You have lupus. Kidney disease is one of the most dangerous complications of lupus, an autoimmune condition that mostly affects young women. If you have lupus and notice blood in your urine, contact your doctor right away.
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Quick Consult
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Foul-Smelling Urine
Urine rarely smells good, but sometimes it smells especially heinous. If the smell wafting up from the bowl makes you gag, you may have a problem.
First, double-check that you haven’t just eaten any asparagus. Even small amounts can wreak quite a reek. Benjamin Franklin noticed this problem all the way back in the 1700s, commenting that “a few stems of asparagus eaten, shall give our urine a disagreeable odour.” (Of note, about half of people don’t have this problem—not because their pee doesn’t stink, but because their noses can’t detect the chemicals responsible for it.)
If you haven’t eaten asparagus and notice a foul smell, it’s possible you have a urinary tract infection. The diagnosis is even likelier if you also have the frequent need to urinate, pain with urination, and/or discoloration of your urine. Call your doctor for some antibiotics.
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You have sickle cell disease. In sickle cell disease, the red blood cells lose their normal spherical shape under certain conditions and instead look like sickles. (As a reminder, a sickle is similar to the stick that the Grim Reaper carries around—not a figure you want to be associated with.) As you might imagine, sickles don’t flow through blood vessels with the same grace as spheres. As a result, the vessels get blocked up, causing excruciating pain. One potential complication is severe damage to the kidneys, pieces of which can break off into the urine in spectacularly bloody fashion. Staying hydrated can reduce the likelihood of this complication. If you have sickle cell disease and notice bloody urine, call your doctor right away. If you can’t get a same-day appointment, go to the emergency room.
Get to the E.R.
You have spasms of severe pain in your lower pelvis and/or back. You’re probably passing a kidney stone. A little rock can form in your kidney and then get stuck in the tube that drains to the bladder. As that tube tries to squeeze the stone through, you experience spasms of intense, life-changing pain. As the stone inches its way down, it often shears a few blood vessels. Once the stone finally reaches the bladder, the pain and bleeding should slow down. (The tube that drains the bladder to the outside world, called the urethra, is usually large enough to accommodate small stones without pain.) You should get to the E.R. for an urgent assessment. The diagnosis is confirmed with a CT scan or an ultrasound. The treatment consists of pain medications and some intravenous fluids, which increase urine production to help push the stone through. If the stone really gets stuck, and the pain never gets better, you may need a procedure that uses lasers or ultrasound to break it into smaller fragments.
You just had a traumatic injury, like a car accident. Maybe you walked away from the accident, thinking you were lucky. If you’re peeing blood now, however, you probably injured your kidneys or bladder and definitely need an emergency assessment. A severe crush injury of your arm or leg can also cause muscle breakdown, releasing chemicals into the blood that cause brown discoloration of your urine.
You have fever, chills, and lightheadedness. You probably have a severe infection in your kidneys or bladder. You need to get to the E.R. for intravenous fluids and antibiotics.
Pain with Urination
Being on fire sure sounds great if you’re an athlete. It’s a lot less appealing if the fire is in your urine . . . a sensation more akin to being engulfed by actual flames.
Dysuria, or painful urination, is a very common symptom that mostly affects women. So ladies, you’ll be the focus of this chapter. (Men, if you have persistent pain with urination, you should see your doctor since you probably have an infection.)
Most of the time, dysuria is the ugly manifestation of a standard urinary tract infection, which occurs when your urine (which usually is totally sterile) becomes overgrown with bacteria, irritating the bladder and the urethra, which connects it to the outside world. Medications, skin irritants (like soap and bubble baths), and sexually transmitted diseases can also cause burning or painful urination.
So what caused your problem? An evening with Mr. Bubble or a romp with Mr. Wrong? A cleansing solution or chlamydia infection? And most important—should you chill out or call your gynecologist for some antibiotics?
Take a Chill Pill
You just did the horizontal tango. Every good movie or book has a romantic sex scene. We’ll spare you the sweet nothings, however, and skip straight to the after-sex scene. If the burning starts right after intercourse, then local irritation from friction, spermicide, and/or semen is far likelier than infection. If, on the other hand, your symptoms begin a few hours to days after intercourse, you may have developed a urinary tract infection or caught a sexually-transmitted infection.
You take a lot of bubble baths, or you scrub everywhere (and we mean, everywhere) in the shower. In case you didn’t know (and a surprising number of women don’t), urine comes out of the urethra, the small hole between the vagina and the clitoris (hopefully you know where that is). Anything that irritates the opening of the urethra can cause dysuria. That includes just about everything in your shower and bath—including shampoos, soaps, body washes, and bubble baths. Don’t freak out, though. As long as the burning goes away within a few hours and you otherwise feel fine, just try to avoid irritating the area again. You’ll be golden! (Sorry, couldn’t resist that joke.)
Make an Appointment
You have cloudy/smelly urine and need to pee more often than usual. You almost certainly have a urinary tract infection, or UTI. Most women endure at least one or two in their lifetime. In women, the anus is just a short distance from the opening of the urethra, which is itself a short skip and a hop from the bladder. As a result, the slightest bit of jostling is enough to get bacteria from point A(nus), where they belong, to point B(ladder), where they do not. Men are less likely to get UTIs because the length of the penis, even if inadequate for other purposes, is usually too great a distance for bacteria to traverse. UTIs are more common if you also have diabetes or kidney stones, or if you’re pregnant. If you think you have a UTI, see a physician within a day or two for simple urine tests to confirm the diagnosis. If you have frequent UTIs, you can lower your risk by drinking lots of fluids (to keep the urine flowing and flush out bacteria), urinating right before bed (so urine doesn’t sit in your bladder overnight and let an infection get established), and urinating right after sex (to expel any bacteria that snuck in). If you continue to get frequent UTIs, your doctor may prescribe antibiotics to take right after sex.
You have all the symptoms of infection, but your doctor swears there’s no infection. Interstitial cystitis, also called painful bladder syndrome, can mimic a urinary tract infection but without evidence of an actual infection. The underlying problem may be inflammation in the lining of your bladder. It’s not easy to treat (or diagnose, for that matter), so make sure you see a urologist for a complete evaluation.
You have vaginal itching with white discharge. Vaginal yeast infections are caused by a fungus known as candida. Infection is more likely when there is abundant sugar for the yeast to feast on (like in diabetes), or a decrease in the healthy vaginal bacteria that keep yeast in check (after taking antibiotics). Yeast infections cause pain (including with urination), itching, and a watery, whitish discharge that is often compared to cottage cheese. (Sorry if you’re eating cottage cheese while reading this book.) Fortunately, yeast infections are easily treated, usually with anti-fungal gel or a single dose of an antifungal pill. If you have frequent yeast infections, ask your doctor for extra pills to stash in your back pocket.
You have genital blisters, sores, and/or yellowish discharge. You may have a sexually transmitted infection like chlamydia, gonorrhea, or herpes. (Though the relationship may be over, the infection continues.) These
bugs irritate the urethra and vagina; in some cases, they can spread to the uterus and Fallopian tubes, causing long-term problems like infertility. Don’t just hope the problem will go away—it won’t, and will likely get worse. Your doctor can usually make the diagnosis with a simple urine test. You (and possibly your partners) will likely need antibiotics or antiviral medications.
Get to the E.R.
You also have fever, back pain, nausea, and lightheadedness. A bad bladder infection can quickly work its way up to your kidneys, leading to a condition known as pyelonephritis. From there, the infection can enter your bloodstream and put your life in serious danger. You need to get to the E.R. for urgent antibiotics, usually given through an IV.
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Should You Drink Cranberry Juice to Prevent UTIs?
If you’ve ever had a urinary tract infection, then you’ve undoubtedly heard from at least one well-intentioned friend that you should drink cranberry juice. (Maybe they’re getting a kickback from Ocean Spray.) You don’t ever want to feel that fire in your bladder again, but on the other hand, you doubt your trainer (or dentist, for that matter) would be thrilled about your refrigerator being packed with fruit juice. So should you swap out your usual water for some of the red stuff?
There’s some evidence that cranberry juice has chemicals that prevent bacteria from attaching to the cells in your bladder. Unfortunately, controlled experiments in humans have failed to show any consistent benefit, either from cranberry juice or capsules of juice extract. Plus, cranberry juice is not exactly calorie-free, and it may increase acid reflux. There’s nothing wrong with drinking cranberry juice on occasion—like any other juice—but we wouldn’t recommend stocking up for the sake of your bladder.
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Frequent Urination
It’s an unspoken rule that commenting on someone’s bathroom habits is just about as polite as asking about their weight or political views. You sure spent a long time in there—is everything ok? Is that the fourth time this afternoon? No one wants to hear that. Seriously.
But perhaps you just walked by your boss’s office for the fifth time this afternoon, and now it’s getting a little awkward. Should you wave again? Just stare at the floor as you walk past? You know you’re peeing a lot, they know you’re peeing a lot, but a key question remains: Why are you peeing a lot?
Frequent urination, also known as polyuria, can range from a minor annoyance to a symptom of a major medical problem. Most people pee six to eight times per day. If you’re hitting the head more often, or if you have to go multiple times at night (also called nocturia), it could be that you’re just drinking too much water, caffeine, or alcohol. On the other hand, it’s possible you have diabetes or a problem with your kidneys.
So should you just keep requesting aisle seats whenever you book airline tickets? Rotate bathrooms in the office so no one gossips about your tiny bladder? Or is there something you can do to slow the trickle and give your bladder a break?
Take a Chill Pill
You guzzle caffeine or fluid. It’s pretty obvious that drinking lots of water (or any other fluid) will cause frequent urination. It’s also false that you need to drink eight glasses of water per day; no one knows where that figure came from, but a more reasonable goal is to avoid thirst and to keep your urine pale yellow or clear. Alcohol and caffeine will further increase urine production, which explains why the bathroom line at the bar always gets unbearably long as last call approaches. Try reducing your intake, especially near bedtime.
Your uterus is not respecting your bladder’s personal space. During pregnancy your body retains extra fluid to support the little tyke in your pelvis. As your hormone levels shift and fluid requirements change, you may find yourself making extra trips to the loo. More important, the growing uterus literally presses on the bladder and prevents it from filling to normal capacity. As a result, even if your kidneys make the exact same amount of urine, you’ll need to empty out your bladder more often.
You’re taking a new medication. Some medications, known as water pills (diuretics), are literally designed to increase your urine output, since doing so lowers blood pressure. (In a sense, you’re peeing off extra fluid from your blood.) In addition, some other blood pressure medications, antidepressants, and antianxiety medications can affect the hormones that control the bladder, making it difficult to reach the toilet in time. Make sure to contact your doctor before stopping or switching medications.
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When the Tap Turns Off
The only thing worse than peeing all the time is not being able to pee at all. You may have this condition, known as urinary retention, if you feel like you have a really full bladder but can’t get any pee out.
In men, the most common cause of urinary retention is an enlarged prostate. Other possible causes include medications, stroke, multiple sclerosis, and spinal cord injury. The biggest medication culprits include antihistamines (allergy medications like diphenhydramine/Benadryl, cetirizine/Zyrtec, and fexofenadine/Allegra), decongestants (pseudoephedrine/Sudafed, phenylephrine/Dayquil), tricyclic antidepressants (amitriptyline/Elavil, nortriptyline/Pamelor), and general anesthesia (if you experience this problem in the hours after surgery).
Urinary retention always requires urgent attention, because the trapped urine can easily become infected. Also, as the bladder starts to overinflate, you will experience a degree of pain that you never before thought possible. Imagine having to pee like crazy, worse than you ever have before, but you can’t do anything about it. The short-term treatment is usually insertion of a plastic tube through the urethra (known as catheterization) to immediately drain the bladder. From there, the long-term treatment consists of medications that help keep the pathway for urine open. Less often, people need to occasionally catheterize themselves to keep their bladder empty.
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Make an Appointment
You’re also feeling lightheaded and/or really thirsty all the time. It’s normal to pee out extra fluid. It’s not normal to keep peeing like a racehorse when you’re already dehydrated. If that happens, and you’re not taking medications that increase urination (like water pills), then you may have diabetes. In this condition, there is so much sugar in your blood that your kidneys make extra urine to dump some out. (Try tasting your urine to see if it’s sweet . . . just kidding.) As a result, your body is constantly thirsty and trying to replace the lost fluids. See your doctor for some urine and blood tests. If you’re feeling really lightheaded and tired, no matter how much fluid you drink, you should go to the E.R.
Your pee dribbles out, and only after you bear down really hard. Men: remember when you could write your name in the snow? With enough precision to cross the Ts? Does it now look like you’re writing your name in Morse code? Blame your prostate. This organ is located around the urethra (the tube that drains the bladder) as it enters the penis. As you get older, your prostate gets larger and can block the flow of urine. It becomes harder to squeeze urine past the prostate, and the bladder ends up being near full at all times. As a result, you’re constantly running to the bathroom, even throughout the night, but can’t fully unload. Lots of medications and procedures can shrink the prostate and improve your urine flow.
It also burns or hurts when you pee. You probably have a urinary tract infection, or UTI. Most women will get at least one UTI during their lifetime. UTIs are less common in men, but become more so later in life. It’s also possible you have a sexually transmitted disease. Some simple urine tests can usually make the correct diagnosis. The treatment is usually antibiotics. If you get these symptoms often and don’t feel better after taking antibiotics, you could have a rare condition known as interstitial cystitis (or painful bladder syndrome).
You’re leaking urine all over the place, especially when you cough or laugh. Sadly, it’s not just your skin that sags with age. The muscles in the pelvis a
lso go a bit slack, and as a result the bladder has less strength to hold its urine. Sudden increases in belly pressure—like while lifting a heavy object or laughing hysterically (at this book, for example)—squeeze the bladder and may wring out some pee. This condition, known as stress incontinence (because of the physical stress on your bladder), is often treated with medications and Kegel exercises. If you’re not familiar with Kegel exercises, they consist of repeatedly tightening the muscles you use to stop urination. Try doing Kegels to pass time during meetings.
You get sudden, strong urges to urinate, but otherwise you feel fine. You’re sitting at your desk, minding your own business, when all of a sudden your bladder starts screaming for attention. You head for the bathroom, but by the time you’re ready to start, your bladder has already finished. (Should you have run?) You may have an overactive bladder, which frequently and suddenly tries to empty itself without much notice. The muscles lining the bladder wall generate forceful contractions even when the bladder isn’t full, and they’re not really sympathetic to the fact that you’re far from a toilet. It’s like being handed a bomb with only five seconds left on the timer. Medications can help calm your bladder muscles down. Don’t be embarrassed; just go see your doctor.
Get to the E.R.
You have pelvic pain along with fever, chills, and/or lightheadedness. A bad bladder infection can spread to the kidneys and bloodstream, putting your life in danger. Because the kidneys are located adjacent to the spine, infection often causes pain on one or both sides of your back as well. You should get to the emergency room as quickly as possible, as you may need intravenous antibiotics and fluids.
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