Urinary
BENIGN PROSTATIC HYPERPLASIA (PROSTATE GLAND ENLARGEMENT)
About
-
- An increase in the size of the prostate gland (a walnut-sized body part made of glandular and muscular tissue)
- The prostate surrounds part of the urethra, which is the tube that carries urine and sperm outside of the body
- Almost all men will develop some enlargement of the prostate as they grow older
- By age 60, 50% of men will have some signs of BPH
- By age 85, 90% of men will have signs of the condition
- Approximately 50% of men will develop symptoms that need to be treated
Potential Causes
-
- Aging: Increased prostate cell growth from lower levels of testosterone and higher levels of estrogen and dihydrotestosterone (DHT)
Symptoms
-
- Urinary frequency
- Urinary urgency
- Slowness/dribbling of your urinary stream
- Hesitancy/difficulty starting to urinate
- Nocturia (Nighttime voiding)
- Pain after ejaculation/while urinating
- Urine that has a different odour/colour than usual
- The enlargement of the prostate can lead to blockage of the urethra, which can lead to:
- Bladder stones
- Bladder infection
- Blood in your urine
- Kidney damage from back pressure caused by retaining large amounts of extra urine in the bladder
Diagnosis
-
- Medical history to address
- Symptoms
- Current health issues
- Over-the-counter and prescription drugs being taken
- Diet and liquid consumption
- Physical exam
- Digital rectal exam: To feel the prostate and estimate its size
- Urine flow study: May be conducted to measure how slow the urinary stream is compared with normal urine flow
- Ultrasound post-urination: To determine if there is any urine left in the bladder
- Cystoscopy: Bladder is looked at through a cystoscope
- Medical history to address
Treatment
-
- Oral Medications
- Drugs that relax the muscle in the prostate (to reduce the tension on the urethra)
- Include doxazosin, tamsulosin, alfuzosin and silodosin
- Drugs that decrease the production of the hormone dihydrotestosterone (DHT), which affects the growth of the prostate gland
- Include finasteride and dutasteride
- To help treat symptoms and improve the flow of urine
-
- Dutasteride and tamsulosin combined
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- Drugs that relax the muscle in the prostate (to reduce the tension on the urethra)
- Surgery
- Transurethral resection of the prostate (TURP): The tissue that blocks the urethra is removed with a special instrument
- Transurethral incision of the prostate (TUIP): Two small cuts are made in the bladder neck (where the urethra and bladder join) and in the prostate to widen the urethra to improve urine flow
- Transurethral electrovaporization: Electrical energy is applied through an electrode to rapidly heat prostate tissue, turning the tissue cells into steam. The enlarged tissue area can then be vaporized to relieve urinary blockage
- The GreenLight laser: Prostate tissue is removed with a laser
- Minimally Invasive Treatments
-
- Prostatic Urethral Lift: Separates the enlarged prostate lobes to make the urethra wider so that it is easier to urinate
- Water Vapour Therapy: Delivers very small amounts of steam to the enlarged prostate to damage the cells causing obstruction, thus reducing the overall size of the prostate
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- Oral Medications
CHRONIC PROSTATITIS/PROSTATODYNIA
About
-
- Inflammation of the prostate gland
- When symptoms start gradually and linger for more than 2 wks
- Affects adult men of all ages and from all backgrounds
- About 5% of men experience symptoms of chronic prostatitis at some point in their lives
- Types:
- Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CPPS): Inflammation of the prostate and an irritation of the nerves which supply this area
- No bacteria are found in a urine sample
- Chronic Bacterial Prostatitis: Uncommon
- Tends to come and go over a long period of time
- Acute Bacterial Prostatitis: Uncommon
- Bacteria is present in the urine
- Asymptomatic Inflammatory Prostatitis: No evidence of prostate infection or inflammation is found
- Could potentially be a result of abnormal buildup of pressure in the urinary tract
Potential Causes
-
- Most often, the nerves and muscles in the pelvis cause pain because of a local inflammation that effects the nerves in the area
- Less commonly, bacterial infection (if it’s a bacterial type of prostatitis) when infected urine flows backwards from the urethra
- Nonbacterial prostatitis may be linked to stress, nerve inflammation/irritation, injuries or prior urinary tract infections
- Can be a reaction to an infection/past injury
Symptoms
-
- Frequent/urgent need to urinate
- Burning during/after urination
- Difficulty starting the urine stream
- Dribbling after urination is complete
- A sensation that the bladder cannot be fully emptied
- Pain felt above the penis, in/below the scrotum or in the back/rectum
- Pain experienced during or after orgasm
- Chills & fever (Bacterial prostatitis only)
Diagnosis
- Medical history to address
- Symptoms
- Current health issues
- Over-the-counter and prescription drugs being taken
- Diet and liquid consumption
- Sexual history
- Physical exam: Your doctor will examine your prostate gland by inserting a gloved and lubricated finger into your rectum
- In chronic prostatitis, the gland may be swollen or firm or it may feel normal
- Urine Sample: Prior to and post exam to check for white blood cells and bacteria
Treatment
-
- Oral Medications
- Nonsteroidal anti-inflammatories (NSAIDs) and muscle relaxants for pain and muscle spasms
- Alpha-blocker medications to relax the muscles that control the bladder and relieve symptoms of urgency, hesitancy or dribbling
- Antibiotics (for chronic and acute bacterial prostatitis)
- Heat application: Baths, heating pads and hot water bottles
- Acupuncture: The insertion of very fine needles to alleviate pain in strategic points
- Biofeedback: Designed to ease pressure and reduce pelvic floor tension
- Diet Modification: Cutting out caffeine, alcohol, carbonated beverages and spicy/acidic foods may reduce irritation of the bladder and prostate
- Oral Medications
CHRONIC URINARY RETENTION
About
-
- When the bladder does not empty properly
Potential Causes
-
- Obstruction in the urinary tract
- Enlarged prostate gland can press on the urethra (in men)
- Cystocele: A bladder that sags (in women)
- Rectocele: Rectum that sags into the back wall of the vagina (in women)
- Drugs including antihistamines, antispasmodics, anticholinergics and tricyclic antidepressants that can change the way the bladder muscle works
- Urethral stricture
- Urinary stones
- Catheter use
- Nerve problems that interfere with signals from the brain to the bladder
- Nerves can be damaged from vaginal childbirth, spinal cord injuries/infections, diabetes, stroke, multiple sclerosis, pelvic injury/trauma and benign prostatic hyperplasia
- If the bladder tries to release but cannot due to weak pelvic floor muscles or the sphincter not relaxing at the right time
Symptoms
-
- A struggle to start the flow of urine
- Weak flow
- Feeling the need to go, but cannot start
- Feeling the need to urinate right after you’ve gone
Diagnosis
-
- Medical history: To address past and current health issues and over-the-counter and prescription drugs being taken
- Physical exam: Of the lower abdomen (for men and women) and prostate check (for men)
- Urinalysis: To test for infection/blood/abnormalities
- Bladder ultrasound: To show how much urine is still in the bladder post-urination
- Cystoscopy: To look at the lining of your urethra and bladder to check for urethral stricture, a blockage caused by a stone, an enlarged prostate or a tumour
- CT scan: Can help find stones or anything else blocking the flow of urine
- Catheter tests: Can determine urine flow rate and how well the bladder empties
- Prostate-specific Antigen (PSA) blood test: To screen for prostate cancer
- Electromyography (EMG): Uses sensors to measure electrical activity of muscles and nerves in and near the bladder and urethral sphincter
Treatment
-
- Enlarged Prostate
- Oral Medications: Alpha-blockers and 5-alpha reductase inhibitors to help shrink the prostate
- Laser therapy: To break up the blockage
- Surgery: Transurethral resection of the prostate to remove a section of the prostate
- Enlarged Prostate
-
- Cystocele/Rectocele
- Pelvic Physiotherapy: To strengthen the pelvic floor muscles
- Vaginal Pessary: Insertion of vaginal pessary (ring) to support the bladder
- Estrogen Therapy: For post-menopausal women
- Surgery: To lift the sagging bladder/rectum
- Cystocele/Rectocele
-
- Urethral Stricture
- Using catheters and balloons to open the urethra
- Stent: Can prop open a closed urethra (in men)
- Surgery: Using a knife/laser to make a cut to open the stricture
- Urethral Stricture
-
- Nerve-related
- Self-catheterization
- Nerve-related
Fowler's Syndrome
About
-
- Caused by spasms of the external urethral sphincter (a band of muscle that opens and closes at the exit of the bladder)
- Affects young women (under the age of 30), leading to urinary retention
Potential Causes
-
- Unknown
- Often seen in women who have had a surgical procedure, childbirth, opiate exposure or an infection/illness
Symptoms
-
- Inability to urinate
- Inability to feel that the bladder is full
- Abnormality of the urethra
- Dysuria (painful/difficult urination)
- Stomach pain
- Polycystic ovaries
- EMG abnormality
Diagnosis
-
- Rule out more common causes of urinary retention
- Determine how much urine the bladder can hold
- Concentric Needle Electromyography (EMG): Will often show a characteristic abnormality
Treatment
-
- Sacral Neuromodulation (SNM) Therapy: A device is implanted in the body to help stimulate the nerves to the bladder
INTERSTITIAL CYSTITIS (IC)/BLADDER PAIN SYNDROME (BPS)
About
-
-
- A chronic bladder condition with lower urinary tract symptoms lasting over 6 wks with no diagnosis of infection or other clear cause
- Two types
- Hunner’s Ulcers
- Distinctive areas of inflammation on the bladder wall that characterize the classic form of IC
- 5-10% of IC patients
- Non-Ulcerative
- Pinpoint hemorrhages, also known as glomerulations, in the bladder wall
- Also referred to as Bladder Pain Syndrome
- 90% of IC patients
- Hunner’s Ulcers
- Difficult to estimate the number of people affected as a result of there being no standard diagnostic protocol
- Typically 2-3x more common in women than in men
- Risk increases with age
-
Potential Causes
-
- What causes IC/BPS is not exactly known, but there are many theories including:
- A defect in the bladder tissue, which may allow irritating substances in the urine to penetrate the bladder
- A specific type of inflammatory cell, called a mast cell. This cell releases histamine and other chemicals that lead to IC symptoms
- An agent in the urine that causes damage to the bladder
- Changes in the nerves that carry bladder sensations so pain is caused by events that are not normally painful (ie: bladder filling)
- The immune system attacks the bladder
- What causes IC/BPS is not exactly known, but there are many theories including:
Symptoms
-
- Vary for each patient and range from mild to severe
- Suprapubic/pelvic pain that may worsen as the bladder fills, be constant or may come and go
- Can be felt in other areas including the urethra, lower abdomen, lower back,
pelvic/perineal area, vulva/vagina (in women) and scrotum/testicles/penis (in men)
- Can be felt in other areas including the urethra, lower abdomen, lower back,
-
- Pressure/discomfort when the bladder is filling
- Urinary frequency often of small amounts, upwards of 60x a day
- Average number of times a person urinates per day: 7
- Persistent urinary urgency that can be triggered by
- Certain foods/beverages
- Physical/mental stress
- Menstrual cycle
- Sexual intercourse
Diagnosis
-
- Medical history to
- Address symptoms
- Past and current health problems
- Over-the-counter and prescription drugs being taken
- Diet and liquid consumption
- Tests
- Baseline Pain Evaluation: Series of questionnaires to determine your baseline pain value with the goal of finding pain location(s), intensity and characteristics and identifying factors that make pain/discomfort better or worse
- Voiding Diary: To evaluate your voiding patterns
- Urodynamic Evaluation: The bladder is filled with water through a catheter to measure bladder pressures as it fills and empties *IC patients have a low capacity and potential pain with filling
- Cystoscopy: Bladder is looked at through a cystoscope and often the bladder will be filled with water to see how much it can hold
- If Hunner’s ulcers are seen (distinctive areas of inflammation on the bladder wall), the diagnosis is fairly certain
- Medical history to
Treatment
*All IC patients respond differently so trial and error needs to be carried out in order to determine what will work best for you
-
- Diet: Certain foods can worsen symptoms
- Bladder irritants for most: Alcohol, caffeine, artificial sweeteners, carbonated beverages, chocolate, citrus fruits, tomatoes and spicy food (See Diet section for a more extensive list)
- Determining which foods irritate your bladder can be discovered through an elimination diet
- Physical Activity: Walking and gentle stretching
- Stress Reduction: Learning stress reduction methods including mindfulness meditation and restorative yoga can be helpful, as stress is a major flare trigger. (See the Lifestyle section)
- Pelvic Physiotherapy: To reduce tenderness/pain/spasms in the pelvic floor area through exercise and massage
- The Canadian Urological Association (CUA) recommends that everyone diagnosed with IC has a pelvic floor exam, looking for trigger points
- Studies show that 79% of people with IC/BPS have trigger points in the pelvic floor
- Up to 83% of patients who see a pelvic floor physiotherapist have their symptoms improved/resolved
- Bladder Retraining: Helping you begin to hold more urine for longer periods of time by gradually increasing the time between each visit to the bathroom
- Track the number of times and how often you have the urge to urinate
- Use the diary to gradually increase the length of time between bathroom breaks
- Medications (Oral & Intravesical)
- Pentosan polysulfate sodium (Elmiron): Used for treating pain
- It could take up to 6 months before any improvement is noticed
- Ophthalmic screening is advised for any patient who has taken Elmiron with any vision complaints for evidence of retinal maculopathy
- ELMIRON ADVISORY
- Heartburn medications: To reduce the amount of acid made by the body
- Muscle relaxants: Can help relieve the symptoms by keeping the bladder from squeezing at the wrong time
- Antihistamines: Decrease the amount of histamine in the bladder that leads to pain and other symptoms
- Tricyclic antidepressants: Amitriptyline/nortriptyline have been shown to decrease bladder spasms and slow the nerves that carry pain messaging
- Bladder Instillations: The bladder is filled with liquid medication including Dimethyl Sulfoxide (DMSO) and Heparin, through a catheter
- DMSO may block swelling, decrease pain sensation and remove free radical toxins that can cause tissue damage
- Combined with Heparin/steroids to decrease inflammation
- Bladder Stretching/Hydrodistension: The bladder is filled with sterile water in order to distend it and increase the amount of urine it can hold
- Neuromodulation Therapy
- Delivers harmless electrical impulses to nerves to change how they work
- More effective for urgency/frequency reduction, but can sometimes help with the bladder/suprapubic pain
- Sacral Neuromodulation (SNS)
- Changes how the sacral nerve works (the nerve that carries signals between the spinal cord and the bladder)
- Electrical wire is implanted under the skin in the lower back
- It’s first connected to a handheld pacemaker to send pulses to the sacral nerve
- If it helps, a permanent pacemaker that can regulate the nerve rhythm is implanted
- Cauterization/Steroid Injections: May provide long-term relief for those with Hunner’s ulcers for up to a year or more
- Injections: To relieve pain, botulism is injected through a catheter to paralyze the bladder muscle
- These often need to be repeated every 6-9 months
- Cyclosporine: Immunosuppressant therapy reserved for severe cases only
- Surgery: Bladder/parts of the bladder are removed
- Reserved for patients with severely limited bladder capacity or severe symptoms that have not responded to other treatments
- Pentosan polysulfate sodium (Elmiron): Used for treating pain
- Diet: Certain foods can worsen symptoms
orchialgia
About
-
- Chronic testicular pain lasting more than 3 months
- Can come on suddenly/gradually
Potential Causes
-
- Spontaneous
- As a result of an infection (UTI/STI)
- Trauma
- Inflammation
- Surgery
Symptoms
-
- Pain originating from the scrotum
Diagnosis
-
- Physical exam
- STI screening (if applicable)
- Urine sample
- Ultrasound to rule out other pathology
Treatment
-
- Heat application: Warm baths, heating pads, hot water bottles
- Oral medications: Anti-inflammatories
- Wearing tight-fitting underwear
- Avoiding heavy lifting
- Pelvic physiotherapy: If pain is due to muscle spasming
- Temporary spermatic cord block: Local anesthetic is injected into the spermatic cord (the structure carrying the vas, nerves, blood vessels and lymphatics to the testicle)
- Surgery: Microsurgical Cord Denervation if the temporary cord block is successful
- The cord is exposed and the nerve containing structures are cut while the blood and lymphatic supply are maintained
- Provides long-term pain relief in over 70% of patients who have
- Chronic pain lasting more than 3 months
- Failed other medical interventions and therapies
- Received temporary relief with a cord block
OVERACTIVE BLADDER (OAB)
About
-
- Name for a group of urinary symptoms
- Sudden, uncontrolled need or urge to urinate
- The need to pass urine many times during the day and night
- Can result if the nerve signals between your bladder and brain are not working properly so that your bladder muscle contracts before it’s full
- You are more susceptible to OAB if
- You live a sedentary lifestyle and are overweight
- You do not manage chronic conditions such as diabetes
- You live with a neurologic condition ie: Multiple Sclerosis, have suffered a stroke
- You have a hypotonic (weak) pelvic floor
Potential Causes
-
- Neurologic disorders/damage to the signals between your brain and bladder
- Hormone changes
- Pelvic muscle weakness/spasms
- A urinary tract infection (UTI)
- Side effects from a medication
Symptoms
-
- Urgency: A sudden, strong urge to urinate that cannot be ignored
- Urge Incontinence: The loss of bladder control
- Frequency: Having to urinate over 8 times/day
- Nocturia: Waking more than once a night to urinate
Diagnosis
-
- Medical History to address
- Past and current health issues
- Over-the-counter and prescription drugs being taken
- Diet and liquid consumption
- Bladder Diary
-
- Over a few weeks, record
- When and how much fluid you drink
- When and how much you urinate
- How often you have that “gotta go” urgency feeling
- When and how much urine you may leak
- Over a few weeks, record
-
- Tests
- Urinalysis: To check for infection/blood/other abnormalities
- Bladder scan: To show how much urine is still in the bladder after you urinate
- Cystoscopy: To look at the bladder through a cystoscope to rule out other conditions
- Medical History to address
Treatment
-
- Diet: Limit foods and drinks that irritate the bladder including caffeine, carbonated beverages, alcohol, spicy and acidic foods
- Bladder diary: To help you find patterns ie: bothersome foods, liquid consumption
- Double voiding: After you think you’ve finished emptying your bladder, try again
- Delayed voiding: Try to hold off when you have to urinate if the urgency is not severe
- Timed urination: Urinate only at set times during the day
- The goal is to prevent that urgent feeling and to regain control
- Bladder muscle relaxation exercises
- Kegels: To strengthen the pelvic floor
- Quick Flicks: Squeeze and relax your pelvic floor muscles over and over again
- Biofeedback: Computer graphs and sounds to monitor muscle movement help teach you how your pelvic muscles move and how strong they are
- Prescription drugs (Oral & Intravesical)
- Antimuscarinics & Beta-3 Adrenoceptor Agonists: Can relax the bladder and increase the amount of urine your bladder can hold and empty
- Botox: Relaxes the muscle of the bladder wall to reduce urgency and urge incontinence
- Effects can last up to 6 months
- Neuromodulation therapy: Electrical pulses are sent to nerves that share the same path for the bladder
- Help the brain and the nerves to the bladder communicate so the bladder can function properly
- Percutaneous Tibial Nerve Stimulation (PTNS): Small electrode is placed near your ankle and pulses are sent to the tibial nerve to help control the signals that aren’t working right
- 12 treatments are usually required
- Sacral Neuromodulation (SNS): Changes how the sacral nerve works (the nerve that carries signals between the spinal cord and the bladder)
- Electrical wire is implanted under the skin in the lower back
- It’s first connected to a handheld pacemaker to send pulses to the sacral nerve
- If it helps, a permanent pacemaker that can regulate the nerve rhythm is implanted
- Bladder Reconstruction/Urinary Diversion Surgery: Used only in rare and severe cases
- Augmentation Cystoplasty: Enlarges the bladder
- Urinary Diversion: Reroutes the flow of urine
RECURRENT URINARY TRACT INFECTIONS (UTIS)
About
-
- Urinary Tract Infection (UTI): Bacterial infection of the urinary system causing an inflammatory response
- Can affect any part of your urinary system: Bladder, kidneys, urethra and/or ureters
- Usual Uropathogens: Escherichia coli, Staphylococcus saprophyticus, Klebsiella pneumoniae and Proteus mirabilis
- A threshold of 3 UTIs in 12 months is used to signify recurrent UTI
- Urinary Tract Infection (UTI): Bacterial infection of the urinary system causing an inflammatory response
-
- The Pathogenesis of Recurrent UTI: Involves bacterial reinfection/bacterial persistence, with the former being much more common
- Reinfection
- Recurrence with the same organism in more than 2 weeks after treatment, a different organism or a sterile intervening culture
- Bacterial Persistence
-
- The same bacteria may be cultured in the urine 2 weeks after initiating sensitivity-adjusted therapy
-
- Reinfection
- The Pathogenesis of Recurrent UTI: Involves bacterial reinfection/bacterial persistence, with the former being much more common
Potential Causes
- More prevalent in women
- Urethra is closer to the rectum
- Urethra is shorter
- Diaphragm use
- The use of products that can change the bacterial makeup of the vagina ie: spermicides, vaginal douches
- Menopause due to hormonal changes resulting in modified vaginal bacteria
- Invasion of E.Coli bacteria into the urinary tract as a result of:
- Improper wiping
- Toilet water backsplash
- Sexual intercourse
- In men
- Enlarged prostate: The bladder does not empty completely, enabling bacteria to grow more easily
- Neurogenic bladder: More prone to recurrent UTIs, as a result of issues with bladder muscle function (urinary retention)
Symptoms
-
- Frequent urination
- A burning sensation while urinating
- Bloody/dark urine
- Pain in your bladder/kidney regions
Diagnosis
-
- Urine culture: To determine which bacteria are present
- Cystoscopy: To look inside the urethra and bladder to see if there are any abnormalities/issues that could cause the UTI to keep coming back
Treatment
- Antibiotics
- For a week followed by long term, low-dose antibiotics after the initial symptoms subside
- Post-intercourse
- When on antibiotics, be sure to take probiotics to replenish good bacteria in your system
- Estrogen therapy: For menopausal women
- Water: Drink lots to dilute your urine and help flush out bacteria
- Heat application: Use a heating pad/hot water bottle on your bladder
Urethral Stricture Disease
About
-
- When a scar from swelling, injury or infection blocks/slows the flow of urine in the urethra
- Can be painful for some
- Men are more susceptible, as a result of having longer urethras than women
- 2 Types are Posterior and Anterior
- Posterior: Happens in the first 1-2” of the urethra
- Due to an injury from a pelvic fractur
- Urethra is disrupted and completely cut/separated
- Urine cannot pass
- Anterior: Happens in the first 9-10” of the urethra
- Due to trauma from a straddle injury, direct trauma to the penis or from urinary catheterization
Causes
-
- Trauma to the urethra from a fall
- Infection
- Damage from surgical tools
- Conditions that cause swelling
- Urinary catheterization
- Prostate surgery
- Kidney stone removal
Symptoms
-
- Decreased urine stream
- Incomplete emptying of the bladder
- Urine stream spraying
- Straining or pain when urinating
- Urinary frequency
- Urinary urgency
- UTIs in men
Diagnosis
-
- Physical exam
- Urethral imaging: X-rays/ultrasound
- Urethroscopy: To see the inside of the urethra
- Retrograde Urethrogram: Uses x-ray images to check for a structural problem/injury of the urethra as well as the length and location of the stricture along the urethra
Treatment
*Dependent on the size of the blockage and how much scar tissue there is
- Dilation: Enlarging the stricture with gradual stretching
- Urethrotomy: Cutting the stricture with a laser/knife through a scope
- Urethroplasty: Surgically removing the narrowed section of the urethra/enlarging it
- The procedure might also involve reconstruction of the surrounding tissues through the use of skin/mouth grafts
URETHRAL SYNDROME
About
-
- Condition that affects the urethra (the tube that carries urine from the bladder to outside the body)
- Inflamed/irritated urethra
- Most common in women
Potential Causes
-
- Physical problems with the urethra such as abnormal narrowing, urethral irritation or injury
- The urethra can be irritated by:
- Scented products (perfumes, soaps, bubble bath and sanitary napkins)
- Spermicidal jellies
- Certain foods and drinks containing caffeine
- Chemotherapy and radiation
- The urethra can be injured by:
- Sexual activity
- Diaphragm use
- Tampon use
- Bike riding
- Increased risk of developing urethral syndrome if you:
- Are prone to bacterial bladder/kidney infections
- Take certain medications
- Have sex without a condom
- Have an STI
Symptoms
-
- Pain with urination
- Lower abdominal pain/pressure
- Urinary urgency
- Urinary frequency
- Urinary difficulty
- Pain during sex
- Blood in the urine
- Bladder not feeling empty after urinating
- Swelling of the testicles (men)
- Pain while ejaculating (men)
- Blood in the semen/urine (men)
- Discomfort in the vulvar area (women)
Diagnosis
-
- Medical history review and symptom evaluation
- Physical exam including the genitals, abdomen and rectum
- Urine sample: To rule out bacterial infection
- Urethroscopy: To see the inside of the urethra
- Pelvic ultrasound
Treatment
- Lifestyle changes: Refrain from using products, eating/drinking food and beverages or doing activities that can irritate the urethra
- Medications
- Anesthetics: Phenazopyridine, Lidocaine
- Antispasmodics: Hyoscyamine, Oxybutynin
- Tricyclic Antidepressants: Amitriptyline, Nortriptyline
- Act on your nerves to help relieve chronic pain
- Alpha-blockers: Doxazosin, Prazosin
- Improve blood flow by relaxing the muscles in your blood vessels
- Dilation/Surgery: To widen your urethra if the syndrome is due to constriction
URINARY INCONTINENCE
About
-
- Uncontrolled leaking of urine
- Affects 1 in 4 women and 1 in 9 men in Canada
- Only 1 in 12 will seek treatment
- 5 Types
- Stress Urinary Incontinence (SUI): Most common, especially in older women
- Happens when the pelvic floor muscles stretch
- Overactive Bladder (OAB): Urgency incontinence and urinary frequency
- Mixed Incontinence (SUI & OAB): Leak urine with activity (SUI) and often feel the urge to urinate (OAB)
- Urge Incontinence: The sudden loss of bladder control secondary to a strong and overwhelming urge to go to the bathroom
- There can be a small amount of urine loss or complete emptying of the bladder
- Overflow Incontinence: Most common in men with prostate issues
- The body makes more urine than the bladder can hold or the bladder is full and cannot empty thereby causing leakage
- In addition, there may be something blocking the flow or the bladder muscle may not contract as it should
Potential Causes
-
- Aging
- Pregnancy, childbirth and number of children
- Post-menopause potentially due to the drop in estrogen in women
- Prostate problems
- Some medications
- Neurological diseases
- Increased risk for those who smoke, are obese, have high blood pressure and/or diabetes
Symptoms
-
- SUI: Leaking when you are physically active
- OAB: Needing to urinate more than normal
- Urinary urgency that sometimes cannot be controlled
- May/may not cause your bladder to leak urine
- Nocturia (nighttime urination)
- Mixed SUI & OAB: Leaking AND a sudden strong urge to urinate
- Overflow Incontinence: Frequent, small urinations and constant dribbling
Diagnosis
-
- Medical history to address
- Past and current health issues
- Over-the-counter and prescription drugs being taken
- Diet and liquid consumption
- The Three Incontinence Questions Tool
- Asks if, when and how often urine leakage is experienced
- Can help categorize the type of urinary incontinence
- Three-day Voiding Diary
- Used as part of the initial assessment for urinary incontinence symptoms
- Record
- When and how much fluid you drink
- When and how much you urinate
- How often you have that “gotta go” urgency feeling
- When and how much urine you may leak
- Cough Stress Test: Most reliable clinical assessment for confirming SUI
- Urodynamic Testing: To determine how well the bladder, sphincters and urethra hold and release
- Postvoid Residual Urine Measurement
- You’re asked to urinate (void) into a container that measures urine output
- The amount of leftover urine in your bladder is checked using a catheter/ultrasound
- Medical history to address
Treatment
-
- Indwelling Catheters: Flexible tube placed in your bladder all day and night. A balloon holds the tube in your bladder and drains urine into an external bag
- Intermittent Catheterization: Catheter is inserted into the urethra 3-5x/day. Once the bladder is empty, you remove the catheter
- Urethral Insert: Inserted into the distal portion of the male urethra, inhibiting the flow of urine. Can be removed before urination and reinserted after urination
- Absorbent Products: Pads, adult diapers, protective underwear, guards and drip collection pouches for men
- Toilet Substitutes: Commode seats, bedside commodes, urinals (plastic jug-type devices)