Urinary Tract Issues By Lisa Glickstein, Ph.D, Triplet Mom Originally printed in July, 2006 When it is working normally, the urinary tract is a marvel of design and function. Waste products are filtered by the kidneys, and urine flows via two small tubes (the ureters) into the reservoir of the bladder where it is retained (once you are successfully potty-trained) before being emptied, on demand, through a larger tube (the urethra), and at your relative convenience. Like most plumbing systems however, the urinary tract is susceptible to blockages, back-ups and faulty valves. Because of it’s proximity to the “other” waste disposal system of the body, it is also susceptible to contamination with gut bacteria, and urine can contain sugars or proteins that are great substrates for bacteria or yeast growth. Urine that can’t drain is a breeding ground for microorganisms, much like standing water in your yard. The urinary tract is designed to be a one-way system. The kidneys work by creating a gradient so waste flows outwards. This also helps keep bacteria or yeast “flushed” out of the system. If urine flow is blocked and the urinary tract backs up, bacteria and waste products are carried up into the kidneys (much like your sink can back up if the pipes are clogged). At first, this simply screws up the gradient and prevents the kidneys from filtering waste out of the blood. The waste builds up in your blood and makes you feel sick. If the flow is restored, the kidneys can start working normally again (over a period of days to weeks). If the waste or bacteria remains in the kidneys for a longer period of time, permanent kidney damage can occur. Once the kidneys are damaged, waste needs to be removed from the blood by machine, called dialysis, daily or several times per week, depending on the extent of the kidney dysfunction. Some babies, more often boys than girls, are born with VUR – vesico-ureteral reflux – a condition in which urine backs up because of a structural problem. Some children will outgrow this condition, but for others, repeated urinary tract infections indicate that surgery is needed to correct the problem and prevent kidney damage. VUR should be suspected and evaluated in any child with a urinary tract infection. Premies are more likely to have underdeveloped urinary tracts and are therefore also more prone to VUR. Urinary tract infections are more common in adult women than men. This is both for anatomical reasons, as well as the hormonal changes that occur during the month that make women more prone to yeast infections. Symptoms include external or internal itching, painful or burning urination, and vaginal discharge. Vaginal yeast infections are a common occurrence in women, and can even occur more rarely in infant girls, particularly those with oral thrush or yeast diaper rash. They are normally treated in adult women with an over-the-counter vaginal antifungal suppository. Some of the newest (and most expensive) formulations work with a single dose. Once a woman has had a yeast infection diagnosed in the doctor’s office (a sample is examined under the microscope), she can usually self-diagnose and treat future infections at home. However, children with suspected yeast infection should always be taken to the pediatrician for diagnosis and treatment. Men are more likely to have bacterial, rather than yeast, infections of the urinary tract, frequently of sexually transmitted bacteria such as Chlamydia or gonorrhea. In adults, most bacterial urinary tract infections are acute, can be treated with 7-14 days of oral antibiotics, and do not recur when treatment is stopped. In some adults, particularly those with anatomical problems, such as radiation scarring from cancer therapy or prostate enlargement in men, urinary tract problems recur and lead to bladder and kidney infections, as in babies and children with VUR. In these cases, surgery to implant tubes (stents) to keep the ureters open, remove the prostate, or intravenous antibiotics may be needed to prevent kidney damage. Adults and children with diabetes are more likely to have urinary tract infections, due to the often higher sugar content of the blood and urine (particularly if blood sugar control isn’t maintained). Because high blood sugar is also a risk factor for kidney damage, diabetics need to be monitored carefully for kidney function. In many women, the problem isn’t retention of urine but the opposite – incontinence. Women who have had children are more likely to have stress incontinence. This is the loss of small or moderate amounts of urine when lifting, coughing, sneezing, or laughing. Pregnancy, rather than vaginal delivery, is the risk factor. The large uterus displaces the bladder and urethra, and stresses the pelvic floor. Some women require surgery to reposition the bladder, while others are helped by exercising the pelvic floor with Kegel exercises. The pelvic and vaginal muscles are contracted (tightened) and held, then released, many times a day. Urinary incontinence can also be caused by nerve damage or inflammation of the lining of the bladder (cystitis). Your primary care doctor can refer you to a urologist to discuss the problem. Sudden onset of major incontinence can be a sign of bladder cancer or urinary retention, particularly if accompanied by urgency and pain, and should be discussed promptly with your doctor. Men are likely as they get older to suffer from gradual, benign (not cancerous) enlargement of the prostate gland. Although technically not part of the urinary tract, the enlargement can cause urinary symptoms (urgency and frequency) in men as they age. The only treatment for prostate enlargement is surgical reduction. In rare cases, prostate enlargement is a sign of prostate cancer, a more serious condition that needs to be treated with surgery, chemotherapy, immunotherapy, or radiation. Like many other cancers, prostate cancer is more treatable if caught at an early stage. Even incurable prostate cancer can be very slow growing or responsive to treatment, and if it occurs at an advanced age may be, in fact, unlikely to be the primary cause of death. Any urinary problems accompanied by low- or high-grade fever, back pain or tenderness, or other serious symptoms should be urgently treated by a doctor. In rare cases, bacteria can spread from the genitor-urinary system to the blood, leading to toxic shock. The best thing you can do for your urinary tract health? Drink plenty of water to help the kidneys function and keep the systems flowing. A diet that contains yogurt with live cultures and a daily glass of cranberry juice (which discourages bacteria from adhering to the bladder wall) can help as well!