When you've got to go, you've got to go. But racing to the bathroom can disrupt sleep, work and everyday life.
When this occurs, it may be time to see a specialist. “You need to see your primary care physician first,” says Evan Lacefield, MD, urologist at Memorial Hermann Medical Group Cypress Multi-Specialty. “Whether they send you to a urologist boils down to diagnoses.”
Dr. Lacefield shares the low-down on several concerning conditions related to your urinary tract or prostate:
What: Bladder and Urinary Tract Infections
Signs: Urination urgency, frequency, burning or bladder pain.
Who: Women account for four out of five patient visits for these types of infections due to their anatomy. “Their urethra (the tube that moves urine from the bladder out of the body) is much shorter than men, so they’re more likely to get infections from germs.”
When: “Women who have three or more UTIs yearly should see a urologist,” he says. “Men should not have bladder infections. If they do, they should see a urologist to make sure there isn’t an underlying issue.”
Why: Women may have thinned vaginal tissue after menopause, sexual activity or constipation. “We think constipation increases the bacteria count in the stool, and those bacteria cause bladder infections.”
Men can have a narrowed urethral tube due to scar tissue or an enlarged prostate, which is the small gland between the bladder and the penis.
Diagnosis: Your doctor will have you provide a urine sample. If a woman has repeated UTIs or a man has even one, a urologist may probe the bladder or kidneys with a camera—a cystoscopy—to see whether a structural problem needs fixing, such as a kidney stone or other obstruction.
Treatment: Antibiotics can treat infections, but men may need a further workup. Some medications can shrink an enlarged prostate, but sometimes a lifelong treatment may be required. Men also may need a procedure to widen a narrowed urethra—a urethroplasty—to remove scarred issue or add tissue to make it larger. The most common outpatient surgeries are the UroLift® System, which is similar to putting a stent into the prostate to widen the urinary channel, or a transurethral resection of the prostate (TURP), which trims a section of the prostate surrounding the urethra.
Prevention: Don’t wait to evacuate. Urinate and empty your bowels when you need to, rather than waiting until you have downtime, or the next TV commercial comes on. “Cranberry supplements also may help women,” Dr. Lacefield says. Your doctor also may treat constipation or postmenopausal women, can support healthy vaginal tissues with estrogen replacement therapy. “Doctors also may prescribe antibiotics as a preventive.”
Myths: “No data supports claims that bubble baths, underwear, tight leggings or the way a woman wipes matter,” he says.
What: Prostate Cancer
Signs: The sole symptom of early prostate cancer is an elevated level of a prostate-specific antigen, or PSA. A blood test reveals levels of the protein produced in the prostate gland. “A normal PSA depends on age, but 3-4 would be on the high end of normal for most men.”
Who: Only men have prostates.
When: Annual screenings tend to start at age 55 unless a man has a family history of the disease.
Why: Genes and obesity can raise the risk, Dr. Lacefield says. As does age. “Autopsies show the vast majority of men in their 90s have prostate cancer.”
Diagnosis: Monitoring PSA is a typical tool to detect prostate cancer and determine treatment options. Magnetic resonance Imaging, or MRI, offers detailed views of the inside of the prostate. Tiny portions of the gland may be removed if any areas of concern emerge on the exam.
Treatment: For those whom doctors believe need further treatment, the prostate gland may be removed, or radiation therapy can be prescribed.
Prevention: Losing excess weight may help.
Myths: Trouble urinating is not a sign of prostate cancer. “There are no early symptoms, which is why we have PSA tests yearly,” he says.
What: Kidney Stones
Signs: Severe flank pain under the bottom of the rib cage that can radiate to the groin or back. Nausea may sometimes accompany the onset of kidney stone development.
Who: Men are twice as likely to have kidney stones.
Why: “Dehydration is the other main risk factor,” Dr. Lacefield says.
Diagnosis: Kidney stones can be detected on computed tomography (CT) scans that uses an X-ray device to show 3D views and different angles inside the body.
Treatment: Depending on the size of the stones, drugs can help them pass through the body. Laser surgery or shock-wave treatments can fragment the stone.
Prevention: Drink fluids with citrus, such as lemon, lime or orange, which bind with calcium and help the stones dissolve. Also limit salt in the diet since kidneys must excrete the excess, which may combine with calcium to form the stones.
Myths: People may think consuming too much calcium causes kidney stones. But curbing calcium increases the risk. “Calcium metabolism is complicated,” Dr. Lacefield says. “If your body doesn’t have enough calcium, it takes it from bones, and it ends up in your urine.”
What: Blood in Urine
Signs: Visible or unseen blood in urine may suggest a bladder infection, kidney stones or bladder cancer. Pain also may occur.
Who: People with a bladder infection, kidney stones or bladder cancer. Fewer than 200,000 people yearly get bladder cancer, with smokers being the highest risk.
Diagnosis: A urine sample can reveal germs or unseen blood. A cystoscopy or kidney images may reveal the cause.
Treatment: Kidney stones that cause blood in urine can be treated and prevented using some of the prevention techniques described earlier. Bladder cancer is detected by an oncologist and may require surgery, chemotherapy or immunotherapy, Dr. Lacefield says. The latter heightens your own immune system to fight the disease. If caught before it spreads, survival odds are high.
Myths: As discussed previously, dairy won’t cause kidney stones.
What: Urinary Incontinence
Signs: Urgency, frequency of urinating and leaks.
Who/Why: Men’s prostates grow larger with age and can compress the urethra and push the bladder. Women may urinate involuntarily due to spasms from an overactive bladder. If women leak when they laugh, cough or sneeze, they may have stress incontinence. Age or childbirth can weaken a woman’s pelvic floor.
Diagnosis: A urine sample, physical exam and sometimes a cystoscopy can reveal the cause.
Treatment: An enlarged prostate can be treated through surgical means or radiation as mentioned above. For women, drugs can soothe an overactive bladder. Botox® injections to the area also can help, as can a bladder nerve stimulator, in which a small battery pack and a wire are surgically inserted. The battery sends impulses to control bladder nerves and thus help reduce contractions. For stress incontinence, if pelvic floor physical therapy isn’t enough, a surgeon can insert a sling under the urethra, or give injections to support the area. “It’s like lip filler around the urethra.”
Prevention: Pelvic floor exercises during and after pregnancy can help thwart stress incontinence in women.
Myths: “That medications resolve stress incontinence,” Dr. Lacefield says. “They don’t.”