Author Archives: Doctor

Asthma Risk Factors

The most common risk factors for developing asthma is having a parent with asthma, having frequent respiratory infections as a child, having an allergic condition, or being exposed to certain chemical irritants or industrial dusts in the workplace.

What puts people at risk for developing asthma?

  • Family history
    If you have a parent with asthma, you are three to six times more likely to develop asthma than someone who does not have a parent with asthma.
  • Viral respiratory infections
    Respiratory problems during infancy and childhood can cause wheezing. Some children who experience viral respiratory infections go on to develop chronic asthma.
  • Allergies
    Having an allergic condition, such as atopic dermatitis (eczema) or allergic rhinitis (hay fever), is a risk factor for developing asthma.
  • Occupational exposures
    If you have asthma, exposures to certain elements in the workplace can cause of asthma symptoms. And, for some people, exposure to certain dusts (industrial or wood dusts), chemical fumes and vapors, and molds can cause asthma to develop for the very first time.
  • Smoking
    Cigarette smoke irritates the airways. Smokers have a high risk of asthma. Those whose mothers smoked during pregnancy or who were exposed to secondhand smoke are also more likely to have asthma.
  • Air Pollution
    The main component of smog (ozone) exposure raises the risk for asthma. Those who grew up or live in urban areas have a higher risk for asthma.
  • Obesity
    Children and adults who are overweight or obese are at a greater risk of asthma. Although the reasons are unclear, some experts point to low-grade inflammation in the body that occurs with extra weight. Obese patients often use more medications, suffer worse symptoms and are less able to control their asthma than patients in a healthy weight range.

Urinary system anatomy and physiology review

The urinary system is responsible for the production and elimination of urine when a type of waste called urea is removed from the blood. Urea is produced when protein-containing foods are broken down in the body. Urea is carried in the bloodstream to the two kidneys, where urine is formed. The two ureters, the urinary bladder, and the urethra, are responsible for the elimination of urine. Figure illustrates the urinary system in relationship to the body, and Figure illustrates the interior and exterior features of the urinary system organs.

The urinary system

FIGURE. The urinary system

Frontal section of the right kidney showing internal structures and blood vessels

FIGURE. (A) Frontal section of the right kidney showing internal structures and blood vessels. (B) Magnified section of the kidney shows several nephrons. (From Scanlon, VC, and Sanders, T: Essentials of Anatomy and Physiology, ed 5. FA Davis, Philadelphia, 2007, p 422, with permission.)

The kidneys, each about the size of a fist, help to regulate the water, electrolyte (ionized salt), and acid-base content of the blood, and they selectively filter the waste products of metabolism.

They also play an important role in regulating blood pressure. Each kidney contains more than 1 million nephrons, which are the principal filtering units of the kidney. Each nephron houses a ball of tiny blood capillaries called the glomerulus and a renal tubule. It is here that the three-part process of selective filtration of wastes, reabsorption of vital minerals and fluid, and secretion of waste products and other substances takes place. As urine is formed, it passes through the nephrons into the renal tubules of the kidneys.

Nephron with associated blood vessels

FIGURE. Nephron with associated blood vessels

From the kidneys, urine travels into the ureters, thin tubes about 8 to 10 inches in length, on its way to the urinary bladder. Small amounts of urine drip into the urinary bladder about every 12 seconds. The urinary bladder is a balloon-shaped muscular organ that stores urine until it is emptied. It can hold about 16 ounces of urine for 2 to 5 hours. Nerves in the urinary bladder indicate when it should be emptied. Sphincter muscles keep urine from leaking into the urethra too soon and relax when it is time to urinate.

It is worth emphasizing the reabsorption process of the kidneys’ nephrons. Were it not for this process, the body would rapidly be depleted of its fluid. Typically, only 1% of the fluid passing through a nephron is excreted as urine.

A routine diagnostic test for suspected urinary disease is a urinalysis, which includes testing the specific gravity; pH; and presence of protein, blood, sugar, and ketones. It includes a microscopic examination for the presence of white blood cells (WBCs) and red blood cells (RBCs), casts, bacteria, and crystals. Normal urine is amber in color with a slightly acid reaction, has a peculiar odor, and frequently deposits a precipitate of phosphates when fresh. The specific gravity varies from 1.005 to 1.030. The greater the rate of urine excretion, the lower is the specific gravity. Refer to Table, Significance of Changes in Urine, throughout the chapter, noting possible abnormalities and their significance to the disease in question.

Table. Significance of Changes in Urine

Significance of Changes in Urine

Renal Calculi (Uroliths or Kidney stones)

ICD-9: 592.0

Description

Renal calculi are the most common cause of urinary obstruction. A renal calculus is a concentration of various mineral salts in the renal pelvis or the cuplike extension of the renal pelvis called the calyx of the kidney or elsewhere in the urinary tract. They can be small like a grain of sand or very large. Most stones develop in the kidney and are formed from calcium salts, uric acid, cystine, and struvite in descending order of frequency.

Renal Calculi

Etiology

Renal calculi form as a result of a disturbance in the kidney’s delicate balancing act of preventing water loss while at the same time eliminating watersoluble mineral wastes. Many factors, such as prolonged dehydration or immobilization, can upset this balance. The balance also may be upset by underlying diseases, such as gout, hyperparathyroidism (disease caused by oversecretion of the parathyroid glands), Cushing syndrome, or urinary tract infections and neoplasms. A person may develop renal calculi because of an excessive intake of vitamin D or dietary calcium. The condition appears to be genetic for certain types of stones, with men much more commonly affected than women. In many instances, no specific cause can be pinpointed.

Location of calculi in the urinary tract

FIGURE. Location of calculi in the urinary tract.

Signs and Symptoms

A person having renal calculi may remain asymptomatic for long periods. If a stone or calculus fragment lodges in a ureter, however, the individual may complain of intense flank pain and urinary urgency. Classic ureteral colicky pain is manifested by acute, intermittent, and excruciating pain in the flank and upper outer quadrant of the abdomen on the affected side. If calculi are in the renal pelvis and calyces, the pain is duller and more constant. Back pain and severe abdominal pain may occur. Other presenting symptoms include nausea, vomiting, chills and fever, hematuria, and abdominal distention.

Diagnostic Procedures

The history may reveal a familial tendency toward the formation of kidney stones. A urinalysis may be ordered to detect elevated levels of RBCs or WBCs in the urine or to check for the presence of protein, pus, and bacteria. CT scan and abdominal x-ray (or KUB) may be ordered to determine the locations of calculus formation. A noncontrast spiral CT scan of the ureters and kidneys is the preferred test for kidney stones. In this test, the scanner moves in a circle as the client moves through the machine. This test takes less time than a standard CT scan and provides better images of the kidneys and ureters. Blood testing may be helpful in confirming imbalances of minerals or the existence of other metabolic disorders.

Treatment

Treatment is directed at clearing obstructive stones and preventing the formation of new ones. Increased fluid intake (greater than 3 L/day) may enhance elimination of stones in some cases, but large stones may require surgical intervention, especially if renal function is threatened. Ureteroscopic removal with the use of fluoroscopic guidance may be used to dilate the ureter to grasp and remove the stone. Techniques such as ultrasonic percutaneous lithotripsy and extracorporeal shock wave lithotripsy pulverize stones in place, allowing them to be passed in the urine or removed by suction. Lithotripsy via a ureteroscope can also be used to remove urethral stones. Antibiotics may be prescribed if it is determined that the calculus buildup is due to bacterial infection. Analgesics may be necessary for the relief of intense pain.

Complementary Therapy

Complementary practitioners recommend drinking 8 or more glasses of water per day and eating a diet high in fiber and low in fat, with reduction of red meat consumption. Vitamins and minerals may be helpful especially when coordinated with the primary care provider. Relaxation techniques may be beneficial to deal with the pain.

Client communication

Stress the importance of proper diet and completing any medicinal therapy. Explain any diagnostic or surgical procedures to clients. Encourage increased fluid intake.

Prognosis

The prognosis is good if urinary tract obstruction is prevented and underlying disorders are promptly treated. However, about 60% of people who have a calcium stone have further stone formation later.

Prevention

An adequate daily fluid intake is the best way to minimize the chance of stone formation, especially among individuals at risk. Fruit juices, especially unsweetened cranberry and blueberry juice, help acidify urine and may help prevent the formation of renal calculi.

Video: How Do Kidney Stones Form? How Can We Prevent Them?

Kidney Stones

What are kidney stones?

Kidney stones, or renal calculi, are solid masses made of crystals. Kidney stones usually originate in your kidneys. However, they can develop anywhere along your urinary tract, which consists of these parts:

  • kidneys
  • ureters
  • bladder
  • urethra

Kidney stones are one of the most painful medical conditions. The causes of kidney stones vary according to the type of stone.

Types of kidney stones

Not all kidney stones are made up of the same crystals. The different types of kidney stones include:

Calcium

Calcium stones are the most common. They’re often made of calcium oxalate (though they can consist of calcium phosphate or maleate). Eating fewer oxalate-rich foods can reduce your risk of developing this type of stone. High-oxalate foods include:

  • potato chips
  • peanuts
  • chocolate
  • beets
  • spinach

However, even though some kidney stones are made of calcium, getting enough calcium in your diet can prevent stones from forming.

Uric acid

This type of kidney stone is more common in men than in women. They can occur in people with gout or those going through chemotherapy. This type of stone develops when urine is too acidic. A diet rich in purines can increase urine’s acidic level. Purine is a colorless substance in animal proteins, such as fish, shellfish, and meats.

Struvite

This type of stone is found mostly in women with urinary tract infections (UTIs). These stones can be large and cause urinary obstruction. They result from a kidney infection. Treating an underlying infection can prevent the development of struvite stones.

Cystine

Cystine stones are rare. They occur in both men and women who have the genetic disorder cystinuria. With this type of stone, cystine — an acid that occurs naturally in the body — leaks from the kidneys into the urine.

Risk factors for kidney stones

The greatest risk factor for kidney stones is making less than one liter of urine per day. This is why kidney stones are common in premature infants who have kidney problems. However, kidney stones are most likely to occur in people between the ages of 20 and 50.

Different factors can increase your risk of developing a stone. Typically, Caucasians are more likely to have kidney stones than those of African descent.

Sex also plays a role. More men than women develop kidney stones, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

A history of kidney stones can increase your risk. So does a family history of kidney stones.

Other risk factors include:

  • dehydration
  • obesity
  • a diet with high levels of protein, salt, or glucose
  • hyperparathyroid condition
  • gastric bypass surgery
  • inflammatory bowel diseases that increase calcium absorption
  • taking medications such as diuretics, antiseizure drugs, and calcium-based antacids

Recognizing the symptoms and signs of a kidney stone

Kidney stones are known to cause severe pain. Symptoms of kidney stones may not occur until the stone begins to move down the ureters. This severe pain is called renal colic. You may have pain on one side of your back or abdomen.

In men, pain may radiate to the groin area. The pain of renal colic comes and goes, but can be intense. People with renal colic tend to be restless.

Other symptoms of kidney stones can include:

  • blood in the urine (red, pink, or brown urine)
  • vomiting
  • nausea
  • discolored or foul-smelling urine
  • chills
  • fever
  • frequent need to urinate
  • urinating small amounts of urine

In the case of a small kidney stone, you may not have any pain or symptoms as the stone passes through your urinary tract.

Why kidney stones can be a problem

Stones don’t always stay in the kidney. Sometimes they pass from the kidney into the ureters. Ureters are small and delicate, and the stones may be too large to pass smoothly down the ureter to the bladder. Passage of stones down the ureter can cause spasms and irritation of the ureters as they pass. This causes blood to appear in the urine.

Sometimes stones block the flow of urine. This is called a urinary obstruction. Urinary obstructions can lead to kidney infection and kidney damage.

Testing for and diagnosing kidney stones

Diagnosis of kidney stones requires a complete health history assessment and a physical exam. Other tests include:

  • blood tests for calcium, phosphorus, uric acid, and electrolytes
  • blood urea nitrogen (BUN) and creatinine to assess kidney functioning
  • urinalysis to check for crystals, bacteria, blood, and white cells
  • examination of passed stones to determine their type

The following tests can rule out obstruction:

  • abdominal X-rays
  • intravenous pyelogram (IVP)
  • retrograde pyelogram
  • ultrasound of the kidney (the preferred study)
  • MRI scan of the abdomen and kidneys
  • abdominal CT scan

The contrast dye used in the CT scan and the IVP can affect kidney function. However, in people with normal kidney function, this isn’t a concern.

There are some medications that can increase the potential for kidney damage in conjunction with the dye. Make sure your radiologist knows about any medications you’re taking.

Can You Have Sex with a Urinary Tract Infection (UTI)?

Can you have sex with a UTI?

Urinary tract infections (UTIs) are common. UTIs can develop anywhere in the urinary tract, from the urethra to the kidneys. Symptoms include:

  • a persistent urge to urinate
  • pain when urinating
  • pelvic pain or tenderness

Although these symptoms can be irritating, they won’t prevent you from having vaginal sex. That doesn’t mean you’ll feel up to it, though. A UTI can irritate the sensitive tissue in your urinary tract, and sexual activity can irritate those tissues even more.

Sexual activity can also increase your risk of complications and potentially put your partner at risk. That’s why doctors usually recommend that you wait to have sex until you’re symptom-free and you’ve finished your entire treatment.

It may cause pain and exacerbate other symptoms

A UTI may irritate and inflame the sensitive tissues in your urinary tract. Any penetrative object — fingers, a toy, or a penis — can put pressure on the urinary organs during vaginal intercourse. The urethral opening of a penis can be irritated from a UTI, too. These symptoms can lead to additional pain and discomfort during sex.

While vaginal sex may not be comfortable if you have a UTI, anal sex could be. If the mood strikes, talk with your partner about how you feel and whether this is something you’re both comfortable with.

Unless you use a dental dam, you shouldn’t receive oral sex while you have a UTI. This can help prevent the spread of any bacteria from the penis or vagina to the mouth. These bacteria could cause a secondary infection.

If you’re eager to engage in sexual activity before your infection is cleared up, work with your partner to find a style or position that is comfortable and enjoyable. If you continue to have pain despite your UTI treatment, make an appointment and follow up with your doctor.

It can introduce new bacteria

Sexual activity is one of the most common ways bacteria get into the urinary tract. Ninety percent of UTIs are the result of Escherichia coli bacteria that have found their way into the urethra and beyond.

E. coli bacteria are most often found in the gastrointestinal (GI) tract or feces. These bacteria may move from the anus or GI tract onto you or your partner’s hands, mouth, genitals, or a sex toy.

Sex can also push bacteria further into your body through penetration, which sets up a higher likelihood of an infection. If you already have a UTI, penetration may reinfect you or introduce a new source of bacteria. This can lead to a longer recovery time.

You may pass the infection to your partner

A UTI isn’t a sexually transmitted infection (STI), and it isn’t considered a contagious condition. However, you can pass the bacteria that causes a UTI between partners.

For example, E. coli bacteria may travel from your anus to the vaginal opening or onto a penis. During vaginal sex, a penis can move the bacteria into the vaginal opening, increasing the risk of developing an infection.

In some cases, the UTI may actually be a side effect of an STI, such as chlamydia or trichomoniasis. These infections can be passed between partners.

If you do decide to have sex

If you decide you want to engage in sexual activity despite your UTI, there are a number of tips to keep in mind.

Heed your symptoms

If you have the sudden urge to pee, take a break. Holding urine in when you have to pee may increase your risk for another UTI or complicate your symptoms.

Pee before and after sex

It may seem tedious and less than romantic, but you should head for the loo as soon as the deed is done. This way, you can flush out any bacteria that may have found their way into your urethra.

Wash after sex

It isn’t uncommon for bacteria from around the anus to travel closer to your urethral opening during penetrative sex. This is especially true if anal sex is involved. Washing after intercourse can help remove these bacteria.

Don’t swap orifices

Reduce your risk of spreading bacteria by not moving from vagina to anus, or vice versa. Also, avoid oral sex to prevent a secondary infection.

Talk with your doctor

If you have questions about what’s safe to do while you’re treating a UTI, talk with your doctor or a nurse. Your doctor should also let you know if the medication they’re prescribing will interfere with any other medications you take, such as oral contraceptives.

When to see your doctor

If you’re still unsure whether it’s safe to engage in sexual activity with a UTI, talk with your doctor.

You should also talk with your doctor if you experience any new symptoms, such as:

  • bleeding during urination
  • severe back or abdominal pain
  • unusual discharge from the penis or vagina

If your symptoms remain after you’ve finished taking your antibiotics, you should schedule a follow-up appointment with your doctor. Your symptoms may be the result of another condition or a secondary infection.

9 Ways to Prevent Kidney Stones

Kidney stone prevention

Kidney stones are hard mineral deposits that form inside your kidneys. They cause excruciating pain when they pass through your urinary tract.

Up to 12 percent of Americans are affected by kidney stones. And once you’ve had one kidney stone, you’re 50 percent more likely to get another within the next 10 years.

There’s no one sure way to prevent kidney stones, especially if you have a family history of the condition. A combination of diet and lifestyle changes, as well as some medications, may help reduce your risk.

How to prevent kidney stones naturally

Making small adjustments to your current diet and nutrition plan may go a long way toward preventing kidney stones.

1. Stay hydrated

Drinking more water is the best way to prevent kidney stones. If you don’t drink enough, your urine output will be low. Low urine output means your urine is more concentrated and less likely to dissolve urine salts that cause stones.

Lemonade and orange juice are also good options. They both contain citrate, which may prevent stones from forming.

Try to drink around eight glasses of fluids daily, or enough to pass two liters of urine. If you exercise or sweat a lot, or if you have a history of cystine stones, you’ll need additional fluids.

You can tell whether you’re hydrated by looking at the color of your urine — it should be clear or pale yellow. If it’s dark, you need to drink more.

2. Eat more calcium-rich foods

The most common type of kidney stone is the calcium oxalate stone, leading many people to believe they should avoid eating calcium. The opposite is true. Low-calcium diets may increase your kidney stone risk and your risk of osteoporosis.

Calcium supplements, however, may increase your risk of stones. Taking calcium supplements with a meal may help reduce that risk.

Low-fat milk, low-fat cheese, and low-fat yogurt are all good calcium-rich food options.

3. Eat less sodium

A high-salt diet increases your risk of calcium kidney stones. According to the Urology Care Foundation, too much salt in the urine prevents calcium from being reabsorbed from the urine to the blood. This causes high urine calcium, which may lead to kidney stones.

Eating less salt helps keep urine calcium levels lower. The lower the urine calcium, the lower the risk of developing kidney stones.

To reduce your sodium intake, read food labels carefully.

Foods notorious for being high in sodium include:

  • processed foods, such as chips and crackers
  • canned soups
  • canned vegetables
  • lunch meat
  • condiments
  • foods that contain monosodium glutamate
  • foods that contain sodium nitrate
  • foods that contain sodium bicarbonate (baking soda)

To flavor foods without using salt, try fresh herbs or a salt-free, herbal seasoning blend.

4. Eat fewer oxalate-rich foods

Some kidney stones are made of oxalate, a natural compound found in foods that binds with calcium in the urine to form kidney stones. Limiting oxalate-rich foods may help prevent the stones from forming.

Foods high in oxalates are:

  • spinach
  • chocolate
  • sweet potatoes
  • coffee
  • beets
  • peanuts
  • rhubarb
  • soy products
  • wheat bran

Oxalate and calcium bind together in the digestive tract before reaching the kidneys, so it’s harder for stones to form if you eat high-oxalate foods and calcium-rich foods at the same time.

5. Eat less animal protein

Foods high in animal protein are acidic and may increase urine acid. High urine acid may cause both uric acid and calcium oxalate kidney stones.

You should try to limit or avoid:

  • beef
  • poultry
  • fish
  • pork

6. Avoid vitamin C supplements

Vitamin C (ascorbic acid) supplementation may cause kidney stones, especially in men.

According to one 2013 study, men who took high doses of vitamin C supplements doubled their risk of forming a kidney stone. Researchers don’t believe vitamin C from food carries the same risk.

7. Explore herbal remedies

Chanca Piedra, also known as the “stone breaker,” is a popular herbal folk remedy for kidney stones. The herb is thought to help prevent calcium-oxalate stones from forming. It’s also believed to reduce the size of existing stones.

Use herbal remedies with caution. They’re not well-regulated or well-researched for the prevention or treatment of kidney stones.

How to prevent kidney stones with medication

In some cases, switching up your dietary choices may not be enough to prevent kidney stones from forming. If you have recurrent stones, talk to your doctor about what role medication can play in your prevention plan.

8. Talk to your doctor about the medications you’re currently taking

Taking certain prescriptions or over-the-counter medications can result in kidney stones.

Some of these medications are:

  • decongestants
  • diuretics
  • protease inhibitors
  • anticonvulsants
  • steroids
  • chemotherapy drugs
  • uricosuric drugs

The longer you take these drugs, the higher your risk of kidney stones. If you’re taking any of these medications, talk to your doctor about other medication options. You shouldn’t stop taking any prescribed medications without your doctor’s approval.

9. Talk to your doctor about preventative medications

If you’re prone to certain types of kidney stones, certain medications can help control the amount of that material present in your urine. The type of medication prescribed will depend on the type of stones you usually get.

For example:

  • If you get calcium stones, a thiazide diuretic or phosphate may be beneficial.
  • If you get uric acid stones, allopurinol (Zyloprim) can help reduce uric acid in your blood or urine.
  • If you get struvite stones, long-term antibiotics may be used to help reduce the amount of bacteria present in your urine
  • If you get cystine stones, capoten (Captopril) may help reduce the level of cystine in your urine

The bottom line

Kidney stones are common. There’s no guarantee that prevention methods will work, but they may reduce your risk. Your best bet for preventing kidney stones is staying hydrated and making certain dietary changes.

If you have a condition that increases your risk of kidney stones, such as inflammatory bowel disease, persistent urinary tract infection, or obesity, talk to your doctor about ways to manage it to decrease your kidney stone risk.

If you’ve passed a kidney stone before, ask your doctor to have it tested. Once you know what type of stone you’ve had, you can take targeted steps to prevent new ones from forming.

8 Signs and Symptoms of Kidney Stones

What are kidney stones?

Kidney stones are hard collections of salt and minerals often made up of calcium or uric acid. They form inside the kidney and can travel to other parts of the urinary tract.

Stones vary in size. Some are as small as the period at the end of this sentence — a fraction of an inch. Others can grow to a few inches across. Some kidney stones can become so large they take up the entire kidney.

A kidney stone forms when too much of certain minerals in your body accumulate in your urine. When you aren’t well hydrated, your urine becomes more concentrated with higher levels of certain minerals. When mineral levels are higher, it’s more likely that a kidney stone will form.

About 1 out of every 11 people in the United States will get a kidney stone. Stones are more common in men, people who are obese, and those who have diabetes

Smaller kidney stones that remain in the kidney often don’t cause any symptoms. You might not notice anything is amiss until the stone moves into your ureter — the tube that urine travels through to get from your kidney to your bladder.

Kidney stones are typically very painful. Most stones will pass on their own without treatment. However, you may need a procedure to break up or remove stones that don’t pass.

Here are eight signs and symptoms that you may have kidney stones.

1. Pain in the back, belly, or side

Kidney stone pain — also known as renal colic — is one of the most severe types of pain imaginable. Some people who’ve experienced kidney stones compare the pain to childbirth or getting stabbed with a knife.

The pain is intense enough to account for more than 1 million visits to emergency rooms each year.

Usually the pain starts when a stone moves into the narrow ureter. This causes a blockage, which makes pressure build up in the kidney.

The pressure activates nerve fibers that transmit pain signals to the brain.

Kidney stone pain often starts suddenly. As the stone moves, the pain changes location and intensity.

Pain often comes and goes in waves, which is made worse by the ureters contracting as they try to push the stone out. Each wave may last for a few minutes, disappear, and then come back again.

You’ll feel the pain along your side and back, below your ribs. It may radiate to your belly and groin area as the stone moves down through your urinary tract.

Large stones can be more painful than small ones, but the severity of pain doesn’t necessarily relate to the size of the stone. Even a little stone can be painful as it moves or causes a blockage.

 2. Pain or burning during urination

Once the stone reaches the junction between the ureter and bladder, you’ll start to feel pain when you urinate. Your doctor might call this dysuria.

The pain can feel sharp or burning. If you don’t know you have a kidney stone, you might mistake it for a urinary tract infection. Sometimes you can have an infection along with the stone.

3. Urgent need to go

Needing to go to the bathroom more urgently or frequently than usual is another sign that the stone has moved into the lower part of your urinary tract. You may find yourself running to the bathroom, or needing to go constantly throughout the day and night.

Urinary urgency can also mimic a urinary tract infection symptom.

4. Blood in the urine

Blood in the urine is a common symptom in people with urinary tract stones. This symptom is also called hematuria.

The blood can be red, pink, or brown. Sometimes the blood cells are too small to see without a microscope (called microscopic hematuria), but your doctor can test for this symptom.

5. Cloudy or smelly urine

Healthy urine is clear and doesn’t have a strong odor. Cloudy or foul-smelling urine could be a sign of an infection in your kidneys or another part of your urinary tract.

One study found that about 8 percent of people with acute kidney stones had a urinary tract infection.

Cloudiness is a sign of pus in the urine, or pyuria. The smell can come from the bacteria that cause urinary tract infections. An odor may also come from urine that’s more concentrated than normal.

6. Going a small amount at a time

Large kidney stones sometimes get stuck in a ureter. This blockage can slow or stop the flow of urine.

If you have a blockage, you may only urinate a little bit each time you go. Urine flow that stops entirely is a medical emergency.

7. Nausea and vomiting

It’s common for people with a kidney stone to have nausea and vomiting.

These symptoms happen because of shared nerve connections between the kidneys and GI tract. Stones in the kidneys can trigger nerves in the GI tract, setting off an upset stomach.

The nausea and vomiting can also be your body’s way of responding to intense pain.

8. Fever and chills

Fever and chills are signs that you have an infection in your kidney or another part of your urinary tract. This can be a serious complication to a kidney stone. It can also be a sign of other serious problems besides kidney stones. Any fever with pain requires urgent medical attention.

Fevers that occur with an infection are usually high — 100.4˚F (38˚C) or more. Chills or shivering often occur along with the fever.

The bottom line

Kidney stones are hard collections of salt and minerals that form in your kidneys and can travel to other parts of your urinary system.

Stones cause symptoms like pain, trouble urinating, cloudy or smelly urine, nausea and vomiting.

Some stones will pass on their own. Others need treatment with sound waves or surgery to break them up or remove them.

Call your doctor if you have any symptoms of kidney stones. Get medical help right away if you have these symptoms, which could indicate that you have an infection or other serious complication:

  • pain so severe that you can’t get comfortable
  • nausea, vomiting, fever, or chills with the pain
  • blood in your urine
  • trouble urinating

Urinary Tract Infection: Symptoms, Diagnosis, and Treatment

What is a UTI?

A urinary tract infection (UTI) is an infection from microbes. These are organisms that are too small to be seen without a microscope. Most UTIs are caused by bacteria, but some are caused by fungi and in rare cases by viruses. UTIs are among the most common infections in humans.

A UTI can happen anywhere in your urinary tract. Your urinary tract is made up of your kidneys, ureters, bladder, and urethra. Most UTIs only involve the urethra and bladder, in the lower tract. However, UTIs can involve the ureters and kidneys, in the upper tract. Although upper tract UTIs are more rare than lower tract UTIs, they’re also usually more severe.

UTI symptoms

Symptoms of a UTI depend on what part of the urinary tract is infected.

Lower tract UTIs affect the urethra and bladder. Symptoms of a lower tract UTI include:

  • burning with urination
  • increased frequency of urination without passing much urine
  • increased urgency of urination
  • bloody urine
  • cloudy urine
  • urine that looks like cola or tea
  • urine that has a strong odor
  • pelvic pain in women
  • rectal pain in men

Upper tract UTIs affect the kidneys. These can be potentially life threatening if bacteria move from the infected kidney into the blood. This condition, called urosepsis, can cause dangerously low blood pressure, shock, and death.

Symptoms of an upper tract UTI include:

  • pain and tenderness in the upper back and sides
  • chills
  • fever
  • nausea
  • vomiting

UTI symptoms in men

Symptoms of an upper tract urinary infection in men are similar to those in women. Symptoms of a lower tract urinary infection in men sometimes includes rectal pain in addition to the common symptoms shared by both men and women.

UTI symptoms in women

Women with a lower tract urinary infection may experience pelvic pain. This is in addition to the other common symptoms. Symptoms of upper tract infections among both men and women are similar.

UTI treatment

Treatment of UTIs depends on the cause. Your doctor will be able to determine which organism is causing the infection from the test results used to confirm the diagnosis.

In most cases, the cause is bacteria. UTIs caused by bacteria are treated with antibiotics.

In some cases, viruses or fungi are the causes. Viral UTIs are treated with medications called antivirals. Often, the antiviral cidofovir is the choice to treat viral UTIs. Fungal UTIs are treated with medications called antifungals.

Antibiotics for a UTI

The form of antibiotic used to treat a bacterial UTI usually depends on what part of the tract is involved. Lower tract UTIs can usually be treated with oral antibiotics. Upper tract UTIs require intravenous antibiotics. These antibiotics are put directly into your veins.

Sometimes, bacteria develop resistance to antibiotics. Results from your urine culture can help your doctor select an antibiotic treatment that will work best against the type of bacteria that’s causing your infection.

Treatments other than antibiotics for bacterial UTIs are being examined. At some point, UTI treatment without antibiotics may be an option for bacterial UTIs by using cell chemistry to change the interaction between the body and the bacteria.

Home remedies for a UTI

There are no home remedies that can cure a UTI, but there are some things that you can do to help your medication work better.

These home remedies for UTIs may help your body clear the infection faster. Cranberry juice or cranberries don’t treat a UTI once it’s started. However, a chemical in cranberries may help prevent certain types of bacteria that can cause a bacterial UTI from attaching to the lining of your bladder. This may be helpful in preventing future UTIs.

Untreated UTIs

It’s important to treat a UTI — the earlier, the better. Untreated UTIs become more and more severe the further they spread. A UTI is usually easiest to treat in the lower urinary tract. An infection that spreads to the upper urinary tract is much more difficult to treat and is more likely to spread into your blood, causing sepsis. This is a life-threatening event.

If you suspect that you have a UTI, contact your doctor as soon as possible. A simple examination and urine or blood test could save you a lot of trouble in the long run.

UTI diagnosis

If you suspect that you have a UTI based on your symptoms, contact your doctor. Your doctor will review your symptoms and perform a physical examination. To confirm a diagnosis of a UTI, your doctor will need to test your urine for microbes.

The urine sample that you give your doctor needs to be a “clean catch” sample. This means the urine sample is collected at the middle of your urinary stream, rather than at the beginning. This helps to avoid collecting the bacteria or yeast from your skin, which can contaminate the sample. Your doctor will explain to you how to get a clean catch.

When testing the sample, your doctor will look for a large number of white blood cells in your urine. This can indicate an infection. Your doctor will also do a urine culture to test for bacteria or fungi. The culture can help identify the cause of the infection. It can also help your doctor choose which treatment is right for you.

If a virus is suspected, special testing may need to be performed. Viruses are rare causes of UTIs but can be seen in people who have had organ transplants or who have other conditions that weaken their immune system.

Upper tract UTIs

If your doctor suspects that you have an upper tract UTI, they may also need to do a complete blood count (CBC) and blood cultures, in addition to the urine test. A blood culture can make certain that your infection hasn’t spread to your blood stream.

Recurrent UTIs

If you have recurrent UTIs, your doctor may also want to check for any abnormalities or obstructions in your urinary tract. Some tests for this include:

  • An ultrasound, in which a device called a transducer is passed over your abdomen. The transducer uses ultrasound waves to create an image of your urinary tract organs that are displayed on a monitor.
  • An intravenous pyelogram (IVP), which involves injecting a dye into your body that travels through your urinary tract and taking an X-ray of your abdomen. The dye highlights your urinary tract on the X-ray image.
  • A cystoscopy, which uses a small camera that’s inserted through your urethra and up into your bladder to see inside your bladder. During a cystoscopy, your doctor may remove a small piece of bladder tissue and test it to rule out bladder inflammation or cancer as a cause of your symptoms.
  • A computerized tomography (CT) scan to get more detailed images of your urinary system.

Causes and risk factors of a UTI

Anything that reduces your bladder emptying or irritates the urinary tract can lead to UTIs. There are also many factors that can put you at an increased risk of a getting a UTI. These factors include:

  • age — older adults are more likely to get UTIs
  • reduced mobility after surgery or prolonged bed rest
  • kidney stones
  • a previous UTI
  • urinary tract obstructions or blockages, such as an enlarged prostate, kidney stones, and certain forms of cancer
  • prolonged use of urinary catheters, which may make it easier for bacteria to get into your bladder
  • diabetes, especially if poorly controlled, which may make it more likely for you to get a UTI
  • pregnancy
  • abnormally developed urinary structures from birth
  • a weakened immune system

Additional UTI risk factors for men

Most UTI risk factors for men are the same as those for women. However, having an enlarged prostate is one risk factor for a UTI that’s unique to men.

Additional UTI risk factors for women

There are additional risk factors for women. Some factors that were once believed to be a cause of UTIs in women have since been shown to not be as important, such as poor bathroom hygiene. Recent studies have failed to show that wiping from back to front after going to the bathroom leads to UTIs in women, like previously believed.

In some cases, certain lifestyle changes may help lessen the risk of some of these factors.

Shorter urethra

The length and location of the urethra in women increases the likelihood of UTIs. The urethra in women is very close to both the vagina and the anus. Bacteria that may naturally occur around both the vagina and anus can lead to infection in the urethra and the rest of the urinary tract.

A woman’s urethra is also shorter than a man’s, and the bacteria have a shorter distance to travel to enter the bladder.

Sexual intercourse

Pressure on the female urinary tract during sexual intercourse can move bacteria from around the anus into the bladder. Most women have bacteria in their urine after intercourse. However, the body can usually get rid of these bacteria within 24 hours. Bowel bacteria may have properties that allow them to stick to the bladder.

Spermicides

Spermicides may increase UTI risk. They can cause skin irritation in some women. This increases the risk of bacteria entering the bladder.

Condom use during sex

Non-lubricated latex condoms may increase friction and irritate the skin of women during sexual intercourse. This may increase the risk of a UTI.

However, condoms are important for reducing the spread of sexually transmitted infections. To help prevent friction and skin irritation from condoms, be sure to use enough water-based lubricant, and use it often during intercourse.

Diaphragms

Diaphragms may put pressure on a woman’s urethra. This can decrease bladder emptying.

Decrease in estrogen levels

After menopause, a decrease in your estrogen level changes the normal bacteria in your vagina. This can increase the risk of a UTI.

UTI prevention

Everyone can take the following steps to help prevent UTIs:

  • Drink six to eight glasses of water daily.
  • Don’t hold urine for long periods of time.
  • Talk to your doctor about managing any urinary incontinence or difficulties fully emptying your bladder.

However, UTIs happen much more frequently in women than in men. The ratio is 8:1. This means that for every eight women who have UTIs, only one man does.

Certain steps may help prevent UTIs in women. For postmenopausal women, using topical estrogen prescribed by your doctor could make a difference in preventing UTIs. If your doctor believes that intercourse is a factor of your recurrent UTIs, they may recommend taking preventive antibiotics after intercourse, or long-term. Some studies have shown that long-term preventive use of antibiotics in older adults reduced the risk of UTIs.

Taking daily cranberry supplements or using vaginal probiotics, like lactobacillus, may also help in the prevention of UTIs. Some studies suggest that using probiotic vaginal suppositories can decrease the occurrence and recurrence of UTIs, by changing the bacteria found in the vagina.

Be sure to discuss with your doctor what the right prevention plan is for you.

Chronic UTIs

Most UTIs go away after treatment. Chronic UTIs either don’t go away after treatment or keep recurring. Recurrent UTIs are common among women.

Many cases of recurrent UTIs are from reinfection with the same type of bacteria. However, some recurrent cases don’t necessarily involve the same type of bacteria. Instead, an abnormality in the structure of the urinary tract increases the likelihood of UTIs.

UTIs during pregnancy

Women who are pregnant and have symptoms of a UTI should see their doctor right away. UTIs during pregnancy can cause high blood pressure and premature delivery. UTIs during pregnancy are also more likely to spread to the kidneys.

Anatomy of the Urinary System

How do the kidneys and urinary system work?

The body takes nutrients from food and converts them to energy. After the body has taken the food components that it needs, waste products are left behind in the bowel and in the blood.

Illustration of the anatomy of the urinary system, front view

The kidney and urinary systems help the body to eliminate liquid waste called urea, and to keep chemicals, such as potassium and sodium, and water in balance. Urea is produced when foods containing protein, such as meat, poultry, and certain vegetables, are broken down in the body. Urea is carried in the bloodstream to the kidneys, where it is removed along with water and other wastes in the form of urine.

Other important functions of the kidneys include blood pressure regulation and the production of erythropoietin, which controls red blood cell production in the bone marrow. Kidneys also regulate the acid-base balance and conserve fluids.

Illustration of the anatomy of the kidney

Kidney and urinary system parts and their functions

  • Two kidneys. This pair of purplish-brown organs is located below the ribs toward the middle of the back. Their function is to remove liquid waste from the blood in the form of urine; keep a stable balance of salts and other substances in the blood; and produce erythropoietin, a hormone that aids the formation of red blood cells. The kidneys remove urea from the blood through tiny filtering units called nephrons. Each nephron consists of a ball formed of small blood capillaries, called a glomerulus, and a small tube called a renal tubule. Urea, together with water and other waste substances, forms the urine as it passes through the nephrons and down the renal tubules of the kidney.
  • Two ureters. These narrow tubes carry urine from the kidneys to the bladder. Muscles in the ureter walls continually tighten and relax forcing urine downward, away from the kidneys. If urine backs up, or is allowed to stand still, a kidney infection can develop. About every 10 to 15 seconds, small amounts of urine are emptied into the bladder from the ureters.
  • Bladder. This triangle-shaped, hollow organ is located in the lower abdomen. It is held in place by ligaments that are attached to other organs and the pelvic bones. The bladder’s walls relax and expand to store urine, and contract and flatten to empty urine through the urethra. The typical healthy adult bladder can store up to two cups of urine for two to five hours.
  • Two sphincter muscles. These circular muscles help keep urine from leaking by closing tightly like a rubber band around the opening of the bladder.
  • Nerves in the bladder. The nerves alert a person when it is time to urinate, or empty the bladder.
  • Urethra. This tube allows urine to pass outside the body. The brain signals the bladder muscles to tighten, which squeezes urine out of the bladder. At the same time, the brain signals the sphincter muscles to relax to let urine exit the bladder through the urethra. When all the signals occur in the correct order, normal urination occurs.

Facts about urine

  • Adults pass about a quart and a half of urine each day, depending on the fluids and foods consumed.
  • The volume of urine formed at night is about half that formed in the daytime.
  • Normal urine is sterile. It contains fluids, salts and waste products, but it is free of bacteria, viruses and fungi.
  • The tissues of the bladder are isolated from urine and toxic substances by a coating that discourages bacteria from attaching and growing on the bladder wall.

Urinary System: Facts, Functions & Diseases

The urinary system, also known as the renal system, produces, stores and eliminates urine, the fluid waste excreted by the kidneys. The kidneys make urine by filtering wastes and extra water from blood. Urine travels from the kidneys through two thin tubes called ureters and fills the bladder. When the bladder is full, a person urinates through the urethra to eliminate the waste.

The urinary system is susceptible to a variety of infections and other problems, including blockages and injuries. These can be treated by a urologist or another health care professional who specializes in the renal system.

Description of the urinary system

The urinary system works with the lungs, skin and intestines to maintain the balance of chemicals and water in the body. Adults eliminate about 27 to 68 fluid ounces (800 to 2,000 milliliters) per day based on typical daily fluid intake of 68 ounces (2 liters), National Institutes of Health (NIH). Other factors in urinary system function include fluid lost through perspiring and breathing. In addition, certain types of medications, such as diuretics that are sometimes used to treat high blood pressure, can also affect the amount of urine a person produces and eliminates. Some beverages, such as coffee and alcohol, can also cause increased urination in some people.

The primary organs of the urinary system are the kidneys, which are bean-shaped organs that are located just below the rib cage in the middle of the back. The kidneys remove urea — waste product formed by the breakdown of proteins — from the blood through small filtering units called nephrons, according to the Cleveland Clinic. Each nephron consists of a ball formed of small blood capillaries, called a glomerulus, and a small tube called a renal tubule. Urea, together with water and other waste substances, forms the urine as it passes through the nephrons and down the renal tubules of the kidney.

From the kidneys, urine travels down two thin tubes, called ureters, to the bladder. The ureters are about 8 to 10 inches long (20 to 25 centimeters), according to the Cleveland Clinic.

Muscles in the ureter walls continuously tighten and relax to force urine away from the kidneys, according to the NIH. A backup of urine can cause a kidney infection. Small amounts of urine are emptied into the bladder from the ureters about every 10 to 15 seconds.

The bladder is a hollow, balloon-shaped organ that is located in the pelvis. It is held in place by ligaments attached to other organs and the pelvic bones, according to the Kidney & Urology Foundation of America. The bladder stores urine until the brain signals the bladder that the person is ready to empty it. A normal, healthy bladder can hold up to 16 ounces (almost half a liter) of urine comfortably for two to five hours.

To prevent leakage, circular muscles called sphincters close tightly around the opening of the bladder into the urethra, the tube that allows urine to pass outside the body. The only difference between the female and male urinary system is the length of the urethra, according to Merck Manuals. In females, the urethra is about 1.5 to 2 inches long (3.8 to 5.1 cm) and sits between the clitoris and the vagina. In males, it is about 8 inches (20 cm) long, runs the length of the penis and opens at the end of the penis. The male urethra is used to eliminate urine as well as semen during ejaculation.

Diseases of the urinary system

Different specialists treat urinary system ailments. Nephrologists treat kidney diseases, while urologists treat problems with the urinary tract, including the kidneys, adrenal glands, ureters, bladder and urethra, according to the American Urological Association (AUA). Urologists also treat the male reproductive organs, while gynecologists often treat urinary diseases or disorders in females, including yeast infections. Nephrologists and urologists often work with endocrinologists or oncologists, depending on the disease.

Urinary tract infections (UTIs) occur when bacteria enter the urinary tract; they can affect the urethra, bladder or even the kidneys. While UTIs are more common in women, they can occur in men. UTIs are typically treated with antibiotics, according to Dr. Oscar Aguirre, a urogynecologist in Denver. In the United States, about 8.1 million people have a urinary tract infection each year, according to the American Urological Association.

Incontinence is another common disease of the urinary system. “The most common bladder problems I see in my practice in women are frequent urges to urinate and leakage of urine,” said S. Adam Ramin, urologic surgeon and founder of Urology Cancer Specialists in Los Angeles. “The most common bladder problems in men are frequent urination at nights and incomplete bladder emptying. This is usually due to an enlarged prostate causing obstruction of bladder emptying.”

Problems can come in the form of a pelvic prolapse, which can result in leakage and can be the result of a vaginal delivery. Then there is the overactive bladder, “which we see a lot and is not related to having children or trauma,” Aguirre said. A third condition involves overflow, in which the bladder does not completely empty.

“Holding your urine for a short period of time, usually up to one hour, is typically okay,” said Ramin. “However protracted and repeated holding of urine may cause over-expansion of bladder capacity, transmission of excess pressure into the kidneys, and the inability to completely empty the bladder. These problems in turn may lead to UTI [urinary tract infection], cystitis and deterioration of kidney function.”

Some common treatments involve medications, physical therapy and pelvic mesh surgery, Aguirre noted. Vaginal laser surgery is also becoming a viable treatment option, he explained. “In another 10 to 15 years, vaginal laser surgery will be another common option for the treatment of urinary conditions.”

Interstitial cystitis (IC), also called painful bladder syndrome, is a chronic bladder condition, primarily in women, that causes bladder pressure and pain and, sometimes, pelvic pain to varying degrees, according to the Mayo Clinic. It can cause bladder scarring, and can make the bladder less elastic. While the cause isn’t known, many people with the condition also have a defect in their epithelium, the protective lining of the bladder.

Prostatitis is a swelling of the prostate gland and, therefore, can only occur in men. Often caused by advanced age, symptoms include urinary urgency and frequency, pelvic pain and pain during urination, the Mayo Clinic noted.

Kidney stones are clumps of calcium oxalate that can be found anywhere in the urinary tract. Kidney stones form when chemicals in the urine become concentrated enough to form a solid mass, according to the Cleveland Clinic. They can cause pain in the back and sides, as well as blood in the urine. Many kidney stones can be treated with minimally invasive therapy, such as extracorporeal shock wave lithotripsy, which disintegrates the kidney stones with shock waves.

Kidney failure, also called renal failure and chronic kidney disease, can be a temporary (often acute) condition or can become a chronic condition resulting in the inability of the kidneys to filter waste from the blood. Other conditions, such as diabetes and hypertension, can cause chronic kidney disease, according to the Mayo Clinic. Acute cases may be caused by trauma or other damage, and may improve over time with treatment. However, renal disease may lead to chronic kidney failure, which may require dialysis treatments or even a kidney transplant.

Bladder cancer is diagnosed in about 75,000 Americans each year and is more frequent in men and the elderly according. It is predicted that 81,190 new cases of bladder cancer (about 62,380 in men and 18,810 in women) and bout 17,240 deaths from bladder cancer (about 12,520 in men and 4,720 in women) will occur in 2018, according to American Cancer Society. The symptoms, including back or pelvic pain, difficulty urinating and urgent/and or frequent urination, mimic other diseases or disorders of the urinary system.