Urinary health

What is it?

The urinary tract includes the kidneys, the ureters (the tubes connecting the kidneys to the bladder), the bladder, and the urethra (the tube that allows urine to exit from the bladder to outside the body).

Urinary health can be maintained by making lifestyle choices that help avoid infections and other problems. Common problems include:

Bladder infection (cystitis) — Bladder infections are extremely common in women of all ages. An infection almost always starts when bacteria enter the opening where urine comes out (urethra). Once bacteria enter a woman's urethra, they only have to travel a short distance to reach the bladder.

Bladder infections are uncommon in younger men. In men over age 50, a bladder infection is usually associated with an enlarged prostate or a prostate infection.

Kidney infection (pyelonephritis) — A kidney usually becomes infected because bacteria have traveled to the kidney from an infection in the bladder. Kidney infections occur more commonly

• during pregnancy
• in men with an enlarged prostate
• in people with diabetes
• in people with abnormal bladder function
• in people with persistent kidney stones
• in children with an abnormal backflow of urine from the bladder to the kidneys (called vesicoureteral reflux) or an obstruction related to abnormal development of the urinary tract.

Pyelonephritis is more common in women than in men.

Urethritis — Urethritis is an inflammation of the urethra. It is usually caused by sexually transmitted diseases (such as chlamydia and gonorrhea). Urethritis can also be caused by contact with an irritating chemical (such as antiseptics, bubble baths, and some spermicides) or by irritation from an object, such as a tube (catheter) inserted to drain urine.

Kidney stones — Kidney stones are abnormal, hard chemical deposits that form inside the kidneys. They can be as small as a grain of sand or as big as a pea or marble — or even larger. Some of these larger stones are too big to be flushed from the kidney. Other kidney stones manage to travel from the kidney into the ureter, where they become trapped.

Cancer — The most common types of cancer in the urinary tract are bladder cancer and kidney cancer. Cancers of other parts of the urinary tract are uncommon.

Symptoms

The symptoms of specific conditions involving the urinary tract vary depending on the condition.

• Bladder infection — Frequent urination, an intense urge to urinate, loss of bladder control, pain in the lower front portion of the abdomen (near the bladder), cloudy urine that may have a strong odor, bloody urine
• Kidney infection — Pain in the upper back, high fever with shaking chills, nausea and vomiting, cloudy urine, frequent urination, an intense urge to urinate
• Urethritis — A discharge from the urethra, redness around the opening of the urethra, frequent urination, vaginal discharge. Partners of people with urethritis that was caused by a sexually transmitted disease often will not have any symptoms.
• Kidney stones — Very small kidney stones may pass out of the body in the urine without causing symptoms. Larger stones may become trapped in the narrow ureter. This can cause
  • severe pain in the back or side
  • nausea and vomiting
  • blood in the urine (urine may look pink, red, or brown)
• Cancer — Bloody urine and back pain are the most common symptoms.

Diagnosis

Many people have occasional episodes of brief discomfort when they start urinating. Usually this is caused by irritation, and does not need to be treated. Make an appointment with your doctor if discomfort while urinating lasts longer than a brief moment, is severe, or if it happens frequently.

Your doctor will ask about your symptoms and your personal and sexual habits. During a physical examination, the doctor will check for tenderness over the kidneys and examine your genitals. For women, this may include a pelvic exam. Men with suspected prostate problems may have a digital rectal exam.

If your doctor thinks you have a simple bladder infection, he or she usually can confirm this with a urine test in the doctor's office.

To diagnose urethritis, the doctor may order a special urine test or may take a swab of the infected area and send it for testing.

If your doctor suspects you have a kidney infection, he or she will ask you to give a urine sample, which will be sent to a laboratory to identify the exact species of bacteria causing the infection. If you have a fever or appear ill, your doctor may take a blood sample to check for bacteria in the blood.

If your doctor is concerned about a kidney stone or cancer, further studies such as a CT scan will usually be performed.

Expected duration

How long a urinary condition lasts depends on its cause. Most people with infections of the urinary tract respond well to treatment within a few days. When the cause is more difficult to determine or more serious, symptoms may last longer.

Prevention

To help prevent bladder and kidney infections, be sure to stay well hydrated with several glasses of water each day to flush out your urinary tract. Women should wipe from front to back after having a bowel movement. They should also urinate soon after sexual intercourse to flush bacteria away from the urethra. This helps prevent bacteria from moving into the bladder.

To help prevent sexually transmitted diseases, practice safe sex. This includes always using a condom unless you have only one steady sexual partner.

To help prevent kidney stones, drink plenty of fluids and avoid dehydration. Staying hydrated dilutes your urine and decreases the chance that chemicals in your urine will combine to form stones.

You can prevent the most common type of kidney stones, known as calcium oxalate stones, by eating low-fat dairy products and other calcium-rich foods. Taking calcium supplements, however, can increase the risk of stone formation. People who excrete too much oxalate into their urine should avoid eating foods high in oxalate. These foods include beets, spinach, chard, and rhubarb. Tea, coffee, cola, chocolate, and nuts also contain oxalate, but these are safe to consume in moderation. Eating too much salt and meat can cause more kidney stones to form.

Not using tobacco products is the best way to prevent bladder cancer and other cancers of the urinary tract.

Treatment

Treatment depends on the condition.

• Bladder and kidney infections — These infections are usually caused by bacteria and can be cured with antibiotics taken by mouth. Antibiotics may be given into a vein (intravenously) for severe kidney infections.
• Urethritis — Urethritis is usually treated with antibiotics. The type of antibiotic used depends on which type of bacteria caused the urethritis. If you are sexually active and are being treated for a sexually transmitted disease, your sex partners must be treated, too.
• Kidney stones — In many cases, a trapped kidney stone eventually flushes out of the urinary tract on its own, especially if you drink plenty of fluids. You can take pain medicine as needed until the stone dislodges and flushes away. Stones that don't pass may need to be removed surgically or broken up with a procedure called lithotripsy.
• Cancer — Treatment options include surgery, immunotherapy, radiation therapy, and chemotherapy.

When to call a professional

Call your doctor or seek urgent care if you have painful urination or blood in the urine and any of these other symptoms:

• fever
• frequent urination and an urgent need to urinate
• abdominal pain
• back pain.

Prognosis

A single episode of infection in the bladder, urethra, or kidney usually goes away completely after treatment with antibiotics if treated promptly. In most cases, there is very little risk of long-term damage. However, women with certain sexually transmitted diseases can experience scarring of the reproductive tract and fertility problems if the infection is not promptly diagnosed and treated.

Up to half of people who pass a kidney stone will never pass a second one. For people with recurrent kidney stones, the prognosis depends on the cause of the kidney stones and the person's response to preventive therapies.

The outlook for cancer of the urinary tract continues to improve with new therapies.

Additional info

Centers for Disease Control and Prevention (CDC)
www.cdc.gov/

American Urological Association
Urology Care Foundation
www.urologyhealth.org/