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Your urinary tract includes the organs that collect and store urine and release it from your body. These organs include the kidneys, which remove liquid waste from the blood in the form of urine, keep a balance of salts and other substances in the blood, and produce a hormone that helps form red blood cells. It also includes the ureters or narrow tubes that carry urine from the kidneys to the bladder, the triangle-shaped chamber in the lower abdomen that stores urine; and the urethra, a tube that carries the urine as it leaves the body. (See the diagram on the next page.)
A urinary tract infection (UTI) is an infection anywhere in the urinary tract. Normal urine is sterile. It contains fluids, salts, and waste products, but it is free of bacteria, viruses, and fungi. An infection occurs when microorganisms, usually bacteria from the digestive tract, cling to the urethra, or opening to the urinary tract, and begin to multiply.
Most infections are caused by one type of bacteria, Escherichia coli (E. coli), which normally live in the colon. In most cases, bacteria first begin growing in the urethra and often move on to the bladder, causing a bladder infection or cystitis. If an infection is not treated quickly, bacteria could then travel up the ureters to infect the kidneys. This serious condition is called pyelonephritis.
Microorganisms called chlamydia and mycoplasma can also cause UTIs in both women and men. These infections usually occur in the urethra and reproductive system (the uterus, or womb, and the ovaries and fallopian tubes). Unlike E. coli, chlamydia and mycoplasma can be sexually transmitted, and both partners should be treated for the infection.
Some women have a long-lasting condition called interstitial cystitis, also known as painful bladder syndrome or frequency-urgency-dysuria syndrome. With this condition, the wall of the bladder becomes inflamed or irritated, which affects the amount of urine the bladder can hold. Interstitial cystitis can cause scarring, stiffening, and bleeding in the bladder. This complex condition is different from a UTI, and scientists do not know what causes it.
Not everyone with a UTI has symptoms, but most people get at least some signs. They can range from slightly irritating to very painful. Symptoms include a frequent urge to urinate, but only passing a small amount of urine and a burning sensation, pressure, or pain in the area of the bladder or when urinating. The urine itself may look milky or cloudy, even reddish if blood is present. It is not unusual to feel tired, shaky or washed out. Often, women feel an uncomfortable pressure above the pubic bone, and some men feel fullness in the rectum. A fever may mean the infection has reached the kidneys. Other symptoms of a kidney infection include pain in your back or your side below the ribs, nausea or vomiting, and chills. It is very important to see your health care provider at the first sign of pain, irritation, or blood when you urinate or if you have discomfort in or near your abdomen, back, or sides. An untreated UTI can lead to a kidney infection. An untreated or recurrent kidney infection can lead to scarring of the kidneys and permanent kidney damage.
Image Source: National Kidney and Urologic Diseases Information Clearinghouse
Some people are more likely to get a UTI than others, but about one of every five women will develop a UTI in her lifetime. Women have more UTIs than men do. It may be because women's urethra is relatively short, which allows bacteria quick access to the bladder. It may also be because a women's urethral opening is near sources of bacteria from the anus and vagina.
For many women, sexual intercourse seems to trigger an infection. According to several studies, women who use a diaphragm are more likely to develop a UTI than women who use other forms of birth control. Recently, researchers found that women whose partners use a condom with a spermicidal foam tend to have growth of E. coli bacteria in their vagina. Unlubricated condoms or condoms with a spermicidal foam increase irritation and help bacteria cause symptoms of a UTI. Other options include using lubricated condoms without spermicide or a nonspermicidal lubricant.
Women are at a higher risk for UTIs after they experience menopause. The walls of the urinary tract become thinner after menopause, which weakens their mucous linings. The mucous linings are then less able to resist bacteria. The muscles of the bladder also become less elastic (or cannot stretch the way they used to) and the bladder may not empty completely. This can contribute to a UTI.
Any abnormality of the urinary tract that blocks the flow of urine (a kidney stone, for example) makes an infection more likely. A common source of infection is catheters, or tubes placed in the bladder to help people who are unconscious or critically ill to urinate. Bacteria on the catheter can infect the bladder, so hospital staff take special care to keep the catheter sterile and to remove it as soon as possible. People with diabetes also have a higher risk of a UTI because of changes in the immune system. Any disorder that suppresses the immune system, like diabetes, raises the risk of a UTI.
Pregnant women do not seem more likely to get UTIs than other women. However, when a UTI does occur in pregnant women, it more likely to travel to the kidneys. Scientists think that hormonal changes and shifts in the position of the urinary tract during pregnancy make it easier for bacteria to travel up the ureters to the kidneys. For this reason, many health care providers test a pregnant woman's urine during her routine visits. If you have symptoms of a UTI while you are pregnant, visit your health care provider right away because the infection could cause premature delivery of your baby and other risks such as high blood pressure.
To find out whether you have a UTI, your health care provider will test a sample of urine for pus and bacteria. You will be asked to give a "clean catch" urine sample by washing the genital area and collecting a "midstream" sample of urine in a sterile container. (This method of collecting urine helps prevent bacteria around the genital area from getting into the sample and confusing the test results.) The urine sample is then sent to the laboratory to be examined for white and red blood cells and bacteria. Then the bacteria are allowed to multiply in a culture. After the bacteria grow, it is tested against different antibiotics to see which drug best destroys the bacteria. This last step is called a sensitivity test. Although your health care provider may begin treatment before the bacterial cultures are back from the lab, the cultures will confirm the diagnosis and may cause a change in the antibiotic your health care provider chooses for you.
If the UTI doesn't clear up with treatment, or if you have had several bladder infections, you may need a test called a cystoscopy. A flexible tube with a light and camera is inserted into the bladder to remove samples of urine and tissue. Your health care provider might order other tests that produce pictures, or images, of the urinary tract, such as the intravenous pyelogram (IVP). This test provides x-ray images of the bladder, kidneys, and ureters. Another imaging test you might need is an ultrasound exam, which gives pictures from the echo patterns of sound waves bounced back from internal organs.
One test allows women with frequent infections to test their first-morning urine sample by themselves. Dipsticks (a type of testing paper that looks like a stick, which you can dip into a sample of your urine) that change color when an infection is present are now available in drug stores without a prescription.
UTIs are treated with antibiotics (a medicine that kills bacteria), usually for seven to ten days. For some infections, however, you may only need a single dose of an antibiotic. The choice of antibiotic and length of treatment depend on your health history and the type of bacteria causing the infection. The antibiotic drugs most often used to treat UTIs are
Other antibiotics are sometimes used as well, including ofloxacin (Floxin), norfloxacin (Noroxin), ciprofloxacin (Cipro), and trovafloxin (Trovan). Some antibiotics are not safe to take during pregnancy. Talk with your health care provider about the risks and benefits of taking the different medications.
Getting proper treatment will prevent your urinary tract problems from getting worse and affecting other parts of your body. You can help prevent kidney infections by seeing your health care provider as soon as you have symptoms of a UTI. If you are in pain, ask your health care provider to prescribe a pain reliever since various drugs are available. A heating pad may also help.
Most healthy women do not get repeat infections. However, women who have had three UTIs are likely to continue having them. Four out of five of these women get another UTI within 18 months of the last UTI. Many women have them even more often. If you have frequent infections (three or more a year), ask your health care provider about one of the following treatment options:
Drink plenty of water every day to help flush bacteria out of your system. Some health care providers suggest drinking cranberry juice or taking Vitamin C (ascorbic acid) supplements, which keep the number of bacteria in your system down. Cleanse the area around the rectum and vagina each day. Urinate when you feel the need (or about every two to three hours, and before and after sex). Wipe the genital area from front to back to prevent bacteria from entering the vagina or urethra. It also helps to take showers instead of baths; avoid irritating douches and feminine hygiene sprays; and wear panties with a cotton crotch, which absorbs moisture. Some women say drinking a lot of water after sexual activity helps to prevent new infections.
Interstitial cystitis (IC) is a chronic bladder condition that can cause pain and other symptoms. People with IC have an inflamed or irritated bladder wall. This inflammation can lead to:
No one knows what causes interstitial cystitis. Because IC varies so much in symptoms and severity, most researchers believe that it may actually be several diseases. One theory being studied is that IC is an autoimmune response following a bladder infection. Another theory is that there are substances in urine which are irritating to people with IC. Other theories are also being studied. Interstitial cystitis is different from urinary tract infections, which are caused by bacteria and can be treated with antibiotics. Studies have shown that antibiotics are not useful for treating IC.
The symptoms of IC vary from person to person and even in the same person. People with IC may experience mild discomfort, pressure, tenderness, or intense pain in the bladder and surrounding pelvic area. Symptoms may include an urgent need to urinate (urgency), frequent need to urinate (frequency), or a combination of these symptoms. Pain may change in intensity as the bladder fills with urine or as it empties. Women's symptoms often get worse during their periods. Pain during sex is common.
Some people find that their bladders cannot hold much urine, which increases the frequency of urination. Yet some people with severe frequency have bladders that can hold a normal amount of urine. People with severe cases of IC may urinate as many as 60 times during a 24-hour period.
The first step in diagnosing IC is to rule out other conditions that may be causing the symptoms. Other possible causes of the symptoms found in IC include urinary tract or vaginal infections, bladder cancer, endometriosis, sexually transmitted diseases, and kidney stones. Various tests on the patient's urine, bladder and urinary tract may be done.
The most important test to confirm IC is a cystoscopy done under anesthesia. This test uses an instrument called a cystoscope to see inside the bladder. A liquid or gas is used to stretch the bladder. Anesthesia is required because stretching the bladder can be very painful for a person with IC. This test can detect bladder wall inflammation, pinpoint bleeding or ulcers, a thick, stiff bladder wall, and maximum bladder capacity.
Diagnosis of IC is based on:
Scientists have not yet found a cure for interstitial cystitis, nor can they predict who will respond best to which treatment. Symptoms may go away for no reason or at the same time as a change in diet or treatment. Even when symptoms go away, however, they may return after days, weeks, months, or years. Scientists do not know why. Because the causes of IC are unknown, treatments are aimed at relieving symptoms.
Treatments for IC include:
Oral medicines, including pentosan polysulfate sodium (Elmiron), which the Food and Drug Administration (FDA) approved for IC treatment in 1996. (Because Elmiron has not been tested in pregnant women, it is not recommended for use during pregnancy, except in severe cases.) Other oral medicines used include aspirin and ibuprofen, stronger painkillers, antidepressants, and antihistamines.
Do artificial sweeteners make symptoms worse? There is no scientific evidence linking diet to IC, but some people believe that alcohol, tomatoes, spices, chocolate, caffeinated and citrus beverages, and high-acid foods may add to bladder irritation and inflammation. Others notice that their symptoms get worse after eating or drinking products containing artificial sweeteners. If you believe certain foods or drinks make your symptoms worse, try avoiding those products. You can reintroduce them one at a time to see which, if any, affect symptoms. It is important, however, to maintain a well-balanced and varied diet.
Researchers have little information about pregnancy and IC, but believe that the disorder does not affect fertility or the health of the fetus. Some women find that their IC symptoms improve during pregnancy, while others' symptoms worsen.
When you are not able to hold your urine until you can get to a bathroom, you have what's called urinary incontinence (also called loss of bladder control). In contrast, bladder control means you urinate only when you want to. Incontinence can often be temporary, and it is always caused by an underlying medical condition.
More than 13 million Americans experience loss of bladder control. However, women suffer from incontinence twice as often as men do. Both women and men can have trouble with bladder control from neurological (nerve) injury, birth defects, strokes, multiple sclerosis (MS), and physical problems associated with aging.
Older women have more bladder control problems than younger women do. The loss of bladder control, however, is not something that has to happen as you grow older. It can be treated and often cured, whatever your age. Don't let any embarrassment about incontinence prevent you from talking to your health care provider about your condition. Find out if you have a medical condition that needs treatment.
Bladder control means more than just telling yourself to wait to urinate until you get to the
bathroom. It is not that simple. It takes teamwork from many organs, muscles, and nerves in your body.
Most of the bladder control system is inside your pelvis, the area of your abdomen between your
hips and below the belly button. Your bladder is a muscle shaped like a balloon. When the bladder
stores urine, the bladder muscle relaxes. When you urinate, the bladder muscle tightens to squeeze
urine out of the bladder.
More muscles help with bladder control. Two sphincter muscles surround the tube that carries urine from your bladder down to an opening in the front of the vagina. The tube is called the urethra. Urine leaves your body through this tube. The sphincter muscles keep the urethra closed by squeezing like rubber bands.
Pelvic floor muscles support the uterus, or womb, and rectum and bladder. They also help keep the urethra closed. When the bladder is full, nerves in your bladder signal the brain. That's when you get the urge to urinate. Once you reach the toilet, your brain sends a message down to the sphincter muscles and the pelvic floor muscles. The brain tells them to relax. The brain also tells the bladder muscles to tighten up to squeeze urine out of the bladder. Loss of bladder control in women most often happens because of problems with the muscles that help to hold or release urine: the bladder muscle, the sphincter muscles, and the pelvic floor muscles. Incontinence occurs if your bladder muscles suddenly contract (or squeeze) or if the muscles around the urethra suddenly relax.
Yes, there are different types of incontinence. They include:
Yes. During pregnancy, the added weight and pressure of the unborn baby can weaken pelvic floor muscles, which affects your ability to control your bladder. Sometimes the position of your bladder and urethra can change because of the position of the baby, which can cause problems. Vaginal delivery and an episiotomy (the cut in the muscle that makes it easier for the baby to come out) can weaken bladder control muscles. And, pregnancy and childbirth can cause damage to bladder control nerves.
After delivery, the problem of urinary incontinence often goes away by itself. But if you are still having problems 6 weeks after delivery, talk to your health care provider. Bladder control problems don't always show up right after childbirth. Some women do not have problems with incontinence until they reach their 40's.
Menopause (when your periods stop completely) can cause bladder control problems for some women. During menopause, the amount of the female hormone estrogen in your body starts decreasing. The lack of estrogen causes the bladder control muscles to weaken. Estrogen controls how your body matures, your monthly periods, and body changes during pregnancy and breastfeeding. Estrogen also helps keep the lining of the bladder and urethra plump and healthy.
Talk with your health care provider about whether taking estrogen to prevent further bladder control problems is best for you. Tell him or her if you or your family has a history of cancer. If you face a high risk of breast cancer or uterine cancer, your health care provider may not prescribe estrogen for you.
If you are having a problem with incontinence, the first step is to see your health care provider. She or he can refer you to a urologist, a doctor who specializes in treating the urinary tract. Some urologists further specialize in the female urinary tract. Gynecologists and obstetricians specialize in the female reproductive tract and childbirth. A urogynecologist focuses on urological problems in women. Family practitioners and internists treat patients for all kinds of complaints. Any of these doctors may be able to help you.
To diagnose the problem, your health care provider will first ask you about your symptoms and for a complete medical history. Your provider should ask you about your overall health, any problems you are having, medications you are taking, surgeries you have had, pregnancy history, and past illnesses. You will also be asked about your bladder habits: how often you empty your bladder, how and when you leak urine, or when you have accidents.
Your provider will then do a physical exam to look for signs of any medical conditions that can cause incontinence, such as tumors that block the urinary tract, impacted stool, and poor reflexes that may be nerve-related. A test may be done to figure out how much your bladder can hold and how well your bladder muscles function. For this test, you will be asked to drink plenty of fluids and urinate into a measuring pan, after which your provider will measure any urine that remains in the bladder. Your provider may also recommend other tests, including the :
You may be asked to keep a diary for a day or a week in order to record when you empty your bladder. This diary should include the times you urinate and the amounts of urine you produce. To measure your urine, you can use a special pan that fits over the toilet rim. These pans are available at drug stores or surgical supply stores.
There are a number of ways to treat incontinence. Your health care provider will work with you to figure out which way(s) is best for you. Don't give up or be embarrassed! Remember, many women have incontinence and all types of incontinence can be treated, no matter what your age.
Treatments include:
Organs or tissues from one human being (the donor) are put into another person's body (the recipient).
In recent years, the science of organ transplantation has made great strides. Unfortunately, the process of securing and allocating organs has not matched this progress. There still is a critical shortage of organs. Here are some statistics:
Experts suggest that each of us could save or help as many as 50 people by being an organ donor.
If you are 18 years or older, you can show you want to be an organ donor by signing a donor card or telling your family members. If you are under age 18, you must have a parent's or guardian's consent. There are no age limits on who can donate.
No. The donor's family neither pays for, nor receives payment for, organ and tissue donation. The transplant recipient's health insurance policy (or Medicare or Medicaid) usually covers the cost of transplant.
No. A transplant team does not become involved with the patient until doctors have determined that all possible efforts to save the patient's life have failed.
No. Donation does not change the appearance of the body. Organs are removed surgically in a routine operation. It does not interfere with having a funeral, including open casket services.
The United Network for Organ Sharing (UNOS) maintains the national Organ Procurement and Transplantation Network (OPTN). Through the UNOS Organ Center, organ donors are matched to waiting recipients 24 hours a day, 365 days a year.
Every transplant hospital in the U.S. is a member of UNOS. You can use the UNOS member directory at www.unos.org/members/search.asp to find a transplant hospital, organ procurement organization, or histocompatibility (tissue) lab.
Minority women suffer more from diseases like diabetes, kidney disease, and high blood pressure diseases that can lead to organ failure. Finding organ donors can be challenging for minority women. Members of different racial and ethnic groups are usually more genetically similar and more likely to find organ donors within their own ethnic groups. For example, the most likely match for a kidney transplant is between a donor and patient of similar ancestry. Therefore, more donations by minority women increase the likelihood that a good match can be found.
American College of Obstetricians and Gynecologists (ACOG) Resource Center
Phone Number(s): (202) 638-5577 Resource Center
Internet Address: http://www.acog.org/
American Foundation for Urologic Disease
Phone Number(s): (800) 242-2383
Internet Address: http://www.afud.org
American Heart Association
Phone Number(s): (800) 793-2665
Internet Address: www.americanheart.org
American Kidney Fund
Phone Number(s): (800) 638-8299
Internet Address: www.akfinc.org
American Liver Foundation
Phone Number(s): (800) 465-4837
Internet Address: www.liverfoundation.org
American Lung Association
Phone Number(s): (800) 586-4872
Internet Address: www.lungusa.org
American Medical Association
Phone Number(s): (312) 464-5000
Internet Address: www.ama-assn.org
American Organ Transplant Association
Phone Number(s): (281) 261-AOTA
Internet Address:
http://aota.schipul.net/
Children's Organ Transplant Association
Phone Number(s): (800) 366-COTA
Internet Address: www.cota.org
Coalition on Donation
Phone Number(s): (888) 355-SHARE
Internet Address: http://www.shareyourlife.org
Interstitial Cystitis Association
Phone Number(s): (301) 610-5300
Internet Address: www.ichelp.org
National Association for Continence
Phone Number(s): (800) 252-3337
Internet Address: http://www.nafc.org/
National Institute of Diabetes and Digestive and Kidney Diseases
Phone Number(s): (301) 654-4415
Internet Address: www.niddk.nih.gov
National Kidney and Urologic Diseases Information Clearinghouse
Phone Number(s): (800) 891-5390
Internet Address:
http://www.niddk.nih.gov/health/kidney/nkudic.htm
National Marrow Donor Program
Phone Number(s): (800) 627-7692
Internet Address: www.marrow.org
National Minority Organ Tissue Transplant Education Program
Phone Number(s): (202) 865-4888
Internet Address: www.nationalmottep.org
Office of Minority Health, Office of the Secretary
Phone Number(s): (800) 444-6472
Internet Address: www.omhrc.gov
Simon Foundation for Continence
Phone Number(s): (800) 237-4666
Internet Address: http://www.simonfoundation.org/html/index2.htm
U.S. Department of Health and Human Services
Secretary's Organ Donation Initiative
Internet Address: www.organdonor.gov
United Network for Organ Sharing (UNOS)
Phone Number(s): (804) 330-8500
Internet Address: www.unos.org