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Bladder Problems - Diagnosis

Below are just a few common bladder / urinary problems and diagnostic information:

Urinary Tract Infection

Your doctor may ask you to turn in a urine sample to determine if pus, red blood cells or bacteria are present in your urine. A urinalysis sometimes followed by a urine culture, can reveal whether you have an infection. There is not a simple test that differentiates between an upper and lower urinary tract infection; the presence of fever and side pain indicate that the infection possibly involves your kidneys.

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Frequency male muscles

Your doctor will request a medical history along with a physical examination; you will also be asked questions to help determine your condition. Such as:

What is your daily void schedule? Is this more or less than normal?
How did the abnormal frequency begin and what is the duration of the frequency?
Are there any related urinary signs or symptoms, such as painful urination, urgency, incontinence, hematuria, discharge, or lower abdominal pain with urination?

You will also be asked about neurologic symptoms, such as muscle weakness, numbness, or tingling. Urinalysis, culture and sensitivity tests will most likely be performed.

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Urgency

The diagnosis of an overactive bladder or urgency includes a complete medical history, together with a voiding diary and a physical examination. Paired with one or more diagnostic procedures, this helps your doctor determine the optimal treatment plan for overactive bladder.

The urine examination may discover medical conditions associated with urgency, such as the following:

Bacteriuria - existence of bacteria in urine; indicator of infection
Glycosuria - surplus glucose in urine; may point to diabetes
Hematuria - blood in urine; may be a sign of kidney disease
Proteinuria - excess protein in urine; may signify kidney disease, cardiac disease, blood disease

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Urinary Retention

The diagnosis of urinary retention includes both a medical and physical examination, for men a prostate examination will also be conducted.

A thin, flexible tube, known as a catheter, will be placed in your urethra. It maneuvers into your bladder and releases the urine into a bag. This is conducted both as a diagnosis and as a treatment of the immediate symptoms.
In order to check for signs of infection, bladder irritation, stones or other problems, a urine sample will be performed.
Additional lab tests may be completed, depending on your doctor’s determination from your medical interview and exam.

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Hematuria

Anatomy

To understand the needed evaluation for hematuria, one must know the anatomy of the urinary tract in The kidneys function to make urine by filtering the blood and discarding into the urine the waste products that are no longer needed. Water and salts accompany these waste products by necessity. The urine is then transported through two narrow tubes, called ureters, to the bladder, which is the reservoir for urine in between each void. The urine exits the bladder through a channel called the urethra that first passes through the prostate and then through the penis to the outside.

The blood in the urine must come from one of the above places: kidneys, ureters, bladder, prostate, or urethra. The evaluation requires that we look at the ENTIRE urinary tract in patients with hematuria.

Your doctor will take a complete personal and family medical history. The personal history will provide useful information such as:

Alcohol, tobacco or drug usage
Exposure to toxic substance for the last 25 or more years
History of kidney stones
Any injuries and infections
Recent illness
Urinary or voiding history

The family history may expose inherited tendency to kidney stone disease, sickle cell anemia or other genetic disorder associated with hematuria.

A comprehensive physical examination is performed, with special emphasis on the urinary tract, abdomen, pelvis, genitals, and rectum.

Based on results from the personal and family history along with the physical examination other test will be performed as deemed necessary.

Evaluation

The evaluation consists of taking a history and doing a physical exam of the individual and an analysis of the urine under a microscope. Many questions about one's urinary tract, including urination habits, stone disease, infections and injuries, will be asked. In addition, we will ask about recent illnesses, family history, drugs used in the recent past, prior operations, social habits such as drinking and smoking, and work related exposures. Regardless of the information generated, we will almost always continue with the diagnostic tests to look at the entire urinary tract. Even if we suspect something from the history, we must try to prove that nothing potentially harmful is also present.

There are usually two diagnostic tests necessary to give us a look at the entire urinary tract. The intravenous pyelogram (IVP) and cystoscopy.

IVP or INTRAVENOUS PYELOGRAM

The intravenous pyelogram or IVP is a special x-ray of the urinary tract. A series of x-rays are taken before and after a special colorless dye is injected into the veins.. The dye, which contains iodine, fills the urinary system and multiple films are taken over a 30-minute period looking for abnormalities. A pressure balloon may be placed on your stomach to help fill out the system better. At the end of the procedure the x-ray technician will ask you to empty your bladder in the bathroom and then one last x-ray film will be taken.

Because a dye is injected the possibility of an allergic reaction is present. A physician is in attendance and will administer the proper therapy if needed. If you have had a previous reaction to intravenous dye or are sensitive to shellfish, tell your doctor before the test. You are also exposed to very small amounts of radiation.

You will be given a prep sheet to describe the proper preparation for the intravenous pyelogram. Usually laxatives will be taken the night before the IVP and some fluid restrictions will occur the morning of the test.

CYSTOSCOPY

Cystoscopy is a procedure that is used to visually inspect the bladder and the urethra (tube leading out of the bladder). This can be done in most instances without discomfort by the use of a local anesthetic jelly (not a shot). The cystoscope or telescope, which is narrower than the urethra, is passed into the bladder and the inspection is carried out. In most instances the telescope used is a flexible fiber optic instrument that conforms to the shape of the urinary channel. The entire exam takes less than 10 minutes. Afterwards you might expect a little discomfort with voiding and perhaps a spot of blood for a day or so. A warm bath helps to relieve this irritation and will wash off the soap we've used to prep the area. You may receive antibiotics afterwards to prevent infection.

OTHER TESTS

Other tests that might be needed depending on the findings of the IVP and cystoscopy are ultrasound or CT scan examinations of the urinary tract. These will be done if some question or abnormality is not answered or explained to the urologist's satisfaction. Other tests, such as special blood studies, are considered if some historical fact about you raises other possibilities.

In the end, we hope to find nothing seriously wrong with the urinary tract. In fact, the most common finding is that we cannot determine a cause of the bleeding. This is actually a good finding because it suggests that the cause is not something that will ever be harmful. Remember that the thrust of the work-up is to exclude harmful diagnoses such as cancers or stones. Many of the other diagnoses include inflammations of the kidneys (nephritis) and would require a kidney biopsy to make a diagnosis. If one's urinary function is normal and we do not find protein in the urine, then the nephritis is usually harmless. This makes the kidney biopsy more dangerous than the disease - so we elect not to go further in the workup. Simple benign enlargement of the prostate is a very common source of blood in the urine and requires no treatment if no significant blockage is present.

FOLLOW-UP

If we find no cause for the hematuria, you will be referred back to your primary physician for follow-up. He or she will probably want to check your urine every year for a while to make certain that no changes are occurring. A blood test to check kidney function and a blood pressure check should be done as well, but then all of these tests are usually done regularly. Men over 50 should have a yearly PSA or Prostate Specific Antigen to screen for prostate cancer.

If the amount of hematuria continues without change and no other symptom arises, the workup need not be repeated.

No discussion of treatment has been offered here. There are too many diagnoses that can account for hematuria to cover them all. Once the work-up is completed, we will be able to give you a better idea of the exact causes and treatments, if any, are needed. Ask if you have any questions about hematuria or any other related urinary problem.

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Urinary Incontinence

Urinary incontinence occurs when you are not able to control when you urinate. While embarrassing, this condition can be treated.

There are nearly 12 million adults in the United States that suffer from urinary incontinence. Whereas it is most commonly experienced in women over 50 years old; it may also affect younger people, especially women who have just given birth.

If you experience symptoms of incontinence, discuss with your doctor. If left untreated, you risk getting skin irritation or sores and urinary tract infections. Additionally, fear of embarrassment may lead to you avoiding friends and family.

Evaluation of the incontinent patient will focus on categorizing the type of incontinence being experienced. With this understanding, specific therapy can be recommended that is individualized to each patient.

If you are struggling with incontinence, it does not have to become a way of life for you. There are exercises you can do, and the latest surgical procedures can virtually "cure" this embarrassing problem. These surgical procedures include collagen injections and the transvaginal sling procedure.

If you are struggling with incontinence, see a urologist to determine the best treatment alternative for you. Remember—you're in control!

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