Urinary Problems

Overview of urinary problems

In a survey conducted by WaterAid in 2017, it was found out that at 732 million people with no access to toilets, India is the leading country in the list of countries with people having minimal toilet access. Out of these, 355 million were females.

Coming to the global statistics, the epidemiological findings by the National Kidney Foundation show that nearly 20% of women having a history of urinary tract infection are likely to develop a recurrent infection in future. Many of these patients grow acute kidney malfunctions in the future. In the USA, 13% of men and 7% of women are reported to develop kidney stones at least once in their lifetime.

All the aforementioned conditions culminate in mild to severe urinary problems. At present, the global health burden of urinary problems is very high and needs to be addressed on priority.

What are urinary problems?

“Urinary problems” is an umbrella term encompassing an array of clinical conditions like urinary tract infection and kidney dysfunctions. These conditions are characterized by acute renal problems, that eventually lead to renal failure. There are incidences where urinary problems are mediated by bacterial and viral pathogens. In most cases, bacterial species that enter the urinary tract are immediately removed by the body. But in people having a weak immune capacity, these bacteria continue residing and propagating within the renal tract and cause urinary problems of severe nature.

Urinary tract infection

Urinary tract infections (UTI) refer to the mild to severe infections of the urinary tract and the reproductive system.  These are mediated mainly by bacteria, although fungal and viral pathogens might have some contribution as well. It is more common in females than in males. This is because women have a shorter urethra as compared to men and thus it becomes easier for microbes to enter the bladder or kidney. Another important reason is that women undergo more hormonal fluctuations than men. These varying hormonal levels also play a role in acquiring urinary infections. Urinary tract infections lead to some major problems in urination.

UTI is of two types- symptomatic and asymptomatic. Both types are characterized by a large number of bacteria in the urine. Cystitis and Pyelonephritis are the two main features of symptomatic infections.

What causes urinary tract infections?

The etiology of urinary tract infections is discussed below-

• E.coli infections in the inner lining of the renal tract
• Infections of the urethra
• Clogging of the urinary tract due to the accumulation of wastes
• Intrusion and obstruction caused by Indwelling Catheter (IDC)
• Use of unclean sanitary napkins or nappies
• Anatomical defects of the renal tract (usually present from birth)
• History of urinary tract infections
• Hormonal alterations
• Glomerular diseases (affects the filtration mechanism)
• Heredity
• Low on fluid intake

What are the main signs and symptoms?

The warning signs of UTI are given below-

• Frequent urination
• Feeling of bladder fullness after passing urine
• Passing small volumes of urine (oliguria)
• Passage of strong smelling and frothy urine
• Presence of blood in the urine (occasional)
• Burning sensation while passing urine
• Lower abdominal pain and cramps

Hematuria (blood in urine)

Hematuria is defined as the clinical condition where excess red blood cells (RBC) are present in urine, giving it a reddish-brown coloration.

Typically, the presence of 3 or more RBCs in the HPF analysis of 2-3 collected urine samples is medically termed as Hematuria.

It is of two types- Microscopic and Macroscopic. In the microscopic type, a very small quantity of blood is present in the urine, while in the macroscopic type, a greater number of RBCs are present in the urine sample.

What causes Hematuria?

Hematuria is caused by a number of factors which are discussed below-

• Occurrence of kidney cysts
• Presence of kidney stones
• Tumors in the urinary bladder or the kidney
• Diseases like Glomerular disease, Polycystic Kidney disease, Sickle cell disease, Intravascular Haemolysis or Benign Prostatic Hyperplasia (BPH)
• Problems in blood coagulation
• Malignancy
• Recent surgeries

What are the main signs and symptoms?

Hematuria is readily identified by the following signs-

• Reddish or brownish urine
• Cloudy appearance of urine
• Foul odor
• Accidental leakage of urine (due to lack of bladder control)
• Painful urination
• Pain in the lower abdomen and pelvic region
• Nausea and vomiting

Proteinuria

This is a pathological condition marked by the presence of excess protein in the urine, giving it a frothy and cloudy appearance. It is attributed to the following factors-

• Increased glomerular filtration and low tubular re-absorption of proteins
• Excess release of plasma proteins and tissue proteins
• Accumulation of excess protein in the vital organs
• Diseases like malaria, lupus or myeloma

Proteinuria mainly presents as-

• Foamy or frothy appearance of urine (due to the presence of excess bubbles)
• Edema (swelling of hands and limbs)
• Strong smell from urine

Kidney failure

It is a disease, or a combination of diseases where the kidney stops functioning properly as a result of renal dysfunctions or urological disorders. Excess build-up of wastes, abnormal electrolyte decomposition, and hormonal disturbances are observed in this case.

The main causes of kidney failure are-

• Aging
• Bacterial infections
• Clogging of urinary tract
• Diseases like Sickle cell disease, arthritis, gout and Leukaemia
• Structural defects like medullary sponge kidney, cysts, and scars
• Accumulation of nicotine or other by-products of tobacco smoking
• Low intake of the essential micronutrients through the regular diet
• Over-the-counter drugs like corticosteroids and diuretics
• Disturbed pH of urine

Cases of acute kidney failure may necessitate dialysis.

Diagnosis, treatment, & prevention

The urologists usually recommend the following diagnostic tests-

• Ultrasound of kidneys
• Cystourethrogram
• MRI and CT scan
• Radionuclide scan
• Cystoscopy
• Urodynamics

The treatment mainly depends on the underlying health condition.

• UTI– The treatment mainly depends on the underlying cause and the clinical manifestations of the condition. In case of Urinary Tract Infections (UTI), antibiotics are prescribed by doctors based on the urine culture reports.
• Urinary urgency– it is treated depending on the case. Antibiotics are usually prescribed. Other treatment modalities are bladder and bowel training, pelvic floor muscle exercises (Kegel exercises), treatment of muscle spasms, medications etc.
• Urinary incontinence– At the initial stage, it is treated by changes in the diet and medications. Reduced liquid intake before sleep is advised. If the condition does not improve, surgery, certain non-invasive outpatient procedures and medications are the treatment options.
• Urinary retention– In this case, a catheter (a thin and flexible plastic tube) is placed in the urethra. It facilitates the release of urine from the bladder in a bag (urobag). In order to promote urination and reduce the blockage, medications are prescribed.
• Hematuria- It is usually treated based on the cause. Antibiotics are prescribed if an infection is diagnosed.

Prevention of urinary problems is by staying well-hydrated. This will help in flushing off the bacteria. Urinating before and after sexual intercourse also reduces the risk of getting UTI. Cleaning the genital and anal area after sex is important to prevent any sort of infection.

References