Bringing Urinary Disorders under Control

When functioning properly, the urinary tract is a marvel of efficiency. Throughout every 24-hour period, it thoroughly cleanses approximately 200 quarts of fluid, returning most of it to the circulatory system and eliminating the remaining two quarts as urine through the bladder.

As with most parts of the body, however, when this system breaks down, it causes pain and discomfort. And unfortunately, it breaks down quite frequently. Urinary tract infections (UTIs), second only to respiratory infections in frequency, account for 10 million visits to the doctor each year. One in five women will suffer from cystitis, an inflammation of the bladder, at some time in her life. Twenty to 30 percent of women who have a UTI will have a second infection, and 30 percent of those will have yet another. In addition, at least 13 million adults suffer from urinary incontinence (an inability to hold urine) to some degree.

Some Facts About Urinary Tract Disorders

• Women are more prone to UTIs than are men or children.
• Urinary tract problems increase with menopause.
• An estimated 3 percent of girls and 1 percent of boys have had a UTI by age 11.
• Young children have the greatest risk of kidney damage caused by urinary tract infections.
• Certain people who contract one or more urinary tract infections may need further testing to ensure they do not suffer from other health problems.

The kidneys, ureters, bladder, and urethra are the key components of the urinary tract. The kidneys filter waste from the blood and eliminate it in the form of urine. The urine travels from the kidneys to the bladder through narrow tubes called ureters. The bladder, a ball-shaped receptacle in the lower abdomen, stores the urine for anywhere from one to eight hours before it is emptied from the body through the urethra. Tracing the Course of the Urinary Tract

Originating at the kidneys, the urinary tract conducts waste fluid down the ureters and into the bladder, where it accumulates until expelled through the urethra. Note the striking difference in the lengths of the male and female                                                        urethras This, more than any other factor, accounts for a woman's greater vulnerability to bladder infections.

 

Urinary Tract Infections

Urine contains fluids, salts, and waste products. Normally it is sterile. Trouble starts when microorganisms, usually Escherichia coli from the digestive tract, cling to the opening of the urethra and multiply. The type of infection that follows depends on whether the bacteria stay in the urethra or travel to the bladder or even the kidneys themselves. Microorganisms called chlamydia and mycoplasma may also cause UTIs. These infections usually remain limited to the urethra.

The chief causes of UTIs are blockages, changes in hormone levels, prostate enlargement, lowered immunity, catheters, structural abnormalities, and, for some women, sexual intercourse. Women who use a diaphragm are also prone to UTIs.

Symptoms of possible urinary tract infection include:

• A frequent urge to urinate
• A painful, burning sensation in the area of the bladder or urethra during urination
• A feeling of tiredness
• Bladder pain, even when not urinating (caused by pressure above the pubic bone in women and fullness in the rectum in men)
• The passing of only a small amount of urine at a time
• In a few cases, lower back pain, fever, or chills
• Milky or cloudy urine
• Blood in the urine, back pain, or a fever (signs that the infection may have reached the kidneys)
• In children or infants, irritability; loss of appetite; unexplained, persistent fever; incontinence or loose bowels; a change in urinary patterns; or a generally unhealthy appearance

UTIs are treated with antibiotics, usually for seven to 10 days. The regimen may be shorter or longer, however, depending on whether the bladder or kidneys are infected. The drugs most commonly used for bladder infections are trimethoprim (Trimpex), trimethoprim/sulfamethoxazole (Bactrim, Septra), amoxicillin (Amoxil, Trimox, Wymox), nitrofurantoin (Macrodantin), ampicillin, the quinolone antibiotics (Cipro, Floxin, Levaquin, Maxaquin, Noroxin, Penetrex, Tequin), and the new antibiotic fosfomycin (Monurol). Longer treatments with tetracycline, trimethoprim/sulfamethoxazole or doxycycline are necessary for infections caused by Chlamydia or Mycoplasma. Lengthier courses of treatment are also usually recommended for men, in part to treat infection of the prostate gland. Women may receive extended treatment to prevent a recurrence. Pregnant women with UTIs should be treated promptly to avoid premature delivery and the risk of high blood pressure (though only certain drugs are safe to use). Severe kidney infections usually require hospitalization and several weeks of antibiotic treatment.

Women who experience recurrent UTIs often respond to one of the following regimens:

• Low doses of an anti-infective drug such as trimethoprim/sulfamethoxazole or nitrofurantoin daily for six months or longer
• A single dose of an antibiotic after sexual intercourse
• A short course (one or two days) of antibiotics when symptoms first appear

Preventing Urinary Tract Infections

During treatment of UTIs, and to prevent their recurrence, the following measures are usually recommended:

• Drink plenty of fluids, especially water.
• Drink cranberry juice or take supplements of vitamin C daily to keep urine acidic.
• Do not resist the urge to urinate.
• Wipe from front to back and wash the genital area thoroughly with soap and water after defecating to prevent bacteria from the anal area from entering the vagina
• Cleanse the genital area before having sex, and empty the bladder immediately afterward.
• Take showers instead of baths.
• Avoid using feminine hygiene sprays and scented douches; they may cause irritation of the urethra.

Urinary Incontinence

The specific causes of incontinence are numerous. Though many cases do not fit a clear-cut classification, they generally fall into one of three main categories:

Stress incontinence is the most common type among women. Its hallmark is the involuntary loss of urine during physical activity, sneezing, or coughing. The disorder may have its roots in the unique stress that pregnancy places on the urinary tract. However, symptoms may not be noticed until menopause, when the bladder tissues start to sag due to a drop in estrogen levels. Estrogen supplements often improve the condition. Other remedies include Kegel exercises (rhythmic flexing of the muscles surrounding the vagina, anus, and urethra), and surgery to reposition the bladder.

Urge incontinence is marked by an urgent, and quickly irresistible desire to urinate. In most cases, uninhibited bladder contractions are at fault. They may be a result of damage to the central nervous system from stroke or diseases such as multiple sclerosis, or may be caused by urinary infections or bladder tumors. Tolterodine (Detrol), a drug that blocks the nerve impulses responsible for bladder contractions, can provide a measure of relief.

A variant of this disorder is reflex incontinence, in which unintended urination occurs without feelings of urgency.

Overflow incontinence happens when the bladder cannot empty normally and becomes overdistended. This condition usually involves frequent, sometimes nearly constant, urine loss. Causes include neurologic abnormalities such as spinal cord injury and conditions that block outflow such as an enlarged or cancerous prostate or a stricture of the urethra.

Treatment depends on the cause of the problem. Medications prescribed for incontinence include bladder relaxants such as propantheline, flavoxate (Urispas), dicyclomine (Bentyl), oxybutynin (Ditropan), tolterodine (Detrol), and the antidepressant imipramine (Tofranil). Estrogen replacement therapy is another possibility. Surgery and behavioral techniques such as pelvic muscle exercises, biofeedback, and bladder training may also be employed.

Other Major Urinary Tract Disorders

Interstitial cystitis occurs when the lining of the bladder becomes scarred or even ulcerated, causing pain when the bladder fills and relief when it empties. This condition is treated by stretching the bladder under anesthesia. It can also be treated by instillations of DMSO (dimethyl sulfoxide) into the bladder through a catheter. Researchers are working on many new treatments for this important and disabling condition.

Bladder cancer accounts for two to four percent of all cancers. More than 50,000 new cases are diagnosed each year. It is most prevalent in people over age 50 and more common in men than in women. Approximately one-quarter of the people with this disease have no early symptoms. Most, however, experience blood in the urine. Other symptoms include pain after urination; frequent urination, especially at night; and dribbling.

The causes of bladder cancer are thought to include tobacco, nitrates, and aniline dyes.

Superficial bladder tumors can be removed surgically through the urethra by use of a cystoscope. If a tumor has penetrated the bladder wall, however, partial or even total removal of the bladder may be necessary, depending on the tumor's location.