The urinary tract can fall prey to a number of conditions related to infection, aging, and just plain anatomy. Because they can have far-reaching consequences, it’s in our best interest to follow up promptly on any disturbing symptoms or changes. Dr. Richard Still, a urologist with Des Peres Hospital, says any changes from normal urine elimination function would warrant a check in with your doctor, including hesitancy or trouble urinating, increased frequency, getting up at night two or three times, changes in color of the urine, blood, or an unusual odor. “An unusual odor could indicate infection or the first signs of diabetes. Pain or burning on urination may also indicate infection. Back or flank pain, in the absence of a known injury, could be indicative of a stone in the kidney or ureter (the tube from the kidney to the bladder).”
If symptoms are nonspecific, Still recommends seeing your primary care doctor first. A simple infection can be treated with antibiotics, but if the infection persists or keeps returning, you should look further. “You can go to a urologist directly if you have a history of kidney stones, blood in the urine, or leakage issues. Frequent urinary tract infections (UTIs) warrant a trip to the urologist because repeated antibiotic use leads to vaginal and gastrointestinal infections, along with antibiotic resistance.”
Urologists use different approaches to determining the cause of blood in the urine, including urinalysis, ultrasound of the kidneys, CAT scan of the pelvis, or even cystoscopy of the bladder to look inside for signs of infection or tumor, says Still. “Patients have to give us a good history—that makes it easier to narrow down a specific diagnosis,” he advises. “Don’t be afraid to ask questions. And don’t think these urinary symptoms are a normal part of aging. Getting up to urinate several times a night or wetting your pants is not normal.”
Dr. Samer Siddiqui with Metropolitan Urological Specialists describes the most common urinary issues he sees with men and women. “For women, urinary infections are fairly common,” he notes. “If they are frequent, it’s important to see a urologist who can put a scope into the bladder to see if an obstruction is causing the infection. Overactive bladder becomes more common after age 50, although we don’t know why.” Siddiqui says the bladder feels like it needs to empty every hour or so with sudden urgency, adding that some things that can mimic the symptoms of overactive bladder are bladder cancer and a stone in the ureter. “If we rule those out, we generally treat overactive bladder, sometimes called urge incontinence, with oral medication that relaxes the nerves, causing the bladder to squeeze, thereby increasing its capacity.”
Siddiqui says stress incontinence, leakage with stress or exertion, can be caused by smoking, obesity, and multiple vaginal deliveries. That is generally treated with surgery to provide support to the urethra, sometimes called a sling procedure. Fewer women than men have kidney stones, but they do get them and the treatment is the same. Sexually transmitted diseases can also cause urinary symptoms. Blood in the urine, if infection is ruled out, may be the first sign of bladder or kidney cancer.
The most frequent urinary issue Siddiqui sees with men is benign prostatic hypertrophy (BPH). Over time, the prostate enlarges in all men. He says if it is big enough, it can impede urine flow. “The primary physician can try medication, but if it doesn’t work, the urologist can open the channel to improve flow.”
Dr. Hani Soudah, president of Stella Maris Internal Medicine and Center for Medical Weight Loss, helps many patients deal with frequent urinary tract infections. He says women are more prone to them anatomically. By studying preventive strategies to extend the time between UTIs, and prevent more from happening, he looked at cranberries, long touted for their urinary health benefits. Soudah looked farther and formulated a natural remedy that was introduced in May. He says it’s made from chokeberries with antioxidant levels far higher than cranberries. “Aronex, the trade name for this preparation, includes antioxidants and phytochemicals to decrease bacterial attachment to the bladder wall, reducing symptoms and the frequency of recurrent UTIs,” he says, adding that it is a part of a product called UroniaGenic, along with selenium and zinc. “By decreasing symptoms, we hope to decrease antibiotic use and prevent antibiotic resistance.”