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Doctors' Answers to "Frequently Asked Questions" - Urinary Problems

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

[posted 04/21/2000]
Question: Despite trying to drink water and fluids, what can I do so that I do not keep getting urinary tract infections. I have suffered from this all my life, since childhood. The doctors just keep giving me antibiotics, but as soon as these are finished a few weeks - the infection recurs. Please help. Thank you.

Answer: Several possibilities. I assume you have had a IVP or CT of your renal system. If there is a congenital problem(about 15% of patients) there may be no solution. Also, you need to ensure that there is not a residual calculi or diverticuli that can be fixed. If this has been done, some basic information. 1. Women must clean their anus away from their urethra(the external urinary opening). This is common since little girls are often not instructed as are little boys to wipe away from the genitalia. 2. Any pelvic pressure or trauma will increase the risk of UTIs. Sex is the most common, but riding horses etc. will do it. Urinary voiding after any pelvic pressure or sex will help. Some women will need to take a small amount of antibiotic with each sexual intercourse to avoid the UTIs. 3. Check the ph of your urine and change it if it is persistently acid or basic. Easily accomplished and sometimes very effective(this is the reason that cranberry juice sometimes works). 4. Ensure you urinate many times a day. Retaining urine will increase the risk and women just don't urinate enough(social training mainly).

[posted 03/16/2000]
Question: For the past 6 wks I have had persistent UTI symptoms
burning, frequency, pressure,pain in the lower pelvic area
etc. I have been on several antibiotics and my cultures
show no growth. A urologist told me this was not uncommon
he prescribed Detrol and I'll re-turn in 6 wks. In the
meantime, my symptoms interfere with sleep, work, and
graduate school. I somehow wish he had done more. I wonder
if my medications, Nardil or Clonazepam could cause any
of these symptoms. Is this common in younger women? Should I
just hope these symptoms go away?

Answer: Nardil can cause this problem occasionally,but would usually be present when you started the drug or increased your dosage. You need to insure that you don't have interstitial cystitis. If the Detrol fixes the problem,ok, but I suspect you have another problem.

[posted 03/12/2000]
Question: In 6/99 developed prostate infection and pain in urethel area. Tried
Levaquin which did not work. Urologist did sonogram and
found urine retention in bladder. Put me on flomax and cipro
( cipro 500 mg twice a day for four months) then reduce to
250 mg twice a day as needed . Pain in urethial area
finally went away, and did sonogram in Oct which showed
bladder was emptying ok. At the same time did a cystocope
which disclosed two structures within the bladder that look
like pockets on non leaking wholes. Was told I do not have
( IC ) the wholes or pockets become infected and cause the
pain that transmits down thru the uretha etc. Cause of the
wholes in medically unknown, thought to be from urine
retention possibly over long period of time. Have had
prostate problems before over the years but they always
cleared up with cipro or another antibotic and did not
reappear for several years. This time it keeps coming back
might feel good for a week or so then it comes back for
for several months befire imoproving again. It came back about
4 days ago creating pain that comes and goes in the urethial
area. Today is 3/11/00. It is beginning to effect my nerves and
anxiety level. I am really fearing having major surgery
done to open up the bladded to try and cut out the pockets
or sturctures. Is there anything else you would recommend
as far as drugs ? I harldy drink any alcohol or caffine,
and eat very litte spicy food etc. Have read about a drug
used for ( IC ) to coat the bladded wall etc its called Elmiron,
would this do anything to help me. Thanks for
your time and advice.

Answer: It sounds like you are describing diverticuli of the bladder. Is this the terminology that your urologist is using? If so, then chronic antibiotics or surgery are the only answers.

[posted 03/8/2000]
Question: My mother has been diagnosed with having bladder spasms. She has frequent infections and experiences a lot of pain. In addition, she has a lot of swelling from her knees down, particularly around the ankles. Is there anything natural or over the counter she can buy to ease the pain from the spasms which seem to occur more at night?

Answer: Not to my knowledge. She should insure the infections are eliminated and then try some of the prescription antispasmodics available by prescription. Topical estrogen cream is often helpful if she is not on systemic estrogen.

[posted 02/11/2000]
Question: Experiencing groin pain/pressure on my right side along with almost constant urge to pee, even after emptying bladder. After peeing, experiencing burning sensation on tip of penis, but not while peeing. Have had problem in past of passing small kidney stones but nothing like this. This discomfort comes and goes away after -009ral hours or
overnight only to return after several days or a week later. Wondering if kidney prob or bladder infection or sexual disease, endless spec, etc. I do suffer from ongoing acid reflux and am taking med for high blood pressure daily. Am slightly obese (30 lbs) and quit smoking 5 years ago after 20 years.

Answer: Probably another stone, but could be an infection. You will need to get a urine looked at to figure this one out. Call your md, or go to a clinic.

[posted 01/20/2000]
Question: I have had recurring problems with a blockage in the urethra (from being kicked when I was young), which in the past has been relieved by metal rods being placed up the urethra to clear out the scar tissue. Is there a new procedure to correct this problem of scar tissue obstructing the flow of urine?

Answer: Not to my knowledge.

[posted 10/13/1999]
Question: Since June of 1999, I've been getting up once a night to urinate, and just recently two times, several times a week. I do not drink, smoke, etc. I excercise daily and began limiting my nightime fluids since August, all to no avail. I've visited with a uroligist (when it was a once a night problem)and there was no infection and the prostate was fine. He told me if I can live with the annoyance of getting up than he would recommend to ignore the problem. Unfortunately this is beginning to affect my quality of life. Is it possible that I have low levels of antidiuretic hormone, or suffer from sleep apnea? I've been looking all over the internet and can't find anything that would help me. Thanks for your assistance.

Answer: Probably just a big prostate that's partially blocking your outlet from your bladder. Flomax or hytrin or cardura would be an option to improve your condition.

[posted 10/13/1999]
Question: my urerthra had been dialated 8 times in the past 30 years.
I have had a narrow urethra since I was a child. Now that I am married and sexually active it is painful to have sex because I feel the urge to empty my bladder even though I did before intercourse. I dont't see my urologist until Dec.
and I would like to know if there are other ways besides bladder retraining, imipramine, and another dialation to improve this 35 year painful situation.

Answer: Probably not, but some would treat it with DMSO and see if that helps to ensure that you do not have a variant of interstitial cystitis.

[posted 11/22/1999]
Question: I have been dating my present girlfriend for 7 months and sexually active for 5 months. She has had 3 uninary tract infections since becoming sexually active. First time, she was treated with antibiotics and a post-coital antibiotic. Second time, treated the same way, seem to clear up. However, the third and last infection showed up negative for bacteria in urine but still had symptoms. She tested negative for common STDs. I have had a reoccuring case of common jock itch. Used common antifungal cream and seems to clear up only to be aggrivated again through intercouse. I was prescribed metronidazole 500mg tabs (4 at one time, once). She said that I am the only sexually partner she has experienced this with. We have heard it all from latex allergies, to something she has to get used to. My questions are 1) Could I be the cause of her problems? 2) If so, how can I prevent this from happening again? and 3) Do you have any suggestions as to what else could be causing this condition and treatment?

Thank you for your time.

Answer: Culture negative dysuria should be checked for chlamydia which is sexually transmitted. Easily done with a spot urine or culture. Another option would be to treat both of you concurrently. The pelvic fungal infection is not doing this. If the cultures are negative, I'd see a Urologist to see if she has interstitial cystitis or some other urologic problem.

[posted 11/16/1999]
Question: I am a 38 year old female and for the past two years have noticed that my urine has developed and extremely strong odor. I have been tested for bladder infection but the test was negative. I am not currently sexually active so I don't think its related to intercourse. I recently had a thorough medical exam, bloodwork and urinalysis for life insurance and there were no abnormal results that were reported to me. I don't consume a lot of fluids (but I never have). My question is whether or not I should be concerned about this phenomena. I have no fever, no back pain. I had a kidney infection that resulted in hospitalization when I was 12 years old. I rarely drink alcohol and I don't smoke. I've given birth to two children via c-section. Any idea what could be causing this embarrasing problem?

Answer: Nothing rings a bell. Occasionally diet will do it(asparagus is notorious) some patients seem to have this with vitamins of one sort or another. But, there is no pathology with this.

Preoteinuria & Pregnancy [posted 12/11/98]
Question: My wife is currently taking 10mg/day of prednisone because of her kidney problem. Can you help me learn about the effects of this drug when pregnant, for both my wife and the child. She started taking prednisone last sept '97 at a 40mg dose per day gradually dropping it down as tests showed improvement in the amount of proteins escaping. She should be down to 5mg per day next month. What are your recommendations?

Answer: 5 mg is a pretty small dosage especially if it is keeping the proteinuria under control. First, what is the cause of her proteinuria? This would make a big difference in recommendations. Proteinuria is usually the precursor to renal failure and if steroids prevent this are worth the risk to the fetus, pretty small by the way in this dosage. You should be in a high risk pregnancy clinic;but, sounds like the options for your wife are small. I wouldn't worry about fetal risk until her health is addressed. There may be some fetal adrenal suppression;but, should be minimal.

Diet & Urinary Problems [posted 12/04/98]
Question: Along with a lot of stress over the years and working through a divorce I am in very good physical shape. I do the treadmill 3 to 4 days a week for 30 minutes.  I am urinating an awful lot the last few months but I do drink plenty of fluids about 60% water, 15-20% gatorade and other juices or caffeine free cola. Is the urinating from the lipitor or some other factors like my diet (very little red meat, lot of chicken and I feel I am a semi or pseudo vegetarian. What other info do you need about my habits, diet, etc.?

Answer: Do you get up at night to urinate? This is a good measure of how frequent you are urinating. Excessive urination should necessitate a check of blood glucose, calcium and if these are normal your urinary tract. Sometimes topical estrogen to the area around where you urinate will fix this problem.

Significance of Frequent Urination, Other than Prostate Problems [posted 10/23/98]
Question: What could be the cause of frequent urination during the night, other than prostrate trouble.

Answer: Urinary infection, diabetes mellitus, hypercalcemia, bladder calculi etc. get it checked.

Significance of Urine Color [posted 10/16/98]
Question: What is the significance of the color of urine

Answer: Usually not much. It can change with hepatitis,etc. but, generally not very much help.

False Positive Urine Test [posted 7/30/98]
Question: My urine test in a detoxification center showed Valium. Would antihistamine over the counter drugs show this? What would? I should have had Alcohol only in the test.

Answer: Over the counter antihistamines would not show as Valium in most drug tests if properly administered. I don't know what the last part of your question is answering.

Urology [posted 7/23/98]
Question: I saw a patient that presented with what he called cloudy urine. I checked for microbial contamination and there was none. Upon inspection his urine appeared to have white "crystalline" objects suspended in the specimen (it was also basic and the crystals eventually settled out). He was also a smoker (I have no idea of that relevancy). He had been told to take 1000mg of vitamin C, but he said that even that quit working and the cloudiness came back. He went on to say that the urine appeared milky as it passed and that it seemed to drain from the prostatic portion of the urethra. He was given an exam for prostatitis and medicated without proper testing. None of this proved to be satisfactory in eliminating the problem. I am curious as to the etiology of this problem and if it is any cause for concern. As I am only doing a preceptorship, I will not be able to follow up on his condition. Is this common? If so, where could I get more information on this? I had a college buddy who complained of white "dixie-like" crystals in his urine and this concerns me. Is a major problem going undiagnosed? Could he be overdosing on the vitamin C?

Answer: Probably crystalline formation due to the pH. Add a drop of acetic acid to the urine. If it clears it is merely pH dependent crystalline formation. Common and without pathology.

Urinalysis Test and Medications [posted 7/16/98]
Question: Could taking the following medication for approximately 1 year or more show amphetamine/methamphetamine in your urinalysis screening/test.
1. daypro 600 mg
2. codeine 500mg
3. hydrocodone/apap 500mg
4. theraflu
5. prozac
Also, a few other prescribed medications for pain in having tendonitis/carpal tunnel. At time of given urine sample I had been drinking theraflu, as well as vicadine, daypro and tylenol with codeine.

Answer: Not amphetamines, but narcotics for the codeine, hydrocodone.

Bladder Infection
Question: What is a bladder infection?

Answer: Bacteria in the urinary system which multiplies in the high nitrogen content of the urine.

Blood in Urine
Question: I sometimes notice blood in my urine. I have no pain. I have noticed this for the last 7 days. I am a 60 year old male. The urine becomes quite red/pinkish. However, for the whole day yesterday I did not notice any redness in my urine. What could be the cause of this? I am otherwise perfectly fine.

Answer: Blood in the urine, or hematuria, can be the result of many conditions. Blood in the urine can be coming from anywhere in the urinary tract, or any of the structures that empty into it. A clue as to the cause can sometimes be found by determining when in the urine stream you see the blood. Is it only at the beginning of the stream, only at the end, or do you see blood throughout the time you are urinating? A wide variety of disorders, including kidney stones, medications, malignancy, urinary tract infections, physical trauma, prostate problems, dehydration, or rarely, a bleeding tendency not related to the urinary system per se. Often there are no other symptoms, and this does not help in narrowing the list of possible causes. An evaluation by your health care provider is the first step you should take. A thorough history and physical examination, as well as urinalysis evaluation, can very often narrow down the possibilities significantly. Your provider can then determine if any further testing is necessary, if referral to a specialist is warranted, and/or what treatment is indicated.

Night time bed-wetting
Question: We have been told that Tosranic can have a dramatic effect on our sons bed-wetting. We are concerned as to the results that can be achieved. We also need to know of any research or other drugs used in this situation. He is 7 years old, in excellent health, a very sound sleeper, and is 4'6" 62 lbs. (no fat). His Iron is low and he is taking a supplement. He has no problem during the day and is dry 60-75% of the time.

Answer: I'm not familiar with this drug. Do you have the manufacturer or generic name? Also, your son should not need iron supplements unless he is losing blood somewhere. I'd discuss the diagnosis with your pediatrician or family doctor.

Urinary Problems
Question: My mother is 70 years old. Two months ago she noticed that her toilet habits has changed. She noticed that she has a lot a wind in her stomach. Her stools are less and urine is also less and she has difficulty in passing urine. I have sent her for urine test and blood test. So far all the tests showed no abnormalities. A scan was also done for the kidney with no indication of abnormality. Doctors advised for either scoping or X-ray which my mother did not want to do. At times, she experiences retention of her urine and will use a hot water bag to help to release the urine. The flow of the urine is not very forceful. When the urine retention is bad, I will massage her back and she will feel the urge to urinate whereby she will go to release part of the urine. I am not sure what I should do, as she does not want to go for further tests.

Answer: Urine retention will usually require further invasive studies to find the cause. However, the simplest treatment is local estrogen cream (assuming she is not on estrogen replacement). This can restore the columnar epithelia necessary for this part of the body. It should be applied twice a day for at least 6 weeks to see if it will help. If this does not help she would be best advised to get further invasive studies.

Question:Is it possible to test positive for either/both cocaine/cannabinoids if you are are taking a combination of other legally prescribed drugs?

Answer:Drug testing can be quite specific or general. Screening urine tests will occasionally test positive for other substances. Better drug testing will not-except in very rare conditions.

Vitamin Therapy
Question:are there any vitamins that help deal with female urinary incontinence?

Answer:Female urinary incontinence has a variety of causes. However, vitamin deficiency is not usually thought to be one of them. Consequently, taking vitamins wouldn't be expected to help the problem. The usual remedies that work are Kegel exercises and topical estrogren cream(in post menopausal women). Kegel exercises were initially described by an Army doctor in France after WW II. He was treating French prostitutes and found that they employed pelvic strengthening exercises to enhance their professional ability. The muscle that is responsible for urinary continence is shaped in a figure eight with one loop around the bladder sphincter and vagina and the other loop around the rectum. Strengthening this muscle will usually dramatically reduce urinary incontinence. This is done by tightening the muscle and pulling it into ones body-holding this for as long as possible-relaxing the muscle and repeating this over and over. This is the easiest and best way to decrease urinary incontinence-it has the added side effect of enhancing your vaginal strength.

Inability to Urinate
Question:In March I had a cysto, CMG, and a hydraulic distention of the bladder. Since the procedures I have been unable to urinate and do a self cath procedure. I have been told that this is a temporary condition. I have had several different diagnoses. I have a mild systole which I have had since 1970, which gave me no problems. I have had a complete physical with no medical problems that could case the urinary retention. Your suggestions or comments would be appreciated.

Answer: Why did you have the procedures? Obviously, you were having some type of problem. A trial of Hytrin or equivalent drug might be useful; but, it sounds mechanical which usually requires surgery.

Home UTI Tests
Question:What is the trade name of the home test for UTIs.

Answer: I'm not aware of this product-sorry.

Question:My 15-year old daughter just had a urinalysis test done for athletics in High School. They have told us that she has a high amount of protein in her urine, along with some Leukocytes. She had to have several re-checks on her urine test, 3 years ago, for the same thing. I don't really understand what can be causing this...???...any ideas? She seems to be very healthy, and also very physically active.

Answer: This needs a physician follow up. There are some kidney conditions that are signaled with protein in the urine. The kidney when healthy usually holds on to 99%+ of protein; so that, spilling protein signals damage to the basement membrane of the kidney. This should not be ignored. She may have one of the benign conditions causing spillage; but, she may need treatment not to avoid renal failure.

UTI & Yeast Infections
Question: I am 26 years old. I started getting frequent UTI's a few years ago. I also usually get yeast infections at the same time. I have been to a urologist and he couldn't find anything. I have an ongoing prescription for Macrobid. The infections were from e-coli. I had a pap a couple of weeks ago and they called to say it showed I had an infection and needed to take metronidazole and be rechecked in 6 months. Is any of this connected? Does anyone have any ideas about what all of this means?

Answer: Frequent UTIs in women are usually related to pelvic trauma. For most women this means intercourse;but, riding on horses, etc. can cause the problem. Increasing fluid intake and voiding after intercourse can help decrease the frequency of infections. If this is not successful, taking one pill of an antibiotic with intercourse can often eliminate the problem. The yeast infections are probably triggered by the antibiotics for your UTIs. Birth control pills also seem to increase the risk. Once you have one they will reoccur and with predictability with antibiotics. The Israelis use yogurt douches to replace the lactobacilli in your vagina and thus eliminate the problem. Use a tablespoon of active yogurt(no additives). It must be actively growing and not pasteurized. You may need to get your own yogurt maker at home or get the yogurt in a health food store since the usual yogurt in a store is of no help. Regarding the infection with metronidazole-this is a common problem and I think is over called by many cytology labs. Most women have no symptoms and it does not appear transmissible sexually. Most ob/gyn will treat this;but, I think the evidence is scanty at best that it is necessary and not a normal condition of many vaginas.

Question: I am a 38 year old male, good health. After I urinate, I drip for about 5 minutes. Enough to be embarrassed by wet spots. This has been going on for about 10 years. Recently, over the past 6 months I have noticed, the amount of urine leaking out is increasing and if I move a certain way while I am sitting I can feel more urine dripping out even though there is no urgency to urinate.I have no pain and my sex life is good. 3-4 times a week.I went to my doctor and he did blood work and urine testing, the test came back negative on a variety of items..urinary infection diabetes, psa, stones etc.. he has recommended a urologist. My question is what could be causing this dripping..I like to be informed so that I may do some further research...getting concerned.

Answer: Either the volume of your bladder is not being completely emptied(prostate problem or stricture) or the muscle is not closing properly. Since you have had this for 20 years or so, I suspect a stricture(congenital or 2nd to previous infection). However, you may need some silicone inject into the closing muscle. The urologist will need to scope your penis and check the volumes and closing pressures before he/she can decide the problem. In general, the next step will be to do this procedure.

Question: I have a friend at work who tells me that her doctor told her she had a urinary infection. He told her to drink cranberry juice and plenty of water. Why cranberry juice? My wife says that it has the right acidity to help clear the infection with causing pain during urination. That sounds a little far fetched to me. Can you shed some light on the subject?

Answer: Sounds a bit far fetched;but, works! This has even been researched and shown to be mildly effective.

Question: I need to go the toilet frequently and sometimes I urinate when I am sleeping at night.

Answer: You will need to check your blood glucose, blood calcium and urinary tract for an infection or bladder calculi. There are other syndromes that could affect the concentrating ability of the kidney;but, these are rare/unusual.

Pyridate & Cephalexin
Question: What is the function of Pyridate 200mg and Cephalexin 250mg. I would like to know what are the side effects and can they be taken together? When taking Pyridate, soon after ingestion vomiting occurs.

Answer: Cephalexin 250 mg is a cephalosporin antibiotic. These are broad spectrum antibiotics used to treat many different types of infections. I'm not sure what you mean by Pyridate. Pyridium is a topical anesthetic used in urinary infections to decrease the pain, spasm and discomfort. I suspect that is what you are referring to with Pyridate. However, it is well tolerated and rarely causes problems like nausea. Cephalexin can cause nausea, diarrhea or allergic reactions.

Protein in Urine
Question: I am 26 years old and for the past two years I have been having a problem with too much protein in my urine. I went to the Doctor at my former college and she said it possibly was due to the wide variety of vitamins that I was taking along with running six miles a day. She told me to stop taking the vitamins and to cut down on my running. Well the protein count did go down, however it was still present in my urine. When I went to see my regular Doctor in august he said that I had way too much protein in my urine. He suggested that I go see a Kidney specialist as soon as I could. I have just recently gotten a job and my benefits don't start until January. I just want to know what could be wrong and is this serious? What could be causing this? A few years ago I was battling an eating disorder and I wonder if that has something to do with this?

Answer: There are two varieties of proteinuria-benign proteinuria and those associated with different diseases. About 5% of patients have benign postural proteinuria. Try checking a urine dip in the morning after being recumbent all night. However, usually further studies including a biopsy of your kidney may be necessary. If is not the benign form, it is usually a sign of coming kidney failure and treatment should be started as soon as possible to avoid irreversible renal damage. It has nothing to do with your eating disorder. You can probably wait until your health benefits kick in or else they will want to identify it as a pre-existing condition that they are not responsible to pay for.


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