Tag Archives: urinary tract

Urinary Tract Problem


Fortunately, treatment of women suffering from symptoms in this age bracket is very successful. Today, therapy is well advanced, and the majority can benefit. Most women can again discover a full, happy, and well-adjusted life with minimum therapy.

Treatment is based on the artificial use of hormones. These are identical to the ones nature produces normally. The most widely used is called ethinyl oestradiol. This is given in minute amounts, from 10 to 20 mcg daily. Treatment is usually tailor-made to the woman’s apparent needs by the doctor. It is varied in accordance with her response.

Treatment is usually given for short courses. Special caution is needed if there has been any cancer history.

Many doctors prefer to use a variation of this medication called conjugated equine oestrogens, which is widely known by its trade name Premarin. A common satisfactory dose of 0.625 mg a day is prescribed. Many believe this gives a more normal type of reaction, and may be preferable, but it is usually much more expensive.

Today, there are definite guidelines laid down for the use of hormones for menopausal women. This follows some fears encountered in the mid-1970s that continual use might cause adverse repercussions, and there was talk of cancer.

However, this has been refuted, provided the oestrogen is taken for a set number of days per calendar month, and taken in conjunction with the other female hormone, progesterone (or Gestalten), in small doses, for a certain number of days per calendar month. The progestogen pill is usually one of the brands used for contraceptive purposes, being norethisterone 350 mcg (Micronor) or levonorgestrel 30 mcg (Nlicroval).

The method of taking the medication (which will be confirmed by your doctor) is as follows:

Take the oestrogen tablet daily from Day 1 to Day 24 of the calendar month, then discontinue until the first day of the following calendar month. In addition: Take theprogestogen tablet daily from Day 15 to Day 24. then discontinue until the 15th day of the following month. Usually this will cause a slight menstrual bleed about three days after the tablets have been discontinued. But most women will accept this fact of life as small payment for the relief obtaineol from symptoms. Keep in close contact with your doctor, especially regarding this so-called “withdrawal bleeding,” which is not due to cancer despite your age. However, some doctors still believe investigation of the womb (probably before or after medication is started) is advisable as a preliminary safeguard.

By the use of these hormones, a general feeling of wellbeing often occurs. Depression and anxiety may vanish. the world smiles again, hot flushes disappear as if by magic, the old irritability wanes, nerves settle, sleep improves, and the outlook brightens.

In some women, the skin becomes less wrinkled, the fingernails and toenails grow more rapidly, and break and crack less easily.

Many cases have been reported where the hair becomes more attractive, wavy and shinier.

These hormones have often been called the youth pill. Women taking them and gaining these results are often apt to agree, but it is not the universal panacea for greater beauty, and it is not the eternal fountain of youth. But it certainly may help.

The bladder is located in very close proximity to the vagina and uterus. The urethral outlet, the tiny external opening through which urine escapes from the body is located just above the vaginal entry This short canal, about three centimetres in length, is closely related to the front wall of the vagina, and it runs into the bladder, also closely related to the front vaginal wall.

With a weakening of the overdistended vaginal walls during the passage of time. a cystocele can readily occur. As the vaginal walls weaken, the bladder presses into the vagina and tends to prolapse down its length. In this way, residual urine can collect in the bladder, and this often becomes a source of chronic infection.

Cystitis persists unless action to clear it up is taken. This can be by the use of the appropriate antibiotic, or more sensibly by surgical repair.

However, another situation can occur concurrently with this, giving rise to a condition called stress incontinence. The valve of the urethra becomes weakened, and any sudden forceful stress on the bladder can cause the sudden release of a small amount of urine, over which the person has little (if any) control. This may be difficult to differentiate from a bladder infection.

It is most important that bladder infections be treated promptly. If they are not, the infection may spread up the canals that lead to the kidneys (called the left and right ureter), and produce kidney disease that may become serious. It can produce its own set of symptoms, such as loin pain, an elevated temperature, nausea. vomiting and rigors.

Enormous numbers of women suffer from urinary-tract disorders, particularly infection. In recent years much work and research has been devoted in major centres to this problem. It seems that many women suffer from urinary-tract infections (UTI) without knowing, and without symptoms being produced. If major infections occur, then the typical burning. scalding, frequency, malaise and urgency occur. But with minor infections which are serious, just the same, due to their implications), symptoms are often entirely absent.

It is well-known that urinary infections can readily be cleared up with the use of suitable antibiotics. But there is a tendency for recurrences. These days, long-term treatment with antibiotics and certain sulfa compounds is widely used. The lower part of the urethra (the canal leading from the bladder to the exterior) normally has bacteria in its lower third. It is well-known that these can be pushed into the bladder following sexual intercourse. Many women complain of cystitis the following day.

A simple and effective way to overcome this is to get out of bed and pass the urine as soon as possible after intercourse. on every occasion. This may present a nuisance problem, but those taking the trouble to do it regularly find the beneficial results well worth the small amount of effort and inconvenience involved. This immediately gets rid of the urinary reservoir and sweeps out the germs that may have recently penetrated there. and so denies them the opportunity for multiplying, which they will surely do otherwise.

Urinary Tract


The kidneys produce urine and serve a number of important functions, including maintaining fluid balance and blood pressure and eliminating waste products. They are very complex and efficient filters of the blood, allowing unnecessary components to pass into the urine while returning 99 percent of the filtered fluid to the circulatory system.

The kidneys adjust to the body’s fluid needs. For example, a dehydrated individual will produce less urine, allowing the body to conserve water. The kidneys also adjust the salt and mineral composition of the blood. When a kidney is damaged, diseased, or receiving an inadequate supply of blood, it cannot carry out its filtering functions properly. When this occurs, certain components of blood such as protein, sugar, and red blood cells may leak into the urine.

Normally the clear yellow urine produced by each kidney flows continuously through a narrow, muscular tube called the ureter to the bladder, where it is stored until automatic or voluntary input from the nervous system causes it to be eliminated. This process involves simultaneous contraction of muscles within the bladder wall and relaxation of muscles (called the sphincter) at the bladder’s outlet.

Painful urination (dysuria)

Discomfort while passing urine can he caused by one of the following situations:

• Infection (see below)

• Irritation from something coming in direct

contact with the genital area, such as bubble bath

or other soapy material in the tub, new laundry

soap, creams, or lotions

• Trauma

• A foreign body in the vagina or urinary tract (see genital care and concerns)

Any time your child complains of painful urination or if you notice a distinctly abnormal color of the urine (especially a reddish tinge that could indicate that blood is present), contact your child’s physician as soon as possible. If a child is having difficulty urinating because of pain, you can help by placing her in a bathtub of warm water and allowing her to urinate there.

Kidney disease

Changes in the characteristics or amount of urine  may result from a disorder of the kidney itself or from a problem in the ureter or bladder. Decreased urine production may be caused specifically by dehydration or kidney disease, or obstruction to the flow of urine. There are  many types of kidney diseases, but they cause only a limited number of symptoms.

Decreased or (more rarely) increased urine production

Passage of blood, which may be visible to the naked eye or detected only by chemical tests or microscopic examination

Sugar (glucose) in the urine, which is virtually always associated with a high level of glucose in the blood (diabetes)

Increased amounts of protein in the urine, which can usually be detected by a simple chemical test in the physician’s office

Swelling of the hands, ankles, feet, scrotum, or eyelids (called edema)

Pain in the mid-back or flank area on one side of the body

Fever, which may be a sign of infection within or adjacent to a kidney

Inceased urine production (polyuria)

Inceased urine production can be a normal response if a child drinks a lot of fluid, or it can indicate are serious problem. Kidneys will produce an abnormal amount of urine for three basic reasons:

Kidney damage prevents the kidneys from concentrating urine.

The hormones that control the kidneys’ concentrating abilities are not being produced or are not functioning properly.

A disease such as diabetes causes a marked elevation of certain substances (especially glucose or blood sugar) in the bloodstream. When the concentration of glucose in blood exceeds a certain level, the kidney can no longer prevent some from spilling into the urine. This results in a higher volume of urine and can eventually lead to a substantial fluid loss in the urine (hematuria)

Seeing blood in the urine can be frightening for both parent and child. But not everything that looks red is blood. It is not uncommon to see a small amount of pinkish red, paste like material in a newborn’s diaper. This is usually caused by urate crystals that form in concentrated urine. If these are seen in a breastfed baby, it may be helpful to nurse more frequently. If you are bottle-feeding, consider giving a few ounces of water. Urate crystals will usually disappear by the second week of life.

Some foods such as beets and certain medications cause a child’s urine to change color. You should consult with your child’s physician if this occurs.

Blood in an infant’s diaper area may come from the urinary tract, from the vagina in little girls, or from the gastrointestinal tract. If you notice blood in the diaper, take the diaper with you to your physician.

Blood in the urine is sometimes clearly visible but at other times may be present in quantities so small that it can be detected only by a microscopic evaluation and/or a dipstick-a thin test strip that identifies a variety of substances in the urine. The following conditions cause red blood cells to be present in the urine, and it is important that the underlying cause be determined if at all possible:

•Urinary tract infection

•Trauma, including injuries to the kidneys or genitalia

•Kidney diseases, including hereditary kidney problems, that leak small amounts of blood into the urine

•Kidney stones

•Blood-clotting problems

•Abnormalities of immune function

•Exposure to toxic substances

•Tumor, which in children would nearly always involve the kidney rather than ureter, bladder, or external genitalia

•Vigorous exercise-running, jumping, etc.

Your physician will examine your child and ask questions to sort through these possibilities. A urine specimen will be evaluated. If a urinary tract infection does not appear to be the problem, the physician will probably do a careful evaluation of the genital area and order special blood and/or imaging tests (X-ray or ultrasound)to help determine the cause of the hematuria.

Obstruction: hydronephrosis

Malformations of any portion of the urinary system can occur during fetal development. The most common ofthese in both girls and boys is an obstruction that decreases or completely stops the flow of urine. The resulting increase in pressure causes swelling within the urinary tract. When one or both kidneys are involved, the condition is called hydronephrosis (literally, “water kidney”). Sometimes this type of obstruction can be diagnosed during pregnancy through an ultrasound. One of the first surgeries developed for preborn babies was the treatment of hydronephrosis by removing the obstruction while the kidneys still had time to grow.

Obstruction: persistent urethral valves

In boys, the urine flows through the urethra inside the penis. During fetal development, small flaps called valves stop the flow of urine. Before the baby is born, these valves normally disappear, allowing urine to pass freely. If the flaps of tissue remain after birth, they can obstruct the urine flow and cause bladder distention. One clue that a baby may have urethral valves is that the urine stream is weak and dribbling rather than forceful. (Most parents of boys have been sprayed during diaper changes, an indication that the flow of urine is not obstructed.)

Obstruction: meatal stenosis

The opening at the end of the penis through which urine passes is called the meatus. If the baby boy is circumcised at birth, the head of the penis (glands) is exposed to urine and stool in the diaper. The sensitive cells of the meatus may become irritated and heal with scar tissue, which can cause a narrowing known as meatal stenosis.If the boy’s urine stream appears narrowed – a thin, jet like stream as if coming from a nozzle – or if it deviates to one side so much that he must deliberately aim his penis to keep the urine stream within the toilet bowl, he should be examined by a physician. If meatal stenosisis severe, a urologist may perform minor surgery to dialate the meatal opening.

Urinary Tract Infections


What is Urinary Tract Infections?

In fact tests on large numbers of schoolchildren have indicated that many youngsters, especially girls, often harbour germs in the bladder. There are not necessarily any symptoms. –It is frequently called a silent bacteriuria. Apparently germs may lie there quiescent for some time. But if there is a sudden “chill,” or lowering of the body temperature, they multiply and make their unpleasant presence felt.

The child may experience a chill, and possibly shivering. The temperature may rise. There may be the desire to pass the urine often. This may be painful, or it may be worse as the last few drops are being voided. Often, when this has happened, the child may want to run off to the toilet again, frequently within a few minutes. Of course, only half a teaspoonful may be passed and this likewise may feel hot and burning. “Like powdered glass,” is a common way of expressing it. I’m not certain how children know what it is like to void powdered glass, but you get the idea, I’m sure.

Sometimes the urine may be foul smelling. It may be cloudy, or there may blood in it. This is not a very good sign. There may be tenderness over the bladder, or over the lower part of the back. The kidneys are just inside this part and they may be tender in the so-called “renal angle,” as the doctors say. The patient may feel generally unwell, may vomit, have loss of appetite, feel clammy and hot and may be weepy and depressed.

Urinary Tract Infections Treatment

With acute symptoms, it’s wise to have medical attention. The doctor will probably order a urine test. A “midstream” specimen is examined by the pathologist, who will check for abnormal components such as blood or albumen, which indicate that abnormal substances are being filtered by the renal mechanism.

The pathologist will also carry out a culture and sensitivity test. This means the germs responsible for the infection are grown so they may be identified. At the same time, they will be checked against the commonly used antibiotics to determine which is the most suitable one for checking the infection, and preventing a recurrence.

Often the doctor will give immediate treatment. But when the results are to hand, it may be changed. A wide variety of antibiotics is currently available. These are highly satisfactory for renal tract infections. Some doctors give a large single dose. Other doctors prefer to continue therapy for some time in an effort to eradicate all traces of infection, and hoping future ones will not take place.

Often urinary “alkalinising agents” are given. These convert the urine to an alkaline state, and this is believed to help kill off the germs. But some other antibiotics act more successfully in an acid medium. Usually a total package form of treatment is prepared for the individual patient.

Extra fluids are usually prescribed. Plenty of water-based fluids and fruit juices are a good idea. Repeat often. If the is a fever and aches and pains, paracetamol elixir often reduces both. Aspirin products are best not given for these symptoms.

Sucking bits of chipped-up ice s good if there is vomiting. Flavoured ones may be made, such as using lemonade. Often a quick, lukewarm sponge will make the youthful patient feel much better. Sometimes, if hot and miserable, a cold pack to the forehead can help improve feelings.

Infections of the urinary tract are extremely common, particularly in women and children. Prompt diagnosis and treatment are essential. If problems recur, then investigation to find the basic cause is imperative. Infections may be present without any symptoms. Progressive kidney disease may readily occur, and if this becomes well established and chronic, there is no suitable long term cure.

Infections of the Urinary Tract Symptoms suggesting infection of the urinary tract are very common. Surveys show that between 12 and 20 of every 1000 surgery consultations arc for this reason.

“Urinary tract infection is one of the most common disorders encountered by the practising clinician,” a Melbourne kidney specialist says. “At all ages, the female is more prone to develop urinary tract infection and in particular, symptoms of dysuria [difficulty in urinating] and frequency are very common in adult women, most of whom have no associated abnormality in the urinary tract.” Much research has taken place in the past few years, and more accurate ways of determining the cause have been worked out. Tests quite different from those used a few years ago are now being used widely in diagnosis and treatment.

Often urinary tract infections are present, yielding no symptoms. Also, other considerations, such as the so-called “vesico-ureteric reflux,” are being demonstrated by new X-ray methods.

This means that during voiding, in some cases the urine is moved back or refluxes into the urethras, the tubes conveying the urine from the kidneys to the bladder. The significance is that this may produce damage and scarring in the kidneys that may have long-term adverse consequences for the patient.

Symptoms.

Often there are no symptoms, or there may be increased frequency of urination and discomfort. In a typical attack, there may be a feeling of being off-colour or quite ill. There may be a high fever with shivers, vomiting, headache and aches and pains all over, and probably constipation. There may be a dull, aching pain in the loin, and possibly marked tenderness over the lower part of the back. An attack may settle, to recur a little later on. There may or may not be associated elevation of the blood pressure.

Diagnosis is usually made on clinical grounds, and this may be confirmed by having a bacterial count carried out. The colonies of infecting organisms are actually checked, and it is accepted that a colony count of 100,000 per ml of urine is evidence of infection. Counts of 10,000 or less are usually considered to be due to contamination of the urine sample during collection.

The majority of urinary infections are due to organisms that are sensitive to sulfas, and these are usually given for at least 10 days. Infections resistant to sulfas should be treated with other suitable antibiotics following special sensitivity tests. These are special tests done in the laboratory in which the germ is cultured and subjected to various antibiotics. In this way the most appropriate antibiotic may be found, and used in subsequent treatment.

Often the cephalosporins, ampicillin, co-trimoxazole or tetracyclines are suitable and effective. Other drugs are available also, such as nitrofurantoin and nalidixic acid tablets. Follow-up bacterial tests are carried out to check the efficacy of therapy.

If the infection recurs or fails to be cured with simple therapy, further investigations will be ordered, such as a kidney X-ray. This is called an intravenous pyelogram (or IVP). Alternatively a CT scan or ultrasound investigation may be carried out. The aim is to discover if there is any obvious disorder of the kidneys, or if there are any anatomical structural anomalies present that could be the basic cause of the infection. Congenital defects, if present, may be an important cause for recurring infections, particularly in children. Prolonged courses of antibiotics may be necessary, especially in children, in an effort to prevent progressive renal damage. Some infections and organisms are very difficult to eradicate.

Surgery may be recommended. If investigation indicates that anatomical or structural faults are present, surgical measures may be recommended. When infections are successfully treated, vesico-ureteric reflux may disappear, but if it persists, it may indicate the need for corrective surgery. This may be in the form of a ureteric transplant or the relief of any obstruction to the bladder neck. The patient should also be instructed in sexual hygiene, and told how to reduce the risks of fecal contamination (eg using toilet tissues with a front-to back sweep, rather than vice versa). Suggestions on avoiding infections following intercourse may be offered. Particularly in newlyweds, and those indulging often in sexual intercourse, urinating as soon as possible afterwards is advisable. Treating any urinary infection promptly is essential, and adequate follow- up is wise. Any child with fevers for no obvious reason could he suffering from urinary infections, and the doctor will check this. Efforts should be made at preventive medicine, for the outlook for recurring infections is poor. It may become chronic, and for this there is no simple cure.