bladder lining, which consists of a mucous layer of surface cells that expand and deflate (transitional epithelial cells), smooth muscle, and a fibrous layer. Tumors are categorized as low-stage (superficial) or high-stage (muscle invasive).

In industrialized countries (e.g., United States, Canada, France), more than 90% of cases originate in the transitional epithelial cells (called transitional cell carcinoma; TCC). In developing countries, 75% of cases are squamous cell carcinomas caused by Schistosoma haematobium (parasitic organism) infection. Rare types of bladder cancer include small cell carcinoma, carcinosarcoma, primary lymphoma, and sarcoma.

Hematuria

Hematuria simply means blood in the urine. Microscopic hematuria means that the blood is only seen when the urine is examined under a microscope. Gross hematuria, on the other hand, means that there is enough blood in the urine so that the change can be appreciated with the naked eye. Obviously, gross hematuria has more blood in the urine than microscopic hematuria, but the types of diagnoses that can cause the problem are the same and the work-up or evaluation that is needed is identical.

ANATOMY

To understand the needed evaluation for hematuria, one must know the anatomy of the urinary tract in the female. A diagram of the urinary tract may be provided so that the explanation makes better sense. The kidneys function to make urine by filtering blood and then discarding into the urine the waste products that are no longer needed. Water and salts accompany these waste products by necessity. The urine is then transported through two narrow tubes, called ureters, to the bladder, which is the reservoir for urine in between each void. The urine exits the bladder through a channel called the urethra that exits the body near the front of the vagina.

The blood in the urine must come from one of the above places: kidneys, ureters, bladder, or urethra. The evaluation requires that we look at the ENTIRE urinary tract in patients with hematuria.

CAUSES

The number of causes of hematuria is great — perhaps 20 or 25 different groups of causes. Some are much more serious than others and require diagnosis sooner that later. These groups include cancers or malignancies, stones, infections, and blockages or obstructions to flow.

In the case of cancers, one must be concerned with every organ in the urinary tract, thus the reason to look at the entire urinary tract. Of the other groups, many are less important and most require no treatment. These may include viral infections, non-specific inflammations of the kidney such as dm~ reactions (non-steroidal anti-inflammatory drugs, such as ibuprofen can cause non-specific inflammation, usually without harm). Many medications can cause blood in the urine, particularly medications which thin the blood’s clotting ability, like coumadin or aspirin.

Bladder Control Problems

In people with an overactive bladder (OAB), the layered, smooth muscle that surrounds the bladder (detrusor muscle) contracts spastically, sometimes without a known cause, which results in sustained, high bladder pressure and the urgent need to urinate (called urgency). Normally, the detrusor muscle contracts and relaxes in response to the volume of urine in the bladder and the initiation of urination.

People with OAB often experience urgency at inconvenient and unpredictable times and sometimes lose control before reaching a toilet. Thus, overactive bladder interferes with work, daily routine, intimacy and sexual function; causes embarrassment; and can diminish self-esteem and quality of life.

Urination (micturition) involves processes within the urinary tract and the brain. The slight need to urinate is sensed when urine volume reaches about one-half of the bladder’s capacity. The brain suppresses this need until a person initiates urination.

Once urination has been initiated, the nervous system signals the detrusor muscle to contract into a funnel shape and expel urine. Pressure in the bladder increases and the detrusor muscle remains contracted until the bladder empties. Once empty, pressure falls and the bladder relaxes and resumes its normal shape.

For a detailed discussion of the diagnosis and management of overactive bladder, click here for the American Urological Association’s clinical guidelines.

Urinary Incontinence

This condition may occur due to a variety of different reasons, to include weak pelvic muscles or diabetes. Common causes include:

  • Diminished skin thickness or drying in the vagina or urethra, particularly after menopause in women

  • Inflamed prostate gland or prostate surgery in men

  • Some medications

  • Stool build-up of in the bowels

  • Immobility

  • Urinary tract infection

  • Elevated calcium levels