Urinary function is something most people don’t think about until problems arise. Urinating too frequently, losing control of bladder activity, or having pain or seeing blood during urination are some of the most common difficulties that occur when the urinary tract becomes inhibited due to infection, a kidney stone, or another cause.
Dr. Ganesh Kartha, a urologist with First Urology in Louisville, visited Kentucky Health to discuss urinary tract problems and which treatments work best for infections and other maladies.
Conditions Affecting Urinary Function
“I think it kind of shocks people if they see blood in the urine or if they have difficulty urinating,” Kartha says. “That can cause significant quality of life issues” such as losing sleep or staying close to a bathroom during waking hours, he notes.
Noticing blood in the urine is alarming, even though Kartha explains that often the amount of blood is minimal. Most of the time, blood in the urine is not caused by cancer, but he recommends scheduling an appointment with the urologist when it occurs to make sure. Cancers originating in the prostate, bladder, and kidney can all cause blood in the urine.
In general, blood in urine is more often caused by an infection, kidney stone, or enlarged prostate. Those conditions can also result in urgency (always feeling the need to empty the bladder), leakage, and/or pain while urinating.
Kartha says that obstruction of urinary flow tends to be more of a problem for men than women due to the fact that males have a prostate gland. “And all men’s prostates grow after the age of 40, whether they like it or not,” he adds.
Both men and women can have urinary problems relating to a blockage in the urethra – the duct that transports urine from the bladder out of the body. This is called a urethral stricture, Kartha explains, and is usually caused by some form of trauma that may have occurred years earlier, such as an accident while straddling or riding a bicycle.
“Pain with urination is most commonly due to infection,” Kartha says. In some cases, though, a condition called interstitial cystitis – inflammation of the bladder not caused by bacterial infection –can also cause pain while urinating. Symptoms of interstitial cystitis may be similar to a urinary tract infection, but the condition is chronic.
“Urinary tract infections (UTIs) are fairly common,” Kartha says, “but we classify them as complicated vs. uncomplicated. An uncomplicated urinary tract infection (occurs in) a female that is sexually active that is at a normal risk of getting an infection. She has an infection and she doesn’t have a history of urinary tract infections… it’s treated with antibiotics and it doesn’t come back.”
Examples of a UTI classified as complicated example would be a woman who has two or three per year, or a man who has one, or someone of either sex who has anatomical abnormalities that increase the prevalence of getting them, Kartha says. A UTI in a male can be related to bacteria getting into the prostate, he explains, which will require stronger antibiotics taken for a longer period of time.
Typical symptoms for someone presenting with a UTI are pain with urination that feels like burning or a prickling sensation, as well as blood in the urine. “If a patient has chills or fever, we’re getting into that complicated realm where there could be something higher up that’s causing it, like a kidney stone or if the infection has ascended up into the kidney,” he says.
Kidney Stones and Incontinence
Kidney stones are small, hard mineral deposits that form when a person’s urine does not break down substances such as calcium or uric acid. These substances crystallize into kidney stones and then get lodged in the ureter (the duct draining the kidneys into the bladder), causing pressure to build back up and affect the kidney. The result is intense pain; Kartha says several of his female patients have described the pain as worse than giving birth.
Most of the time, kidney stones are caused by dietary habits, Kartha explains. Roughly 80% of kidney stones are calcium oxalate stones, he says, and certain foods and drinks increase the chances of a person getting them. The list includes dark tea, dark soft drinks, chocolate, spinach, and rhubarb. Another cause is dehydration.
“For most people, if you stay well hydrated and you watch what you eat, and we can tailor certain foods to avoid based on the individual parameters of that patient, we can be highly successful in preventing them from forming stones,” Kartha says.
If a person does develop a kidney stone, there is a 50% chance he/she will eventually have another one, according to Kartha. “Stone formers tend to run in families,” he adds. Persons with a family history of gout (inflammatory arthritis caused by a buildup of uric acid in joints) are at a higher risk for developing those types of kidney stones, for example.
If a patient presents with acute pain due to a kidney stone, Kartha will order imaging tests to determine the size and location. While smaller stones may be passed on their own, “larger stones, greater than five millimeters, are unlikely to pass and may need urologic intervention,” he says. A urologist can break up a larger stone by a using a scope or a procedure where two ultrasound waves are fixed to intersect at the stone and dissolve it.
Incontinence, when a person is unable to control urinary function, occurs more often in women than in men, Kartha says. “There’s two types of urinary incontinence,” he explains, “stress urinary incontinence, where when you cough, sneeze, or laugh you secrete urine, and then urge incontinence, where you have the urgency to go to the bathroom and you just can’t make it to the bathroom on time and your bladder contracts and you leak.”
The two types are evaluated, treated, and managed separately. “Stress urinary incontinence is typically a surgically managed problem,” Kartha says. “Certainly you can try Kegel exercises and pelvic floor strengthening to help, that’s the first line therapy. If that doesn’t work, there can be urethral bulking agents where you inject a collagen-like substance to bulk up the urethra … and lastly, the most definitive therapy is a sling, which is a small tape that you put around the urethra to help with any leakage.”
Urge incontinence, on the other hand, is managed medically, Kartha explains. Patients take medications that quiet bladder activity and reduce the urge to go to the bathroom. If medication doesn’t work, Kartha says “second-line therapy for urge incontinence is either Botox injections to the bladder which can quiet the bladder and prevent that overactivity, and also neuro-modulation of the bladder where we implant a pacemaker-like device to kind of help with bladder function and control.”
