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Urinary

Urinary

BENIGN PROSTATIC HYPERPLASIA (PROSTATE GLAND ENLARGEMENT)
About
    • An increase in the size of the prostate gland (a walnut-sized body part made of glandular and muscular tissue)
    • The prostate surrounds part of the urethra, which is the tube that carries urine and sperm outside of the body
    • Almost all men will develop some enlargement of the prostate as they grow older          
      • By age 60, 50% of men will have some signs of BPH
      • By age 85, 90% of men will have signs of the condition   
    • Approximately 50% of men will develop symptoms that need to be treated                                            
Potential Causes

Aging

      • Increased prostate cell growth from lower levels of testosterone and higher levels of estrogen and dihydrotestosterone (DHT)
  •  
Symptoms
    • Urinary frequency
    • Urinary urgency
    • Slowness/dribbling of your urinary stream
    • Hesitancy/difficulty starting to urinate
    • Nocturia (Nighttime voiding)
    • Pain after ejaculation/while urinating
    • Urine that has a different odour/colour than usual
    • The enlargement of the prostate can lead to blockage of the urethra, which can lead to:
      • Bladder stones
      • Bladder infection
      • Blood in your urine
      • Kidney damage from back pressure caused by retaining large amounts of extra urine in the bladder
Diagnosis

Medical history to address

    • Symptoms
    • Current health issues
    • Over-the-counter and prescription drugs being taken
    • Diet and liquid consumption      

 

Physical exam

 

Digital rectal exam

    • To feel the prostate and estimate its size

 

Urine flow study

    • May be conducted to measure how slow the urinary stream is compared with normal urine flow

 

Ultrasound post-urination

    • To determine if there is any urine left in the bladder

 

Cystoscopy

    • Bladder is looked at through a cystoscope
Treatment

Oral Medications

    • Finasteride and Dutasteride work by decreasing the production of the hormone dihydrotestosterone (DHT), which affects the growth of the prostate gland
    • Drugs that relax the muscle in the prostate (to reduce the tension on the urethra) are more commonly used and include doxazosin, tamsulosin, alfuzosin and silodosin
    • Dutasteride and tamsulosin can be combined to help treat symptoms and improve the flow of urine

 

Surgery

    • Transurethral resection of the prostate (TURP)
      • The tissue that blocks the urethra is removed with a special instrument
    • Transurethral incision of the prostate (TUIP)
      • Two small cuts are made in the bladder neck (where the urethra and bladder join) and in the prostate to widen the urethra to improve urine flow
    • Transurethral electrovaporization
      • Electrical energy is applied through an electrode to rapidly heat prostate tissue, turning the tissue cells into steam. The enlarged tissue area can then be vaporized to relieve urinary blockage
    • The GreenLight laser
      • Prostate tissue is removed with a laser

 

Minimally Invasive Treatments

    • Prostatic Urethral Lift
      • Separates the enlarged prostate lobes to make the urethra wider so that it is easier to urinate
    • Water Vapour Therapy
      • Delivers very small amounts of steam to the enlarged prostate
      • This process damages the cells causing obstruction, thus reducing the overall size of the prostate
CHRONIC PROSTATITIS/PROSTATODYNIA
About
    • Inflammation of the prostate gland
    • When symptoms start gradually and linger for more than 2 wks
    • Affects adult men of all ages and from all backgrounds
    • About 5% of men experience symptoms of chronic prostatitis at some point in their lives

 

4 Types:

1.  Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CPPS)

    • Inflammation of the prostate and an irritation of the nerves which supply this area
    • No bacteria are found in a urine sample 

 

2.  Chronic Bacterial Prostatitis

    • Uncommon
    • Tends to come and go over a long period of time
  •  

3.  Acute Bacterial Prostatitis

    • Uncommon
    • Bacteria is present in the urine
  •  

 

4.  Asymptomatic Inflammatory Prostatitis

    • No evidence of prostate infection or inflammation is found
    • Could potentially be a result of abnormal buildup of pressure in the urinary tract
Potential Causes
    • Most often, the nerves and muscles in the pelvis cause pain because of a local inflammation that effects the nerves in the area
    • Less commonly, bacterial infection (if it’s a bacterial type of prostatitis) when infected urine flows backwards from the urethra
    • Nonbacterial prostatitis may be linked to stress, nerve inflammation/irritation, injuries or prior urinary tract infections
    • Can be a reaction to an infection/past injury
  •  
Symptoms
    • Burning during/after urination
    • Difficulty starting the urine stream
    • Dribbling after urination is complete
    • Frequent/urgent need to urinate
    • A sensation that the bladder cannot be fully emptied
    • Pain felt above the penis, in/below the scrotum or in the back/rectum
    • Pain experienced during or after orgasm
    • Chills & fever (Bacterial prostatitis only)
Diagnosis

Medical history to address

      • Symptoms
      • Current health issues
      • Over-the-counter and prescription drugs being taken
      • Diet and liquid consumption
      • Sexual history

 

Physical exam

      • Your doctor will examine your prostate gland by inserting a gloved and lubricated finger into your rectum
        • In chronic prostatitis, the gland may be swollen or firm or it may feel normal

 

Urine Sample

      • Prior to and post exam to check for white blood cells and bacteria
Treatment

Oral Medications

    • Nonsteroidal anti-inflammatories (NSAIDs) and muscle relaxants for pain and muscle spasms
    • Alpha-blocker medications to relax the muscles that control the bladder and relieve symptoms of urgency, hesitancy or dribbling
    • Antibiotics (for chronic and acute bacterial prostatitis)

 

Heat application

    • Baths, heating pads and hot water bottles

 

Acupuncture

    • The insertion of very fine needles to alleviate pain in strategic points

 

Biofeedback

    • Designed to ease pressure and reduce pelvic floor tension

 

Diet Modification

    • Cutting out caffeine, alcohol, carbonated beverages and spicy/acidic foods may reduce irritation of the bladder and prostate
CHRONIC URINARY RETENTION
About
  • When the bladder does not empty properly
Potential Causes
  • Obstruction in the urinary tract
  • Enlarged prostate gland can press on the urethra (in men)
  • Cystocele: A bladder that sags (in women)
  • Rectocele: Rectum that sags into the back wall of the vagina (in women)
  • Drugs including antihistamines, antispasmodics, anticholinergics and tricyclic antidepressants that can change the way the bladder muscle works
  • Urethral stricture
  • Urinary stones
  • Catheter use
  • Nerve problems that interfere with signals from the brain to the bladder
  • Nerves can be damaged from vaginal childbirth, spinal cord injuries/infections, diabetes, stroke, multiple sclerosis, pelvic injury/trauma and benign prostatic hyperplasia
  • If the bladder tries to release but cannot due to weak pelvic floor muscles or the sphincter not relaxing at the right time
Symptoms
    • A struggle to start the flow of urine
    • Weak flow
    • Feeling the need to go, but cannot start
    • Feeling the need to urinate right after you’ve gone
Diagnosis

Medical history

      • To address past and current health issues and over-the-counter and prescription drugs being taken

 

Physical exam

      • Of the lower abdomen (for men and women) and prostate check (for men)

 

Urinalysis

      • To test for infection/blood/abnormalities

 

Bladder ultrasound

      • To show how much urine is still in the bladder post-urination

 

Cystoscopy

      • To look at the lining of your urethra and bladder to check for urethral stricture, a blockage caused by a stone, an enlarged prostate or a tumour

 

CT scan

      • Can help find stones or anything else blocking the flow of urine

 

Catheter tests

      • Can determine urine flow rate and how well the bladder empties

 

Prostate-specific Antigen (PSA) blood test:

      • To screen for prostate cancer

 

Electromyography (EMG):

      • Uses sensors to measure electrical activity of muscles and nerves in and near the bladder and urethral sphincter
Treatment

Enlarged Prostate

    • Oral Medications
      • Alpha-blockers and 5-alpha reductase inhibitors to help shrink the prostate
    • Laser therapy
      • To break up the blockage
    • Surgery
      • Transurethral resection of the prostate to remove a section of the prostate

 

Cystocele/Rectocele

    • Pelvic Physiotherapy
      • To strengthen the pelvic floor muscles
    • Vaginal Pessary
      • Insertion of vaginal pessary (ring) to support the bladder
    • Estrogen Therapy
      • For post-menopausal women
    • Surgery
      • To lift the sagging bladder/rectum

 

Urethral Stricture

    • Using catheters and balloons to open the urethra
    • Stent
      • Can prop open a closed urethra (in men)
    • Surgery
      • Using a knife/laser to make a cut to open the stricture

 

Nerve-related

    • Self-catheterization
Fowler's Syndrome
About
  • Caused by spasms of the external urethral sphincter (a band of muscle that opens and closes at the exit of the bladder)
  • Affects young women (under the age of 30), leading to urinary retention
Potential Causes
  • Unknown 
  • Often seen in women who have had a surgical procedure, childbirth, opiate exposure or an infection/illness
Symptoms
    • Inability to urinate
    • Inability to feel that the bladder is full
    • Abnormality of the urethra 
    • Dysuria (painful/difficult urination)
    • Stomach pain
    • Polycystic ovaries
    • EMG abnormality
Diagnosis
    • Rule out more common causes of urinary retention
    • Determine how much urine the bladder can hold 
    • Concentric Needle Electromyography (EMG)
      • Will often show a characteristic abnormality
Treatment

Sacral Neuromodulation (SNM) Therapy

      • A device is implanted in the body to help stimulate the nerves to the bladder
INTERSTITIAL CYSTITIS (IC)/BLADDER PAIN SYNDROME (BPS)
About
  • A chronic bladder condition with lower urinary tract symptoms lasting over 6 wks with no diagnosis of infection or other clear cause
  • Two types
    • Hunner’s Ulcers
      • Distinctive areas of inflammation on the bladder wall that characterize the classic form of IC
      • 5-10% of IC patients
    • Non-Ulcerative
      • Pinpoint hemorrhages, also known as glomerulations, in the bladder wall
      • Also referred to as Bladder Pain Syndrome
      • 90% of IC patients
  • Difficult to estimate the number of people affected as a result of there being no standard diagnostic protocol
  • Typically 2-3x more common in women than in men
  • Risk increases with age
Potential Causes
  • What causes IC/BPS is not exactly known, but there are many theories including:
    • A defect in the bladder tissue, which may allow irritating substances in the urine to penetrate the bladder
    • A specific type of inflammatory cell, called a mast cell. This cell releases histamine and other chemicals that lead to IC symptoms
    • An agent in the urine that causes damage to the bladder
    • Changes in the nerves that carry bladder sensations so pain is caused by events that are not normally painful (ie: bladder filling)
    • The immune system attacks the bladder
  •  
Symptoms
    • Vary for each patient and range from mild to severe
    • Suprapubic/pelvic pain that may worsen as the bladder fills, be constant or may come and go
      • Can be felt in other areas including the urethra, lower abdomen, lower back,
        pelvic/perineal area, vulva/vagina (in women) and scrotum/testicles/penis (in men)
      • Pressure/discomfort when the bladder is filling
      • Urinary frequency often of small amounts, upwards of 60x a day
        • Average number of times a person urinates per day: 7
      • Persistent urinary urgency that can be triggered by
        • Certain foods/beverages
        • Physical/mental stress
        • Menstrual cycle
        • Sexual intercourse
Diagnosis

Medical history to

    • Address symptoms
    • Past and current health problems
    • Over-the-counter and prescription drugs being taken
    • Diet and liquid consumption

 

Tests

    • Baseline Pain Evaluation
      • Series of questionnaires to determine your baseline pain value with the goal of finding pain location(s), intensity and characteristics and identifying factors that make pain/discomfort better or worse
    • Voiding Diary
      • To evaluate your voiding patterns 
    • Urodynamic Evaluation
      • The bladder is filled with water through a catheter to measure bladder pressures as it fills and empties
      • IC patients have a low capacity and potential pain with filling
    • Cystoscopy
      • Bladder is looked at through a cystoscope and often the bladder will be filled with water to see how much it can hold
      • If Hunner’s ulcers are seen (distinctive areas of inflammation on the bladder wall), the diagnosis is fairly certain
Treatment

All IC patients respond differently so trial and error needs to be carried out in order to determine what will work best for you

Diet

    • Certain foods can worsen symptoms
    • Bladder irritants for most: Alcohol, caffeine, artificial sweeteners, carbonated beverages, chocolate, citrus fruits, tomatoes and spicy food (See Diet section for a more extensive list)
    • Determining which foods irritate your bladder can be discovered through an elimination diet
      • Stop eating all foods that could irritate your bladder. After 1-2 weeks, introduce 1 food back into your diet. Continue bringing foods back into your diet one at a time so you know if that food is an irritant or not

 

Physical Activity

    • Walking and gentle stretching

 

Stress Reduction

    • Learning stress reduction methods including mindfulness meditation and restorative yoga can be helpful, as stress is a major flare trigger

 

Pelvic Physiotherapy

    • To reduce tenderness/pain/spasms in the pelvic floor area through exercise and massage
    • The Canadian Urological Association (CUA) recommends that everyone diagnosed with IC has a pelvic floor exam, looking for trigger points
    • Studies show that 79% of people with IC/BPS have trigger points in the pelvic floor
    • Up to 83% of patients who see a pelvic floor physiotherapist have their symptoms improved/resolved

 

Bladder Retraining

    • Helping you begin to hold more urine for longer periods of time by gradually increasing the time between each visit to the bathroom
    • Track the number of times and how often you have the urge to urinate 
    • Use the diary to gradually increase the length of time between bathroom breaks

 

Medications (Oral & Intravesical)

    • Pentosan polysulfate sodium (Elmiron)
      • Used for treating the pain of IC
      • It could take up to 6 months before any improvement is noticed
      • Ophthalmic screening is advised for any patient who has taken Elmiron with any vision complaints for evidence of this maculopathy
    • Heartburn medications
      • To reduce the amount of acid made by the body
    • Muscle relaxants
      • Can help relieve the symptoms by keeping the bladder from squeezing at the wrong time
    • Antihistamines
      • Decrease the amount of histamine in the bladder that leads to pain and other symptoms
    • Tricyclic antidepressants
      • Amitriptyline/nortriptyline have been shown to decrease bladder spasms and slow the nerves that carry pain messaging
    • Bladder Instillations:
      • The bladder is filled with liquid medication including Dimethyl Sulfoxide (DMSO) and Heparin, through a catheter
      • DMSO may block swelling, decrease pain sensation and remove free radical toxins that can cause tissue damage
      • Combined with Heparin/steroids to decrease inflammation

 

Bladder Stretching/Hydrodistension

    • The bladder is filled with sterile water in order to distend it and increase the amount of urine it can hold

 

Neuromodulation Therapy

    • Delivers harmless electrical impulses to nerves to change how they work
    • More effective for urgency/frequency reduction, but can sometimes help with the bladder/suprapubic pain

 

Sacral Neuromodulation (SNS)

      • Changes how the sacral nerve works (the nerve that carries signals between the spinal cord and the bladder)
      • Electrical wire is implanted under the skin in the lower back
      • It’s first connected to a handheld pacemaker to send pulses to the sacral nerve
      • If it helps, a permanent pacemaker that can regulate the nerve rhythm is implanted

 

Cauterization/Steroid Injections

      • May provide long-term relief for those with Hunner’s ulcers for up to a year or more

 

Injections

      • To relieve pain, botulism is injected through a catheter to paralyze the bladder muscle
      • These often need to be repeated every 6-9 months

 

Cyclosporine

      • Immunosuppressant therapy reserved for severe cases only

 

Surgery

      • Bladder/parts of the bladder are removed
      • Reserved for patients with severely limited bladder capacity or severe symptoms that have not responded to other treatments
  •  
orchialgia
About
    • Chronic testicular pain lasting more than 3 months
    • Can come on suddenly/gradually
Potential Causes
    • Spontaneous
    • As a result of an infection (UTI/STI)
    • Trauma
    • Inflammation
    • Surgery
Symptoms
    • Pain originating from the scrotum
Diagnosis
    • Physical exam
    • STI screening (if applicable)
    • Urine sample
    • Ultrasound to rule out other pathology
Treatment

Heat application

      • Warm baths, heating pads, hot water bottles

 

Oral medications

      • Anti-inflammatories

 

Wearing tight-fitting underwear

Avoiding heavy lifting

Pelvic physiotherapy

      • If pain is due to muscle spasming

 

Temporary spermatic cord block

      • Local anesthetic is injected into the spermatic cord (the structure carrying the vas, nerves, blood vessels and lymphatics to the testicle)

 

Surgery

      • Microsurgical Cord Denervation if the temporary cord block is successful
        • The cord is exposed and the nerve containing structures are cut while the blood and lymphatic supply are maintained
        • Provides long-term pain relief in over 70% of patients who have
          • Chronic pain lasting more than 3 months
          • Failed other medical interventions and therapies
          • Received temporary relief with a cord block
OVERACTIVE BLADDER (OAB)
About
  • Name for a group of urinary symptoms
  • Sudden, uncontrolled need or urge to urinate
  • The need to pass urine many times during the day and night
  • Can result if the nerve signals between your bladder and brain are not working properly so that your bladder muscle contracts before it’s full
  • You are more susceptible to OAB if
    • You live a sedentary lifestyle and are overweight
    • You do not manage chronic conditions such as diabetes
    • You live with a neurologic condition ie: Multiple Sclerosis, have suffered a stroke
    • You have a hypotonic (weak) pelvic floor
Potential Causes
    • Neurologic disorders/damage to the signals between your brain and bladder
    • Hormone changes
    • Pelvic muscle weakness/spasms
    • A urinary tract infection (UTI)
    • Side effects from a medication
Symptoms
    • Urgency
      • A sudden, strong urge to urinate that cannot be ignored
    • Urge Incontinence
      • The loss of bladder control
    • Frequency
      • Having to urinate over 8 times/day
    • Nocturia
      • Waking more than once a night to urinate
Diagnosis

Medical History to address

    • Past and current health issues
    • Over-the-counter and prescription drugs being taken
    • Diet and liquid consumption

 

Bladder Diary 

    • Over a few weeks, record
      • When and how much fluid you drink
      • When and how much you urinate
      • How often you have that “gotta go” urgency feeling
      • When and how much urine you may leak

 

Tests

    • Urinalysis
      • To check for infection/blood/other abnormalities
    • Bladder scan
      • To show how much urine is still in the bladder after you urinate
    • Cystoscopy
      • To look at the bladder through a cystoscope to rule out other conditions
Treatment

Diet

    • Limit foods and drinks that irritate the bladder including caffeine, carbonated beverages, alcohol, spicy and acidic foods

 

Bladder diary

    • To help you find patterns ie: bothersome foods, liquid consumption

 

Double voiding

    • After you think you’ve finished emptying your bladder, try again

 

Delayed voiding

    • Try to hold off when you have to urinate if the urgency is not severe

 

Timed urination

    • Urinate only at set times during the day
    • The goal is to prevent that urgent feeling and to regain control

 

Bladder muscle relaxation exercises

    • Kegels: To strengthen the pelvic floor
    • Quick Flicks: Squeeze and relax your pelvic floor muscles over and over again
    • Biofeedback: Computer graphs and sounds to monitor muscle movement help teach you how your pelvic muscles move and how strong they are

 

Prescription drugs (Oral & Intravesical)

    • Antimuscarinics & Beta-3 Adrenoceptor Agonists
      • Can relax the bladder and increase the amount of urine your bladder can hold and empty
    • Botox
      • Relaxes the muscle of the bladder wall to reduce urgency and urge incontinence
      • Effects can last up to 6 months

 

Neuromodulation therapy

    • Electrical pulses are sent to nerves that share the same path for the bladder
    • Help the brain and the nerves to the bladder communicate so the bladder can function properly

 

Percutaneous Tibial Nerve Stimulation (PTNS)

    • Small electrode is placed near your ankle and pulses are sent to the tibial nerve to help control the signals that aren’t working right
    • 12 treatments are usually required

 

Sacral Neuromodulation (SNS)

    • Changes how the sacral nerve works (the nerve that carries signals between the spinal cord and the bladder)
    • Electrical wire is implanted under the skin in the lower back
    • It’s first connected to a handheld pacemaker to send pulses to the sacral nerve
    • If it helps, a permanent pacemaker that can regulate the nerve rhythm is implanted

 

Bladder Reconstruction/Urinary Diversion Surgery

    • Used only in rare and severe cases
    • Augmentation Cystoplasty
        • Enlarges the bladder
    • Urinary Diversion
        • Reroutes the flow of urine
RECURRENT URINARY TRACT INFECTIONS (UTIS)
About

Urinary Tract Infection (UTI)

    • Bacterial infection of the urinary system causing an inflammatory response
    • Can affect any part of your urinary system: Bladder, kidneys, urethra and/or ureters
    • Usual Uropathogens
      • Escherichia coli, Staphylococcus saprophyticus, Klebsiella pneumoniae and Proteus mirabilis
    • A threshold of 3 UTIs in 12 months is used to signify recurrent UTI

 

The Pathogenesis of Recurrent UTI

    • Involves bacterial reinfection/bacterial persistence, with the former being much more common
    • Reinfection
      • Recurrence with the same organism in more than 2 weeks after treatment, a different organism or a sterile intervening culture
    • Bacterial Persistence
        • The same bacteria may be cultured in the urine 2 weeks after initiating sensitivity-adjusted therapy
Potential Causes

More prevalent in women

      • Urethra is closer to the rectum
      • Urethra is shorter
      • Diaphragm use
      • The use of products that can change the bacterial makeup of the vagina ie: spermicides, vaginal douches
      • Menopause due to hormonal changes resulting in modified vaginal bacteria
      • Invasion of E.Coli bacteria into the urinary tract as a result of:
        • Improper wiping
        • Toilet water backsplash
        • Sexual intercourse

 

In men

      • Enlarged prostate
        • The bladder does not empty completely, enabling bacteria to grow more easily

 

Neurogenic bladder

      • More prone to recurrent UTIs, as a result of issues with bladder muscle function (urinary retention)
          •  
  •  
  •  
Symptoms
    • Frequent urination
    • A burning sensation while urinating
    • Bloody/dark urine
    • Pain in your bladder/kidney regions
Diagnosis

Urine culture

    • To determine which bacteria are present

 

Cystoscopy

    • To look inside the urethra and bladder to see if there are any abnormalities/issues that could cause the UTI to keep coming back
Treatment

Antibiotics

    • For a week followed by long term, low-dose antibiotics after the initial symptoms subside
    • Post-intercourse
    • When on antibiotics, be sure to take probiotics to replenish good bacteria in your system

 

Estrogen therapy

    • For menopausal women

 

Water

    • Drink lots to dilute your urine and help flush out bacteria

 

Heat application

    • Use a heating pad/hot water bottle on your bladder
  •  
Urethral Stricture Disease
About
    • When a scar from swelling, injury or infection blocks/slows the flow of urine in the urethra
    • Can be painful for some
    • Men are more susceptible, as a result of having longer urethras than women
  •  

2 Types
Posterior

    • Happens in the first 1-2” of the urethra
    • Due to an injury from a pelvic fractur
    • Urethra is disrupted and completely cut/separated
    • Urine cannot pass
    •  

Anterior

    • Happens in the first 9-10” of the urethra
    • Due to trauma from a straddle injury, direct trauma to the penis or from urinary catheterization
Causes
    • Trauma to the urethra from a fall
    • Infection
    • Damage from surgical tools
    • Conditions that cause swelling
    • Urinary catheterization
    • Prostate surgery
    • Kidney stone removal
Symptoms
    • Decreased urine stream
    • Incomplete emptying of the bladder
    • Urine stream spraying
    • Straining or pain when urinating
    • Urinary frequency
    • Urinary urgency
    • UTIs in men
Diagnosis

Physical exam

 

Tests

Urethral imaging

    • X-rays/ultrasound

Urethroscopy

    • To see the inside of the urethra

Retrograde Urethrogram

    • Uses x-ray images to check for a structural problem/injury of the urethra as well as the length and location of the stricture along the urethra
Treatment

*Dependent on the size of the blockage and how much scar tissue there is

Dilation

      • Enlarging the stricture with gradual stretching

 

Urethrotomy

      • Cutting the stricture with a laser/knife through a scope

 

Urethroplasty

      • Surgically removing the narrowed section of the urethra/enlarging it
      • The procedure might also involve reconstruction of the surrounding tissues through the use of skin/mouth grafts
  •  
URETHRAL SYNDROME
About
    • Condition that affects the urethra (the tube that carries urine from the bladder to outside the body)
    • Inflamed/irritated urethra
    • Most common in women
Potential Causes
    • Physical problems with the urethra such as abnormal narrowing, urethral irritation or injury
    • The urethra can be irritated by:
      • Scented products (perfumes, soaps, bubble bath and sanitary napkins)
      • Spermicidal jellies
      • Certain foods and drinks containing caffeine
      • Chemotherapy and radiation
    • The urethra can be injured by:
      • Sexual activity
      • Diaphragm use
      • Tampon use
      • Bike riding
    • Increased risk of developing urethral syndrome if you:
      • Are prone to bacterial bladder/kidney infections
      • Take certain medications
      • Have sex without a condom
      • Have an STI
Symptoms
    • Pain with urination
    • Lower abdominal pain/pressure
    • Urinary urgency
    • Urinary frequency
    • Urinary difficulty
    • Pain during sex
    • Blood in the urine
    • Bladder not feeling empty after urinating
    • Swelling of the testicles (men)
    • Pain while ejaculating (men)
    • Blood in the semen/urine (men)
    • Discomfort in the vulvar area (women)
Diagnosis
    • Medical history review and symptom evaluation
    • Physical exam including the genitals, abdomen and rectum
    • Urine sample
      • To rule out bacterial infection
    • Urethroscopy
      • To see the inside of the urethra
    • Pelvic ultrasound
Treatment

Lifestyle changes

    • Refrain from using products, eating/drinking food and beverages or doing activities that can irritate the urethra

 

Medications

    • Anesthetics: Phenazopyridine, Lidocaine 
    • Antispasmodics: Hyoscyamine, Oxybutynin
    • Tricyclic Antidepressants: Amitriptyline, Nortriptyline
      • Act on your nerves to help relieve chronic pain
    • Alpha-blockers: Doxazosin, Prazosin
        • Improve blood flow by relaxing the muscles in your blood vessels

 

Dilation/Surgery

    • To widen your urethra if the syndrome is due to constriction
URINARY INCONTINENCE
About
    • Uncontrolled leaking of urine
    • Affects 1 in 4 women and 1 in 9 men in Canada
    • Only 1 in 12 will seek treatment

5 Types

1. Stress Urinary Incontinence (SUI)

    • Most common, especially in older women
    • Happens when the pelvic floor muscles stretch
  •  

2. Overactive Bladder (OAB)

    • Urgency incontinence
    • Urinary frequency
  •  

3. Mixed Incontinence (SUI & OAB)

    • Leak urine with activity (SUI) and often feel the urge to urinate (OAB)

 

4. Urge Incontinence

    • The sudden loss of bladder control secondary to a strong and overwhelming urge to go to the bathroom
    • There can be a small amount of urine loss or complete emptying of the bladder
  •  

5. Overflow Incontinence

    • Most common in men with prostate issues
    • The body makes more urine than the bladder can hold or the bladder is full and cannot empty thereby causing leakage
    • In addition, there may be something blocking the flow or the bladder muscle may not contract as it should
Potential Causes
  • Aging
  • Pregnancy, childbirth and number of children
  • Post-menopause potentially due to the drop in estrogen in women
  • Prostate problems
  • Some medications
  • Neurological diseases
  • Increased risk for those who smoke, are obese, have high blood pressure and/or diabetes
Symptoms

SUI

    • Leaking when you are physically active

 

OAB

    • Needing to urinate more than normal
    • Urinary urgency that sometimes cannot be controlled
    • May/may not cause your bladder to leak urine
    • Nocturia (nighttime urination)

 

Mixed SUI & OAB

    • Leaking AND a sudden strong urge to urinate

 

Overflow Incontinence

    • Frequent, small urinations and constant dribbling
Diagnosis

Medical history to address

    • Past and current health issues
    • Over-the-counter and prescription drugs being taken
    • Diet and liquid consumption

 

The Three Incontinence Questions Tool

    • Asks if, when and how often urine leakage is experienced
    • Can help categorize the type of urinary incontinence

 

Three-day Voiding Diary

    • Used as part of the initial assessment for urinary incontinence symptoms
    • Record
      • When and how much fluid you drink
      • When and how much you urinate
      • How often you have that “gotta go” urgency feeling
      • When and how much urine you may leak
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Cough Stress Test

    • Most reliable clinical assessment for confirming SUI

 

Urodynamic Testing

    • To determine how well the bladder, sphincters and urethra hold and release

 

Postvoid Residual Urine Measurement

    • You’re asked to urinate (void) into a container that measures urine output
    • The amount of leftover urine in your bladder is checked using a catheter/ultrasound
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Treatment

Indwelling Catheters

    • Flexible tube placed in your bladder all day and night. A balloon holds the tube in your bladder and drains urine into an external bag

 

Intermittent Catheterization

    • Catheter is inserted into the urethra 3-5x/day. Once the bladder is empty, you remove the catheter

 

Urethral Insert

    • Inserted into the distal portion of the male urethra, inhibiting the flow of urine. Can be removed before urination and reinserted after urination

 

Absorbent Products

    • Pads, adult diapers, protective underwear, guards and drip collection pouches for men

 

Toilet Substitutes

    • Commode seats, bedside commodes, urinals (plastic jug-type devices)