Bladder Problems – Symptoms and Causes
The bladder has a rather limited means of expressing its own pathology. No matter what is wrong, there are only five sets of symptoms that encompass all of the known conditions that affect the bladder and resulting bladder problems.
These symptoms are:
(1) urinary frequency, urgency, and nocturia (urinating at night);
(2) loss of urinary control (incontinence);
(4) difficulty urinating or the inability to urinate at all (urinary retention); and
(5) blood in the urine.
Discovering the source of bladder problems is not always easy. A disabling, unrelenting pain can be caused by a simple bladder infection; a seemingly trivial complaint, like frequency of urination, can be caused by a serious condition like bladder or prostate cancer. How do you know what’s wrong? How do you even know when to see a doctor?
URINARY FREQUENCY, URGENCY, AND NOCTURIA
How often should you urinate?, it all depends on how much you drink. The more you drink, the more urine your kidneys produce and the more you have to urinate.
The frequency of urination and the associated sensations are also dependent on a complex interaction between the signals that the bladder sends out and the signals that the brain receives from other environmental and psychosocial sources.
There is no simple definition of urinary frequency because some people are perfectly comfortable going to the bathroom every hour for the sake of convenience, whereas others find it very distressing to have to interrupt what they are doing more than three or four times per day to urinate.
These are not necessarily bladder problems. Thus, in part, it is not how often you urinate, but why and how you react to the frequency of urination that determines whether or not it is a “symptom.”
There are no strict values for normal and abnormal when it comes to bladder problems, but, on average, most people ingest approximately 1500-2000 ml of fluid per day (1’/,-2 qt.) and void a total of about 1000-2500 ml (1-2’/2 qt.) of urine per 24 hours.
The volume of each urination is also variable. Some people void only 100-200 ml at a time; others void as much as 1000 ml or more at a time. Thus, depending on the amount of urine that your bladder can comfortably hold before you feel the need to urinate, it is possible to urinate as little as two to three times per day or as much as once an hour, yet still pass the same total amount of urine.
Most normal people, though, urinate about once very three to five hours during the day and most are not awakened more than once a night by the urge to urinate once they go to sleep.
One of the more common bladder problems, Nocturia literally means “urinating at night.” Sometimes it is a symptom; sometimes it is not. If you’re awakened every hour once you go to sleep because of the urge to urinate, that’s a symptom.
If you’re worried about something and you can’t sleep, and you drink tea or milk to help you sleep and you get up every hour to urinate, that’s a symptom of worry, but it’s not a bladder problem.
If you are a night watchman (or a night watch-woman) and you’re up all night, it’s normal to urinate at night and it’s not a symptom, but if you’re up all day urinating, when you’re supposed to be sleeping, that’s a symptom.
As you might have guessed, the most common reason why people get up at night to urinate is that their kidneys make a lot of urine at night, so the bladder responds the way it is supposed to, by waking them up and telling them to urinate.
Another reference to bladder problems, urinary incontinence means the loss of urinary control. In the most severe cases, you may simply urinate without knowing it at all and find your clothes suddenly saturated.
Or you may get a sudden urge to urinate when you put your key in the front door and leak on the way to the bathroom because you can’t get there in time. You may lose a few drops of urine when you run and jump or you may lose a gush of urine when you cough or sneeze.
Incontinence is very embarrassing and one of the more distressing bladder problems. It can make you feel unclean or it can make you smell of urine. It can be a severe problem that can make you fearful of even leaving your house. But it’s treatable and curable. If you wet yourself now, you don’t have to wet yourself in the future if you get proper treatment.
There are many causes of incontinence. If you wet yourself there are only three possible causes-either the bladder contracts when it is not supposed to, or the sphincter relaxes when it’s not supposed to, or there’s a hole in your bladder.
Pain is impossible to define; it can only be described. Pain from the bladder and urethra is variously described as pressure, burning, aching, stinging, searing … the list is endless. Some pains are characteristic of bladder problems or a urethral problem; others are too vague to be used as symptoms.
The most common pain is that which is due to a urinary tract infection. It usually begins with a severe urgency, a need to rush to the bathroom. When you get there, as you start to urinate, you feel a burning sensation.
The burning is usually felt in the urethra, but most people don’t know exactly where their urethra is. In women, the urethra opens into the upper part of the vagina, about an inch below the clitoris. In men the urethral opening is at the tip of the penis.
DIFFICULTY URINATING AND URINARY RETENTION
Normally, urination is an effortless, almost unconscious act. You perceive the urge to urinate and, at a socially convenient time, go to the bathroom. Normal urination is accomplished almost immediately without pushing or straining, without hesitation, and in most instances, without any conscious effort at all.
There are a number of symptoms that can occur during the act of micturition (urination)-hesitancy (a delay in starting), weak or dribbling urinary stream, intermittency (a starting-stopping urinary flow), a feeling of incomplete bladder emptying, a dribbling or dripping of urine after you think you are done, and, the most dramatic and frightening symptom, the inability to urinate at all.
These symptoms are all nonspecific, which means that each symptom may be caused by a number of conditions. It is impossible to know what is wrong with you just by knowing what your symptoms are without doing more tests.
For example, urinating with a weak or dribbling stream could be due to a blockage in the urethra, a weak bladder, or your own inability to relax. Each of these things can, in turn, be caused by many other conditions that require further evaluation to diagnose.
BLOODY URINE (HEMATURIA)
Blood in the urine is called hematuria (heem-a-tour-ia) and it is always abnormal (unless the urine was collected during menstruation and blood accidentally got into the urine sample).
When there is so much bleeding that it is visible to the naked eye the proper term is gross hematuria. Bleeding that is only detected by looking at the urine under the microscope is called microscopic hematuria.
Gross hematuria may manifest as pink, red, or burgundy-colored urine. When bleeding is severe, blood clots may be passed in the urine as well. Blood in the urine, whether gross or microscopic, should never be taken lightly.
Overwhelmingly, the most common cause is just a simple bladder infection, but it may also be a sign of bladder cancer, kidney cancer, prostate cancer, and other serious bladder problems or conditions. This means that it should always be checked out by a doctor.
How to Determine the Cause of Bladder Symptoms
You get a sudden, severe urge to urinate and rush to the bathroom, but when you get there you manage to force out only a few drops of urine while your insides feel like they are on fire.
Fifteen minutes later the same thing happens again, and then again and again. With symptoms of such intensity, only a stoic would fail to see a doctor. But what about the person who has a single episode of bloody urine, or the person who notices a gradual onset of difficulty initiating urination, or the person who is in the bathroom every hour around the clock, or the person who is incontinent and thinks there is nothing that can be done.
All of these people should see a doctor and in almost every instance there will be an appropriate therapy that is likely to cure the condition.
WHEN TO SEE THE DOCTOR
There are two reasons to see a doctor for urinary bladder symptoms (or for that matter any other symptoms). The first, and foremost, reason is to determine whether or not your symptoms are the sign of a serious condition that, if undiagnosed, unrecognized, or untreated could go on to cause serious medical complications or even death.
Untreated bladder, kidney, and prostate cancer can and do cause death, and, as is the case with most cancers, the key to cure is early diagnosis and treatment.
Kidney stones can destroy kidneys; fortunately they usually cause a great deal of pain so an early diagnosis is usually obvious. Damage to the nerves of the bladder can also destroy kidneys, but this often causes no pain and minimal symptoms.
For that reason, early diagnosis is much more difficult, and for many patients the condition is not diagnosed until the kidneys are already damaged.
The second reason to see a doctor is because your symptoms bother you and you want them treated. For example, if you are incontinent, you are wetting your pants, which is causing you embarrassment and interfering with your job and your sex life.
In short, incontinence is ruining your life. Or you urinate every half hour both day and night because it hurts too much if you don’t urinate, so you end up planning your entire day around the availability of a bathroom. Or you’re so frightened that you won’t be able to urinate at all that you spend all of your time in the bathroom trying to go.
These are bladder problems that should be discussed with your physician in order to get you back on track.