Doctor consulting with patient

July 27, 2022

It’s nice to be able to boast about being a runner—unless it’s to the bathroom.

If urinating is difficult, uncontrollable or painful, you should pay attention. Here are some likely culprits for those unable to go with a normal flow, according to Dr. Samit Soni, MD, an urologist at Memorial Hermann Medical Group Memorial City.

What: Englarged Prostate

SIGNS: Men may have a weak or intermittent urinary stream or urinate with urgency or frequency, the latter of which can include multiple nighttime awakenings.

CAUSE: Blame aging, Dr. Soni says. The prostate is a gland that sits below men’s bladders and continues to grow throughout life. Eventually, an oversized prostate squeezes the urethra that runs through it, often after age 50.

DIAGNOSIS: Your urologist can look inside your bladder and prostate using cystoscopy, in which a slender flexible tube with a camera is inserted into the urethra and moved through the prostate and bladder. An ultrasound also can confirm how large the prostate is.

TREATMENT: Some long-term medication can shrink or relax the prostate, Dr. Soni says. Minor in-office procedures also may ease the flow. “A UroLift procedure separates prostate lobes with tiny metallic implants, much like tie backs on curtains.” Alternatively, surgeons can trim tissues within the prostate using heated electrodes or a laser in a procedure known as transurethral resection of the prostate (TURP). In less than 10 percent of cases, prostates are so supersized they may need to be removed with robotic surgery, Dr. Soni says. “All of these processes have the same goal of unblocking urine’s flow from the bladder.”

MYTH: An enlarged prostate does not cause prostate cancer, but prostate cancer is one of the most common cancers in men, and risk rises with age. That’s why men should get regular prostate-specific antigen (PSA) blood tests after age 50. “If you have a family history of prostate cancer, you should start sooner,” Dr. Soni says.

What: Kidney Stones

SIGNS: The size of kidney stones—actually, salt crystals—often determines your symptoms. “Passing a kidney stone can cause excruciating flank pain on either side, under the rib cage, and the pain can radiate to the front,” Dr. Soni says. Nausea, vomiting and blood in the urine also may occur or you can have fever and chills from an infection. “That becomes a more urgent situation.”

CAUSE: “Dehydration is by far the most common underlying reason for kidney stones, especially in warmer climates like ours,” he says. Heredity is a minor contributor but diets with excess salt, meat products or plant-based compounds called oxalates are a major one. The latter include spinach, berries, nuts, tea and chocolate.

DIAGNOSIS: Kidney stones can be detected via X-ray or ultrasound, but a “CT scan (computerized tomography with multiple X-rays combined for greater detail) is the gold standard for evaluating stones,” Dr. Soni says. Doctors also may perform urine and blood tests over a 24-hour span to pinpoint components in those with repeated stones despite dietary changes.

TREATMENT: Drinking plenty of water and reducing meat and oxalates intake often is enough to stop stones from forming or growing. “Only rare stones from uric acid can be dissolved,” he says. “Medication cannot treat other stones, so surgery may be needed to remove them.” 

One noninvasive option is shock wave lithotripsy (SWL), in which shock waves outside the body blast stones into fragments. Another approach is ureteroscopy, in which a very thin flexible tube with a camera is moved through the ureter and a laser is used to shatter the stones. Fewer than 10 percent of stones are so big that they need surgery through the skin to enter the kidney directly to break up and vacuum out stones. “Stones should not be ignored, even if they’re small and not causing pain,” he says. “We can monitor or treat them upfront to prevent problems down the road.”

MYTH: Dietary calcium is typically not a big factor in stone formation, but excess vitamin C or D through supplements may raise risk of stones. Also, some may be surprised to know that not only adults, but also school-age kids can get stones.

What: Bloody Urine

SIGNS: Your urine may have a reddish cast, or you may learn you’ve got blood in your urine (hematuria) after your doctor orders a urinalysis at your annual physical.  “If somebody develops visible blood in the urine, it means there’s a large amount of bleeding in the urinary tract,” Dr. Soni says.

CAUSE: “Blood in the urine can happen to anybody and be an early indicator of a serious urinary tract condition,” he says. “It’s more alarming in those 40 and over, especially in people with a history of smoking because smoking increases the likelihood of kidney and bladder cancer.” Kidney stones or an enlarged prostate also may be culprits.

DIAGNOSIS: “Anytime there’s blood in the urine it warrants a workup,” Dr. Soni says. Urologists most likely will check urine for infection and, if needed, follow with a CT scan, ultrasound or cystoscopy of the bladder, urethra or prostate.

TREATMENT: The source of blood dictates how it is treated. A UTI, for instance, can be healed with antibiotics. Tumors or other concerning conditions may require surgery.  

MYTH: “Even patients on blood thinners (to prevent or treat clots) should not accept blood in the urine as normal unless they’ve had a workup,” Dr. Soni says.

What: Frequent UTIs (Urinary Tract Infections)

SIGNS: UTIs may cause pain as you urinate due to inflammation in your urethra, bladder or kidneys.;

CAUSE: “Women are more vulnerable to UTIs since they have a very short urethra compared to men,” Dr. Soni says. This makes it easier for bacteria to enter the bladder and lead to infections. Some women are prone to UTIs and bladder infections following sex. Men rarely have UTIs, and when they do, they’re usually tied to an underlying anatomy issue that needs to be found.

DIAGNOSIS: Your doctor will start with a urine culture to determine what germs are the source. If you have recurring infections, ultrasound, CT scan or cystoscopy can detect kidney stones, inadequate drainage or an enlarged prostate.

TREATMENT: Once doctors know the type of germ, they can use antibiotics that target it best. If you have no anatomic issues, you might be given cranberry extract as a preventive. Drinking plenty of water helps flush the urinary tract of germs.

MYTH: Doctors always should prescribe preventive antibiotics to prevent future UTIs. “This should be discouraged as it breeds resistance, making UTIs and other infections harder to treat,” Dr. Soni says.

What: Overactive Bladder

SIGNS: You’re running to the bathroom—literally—during the day and night. At its most severe, an overactive or hypersensitive bladder may cause accidents when you’re unable to make it to the bathroom in time, known as urge incontinence. If you need to urinate two or more times nightly, it’s called nocturia.

CAUSE: Age matters. Urination often becomes urgent or frequent as we head into our 50s and beyond. The underlying cause in older men tends to be in part, or entirely, an enlarged prostate. UTIs, medications, caffeine and spicy or acidic food also can irritate and stimulate the bladder to spasm.

DIAGNOSIS: Your symptoms alone are a sign, but your urologist may suggest you keep a log of the time at which you void or eat certain foods. If your diet is free of contributing foods, your urologist may perform a urodynamics test, in which a slender, flexible catheter is threaded through your urethra to your bladder. There it senses pressure as the doctor has you fill and empty your bladder.

TREATMENT: If diet changes and weight loss doesn’t solve the problem, you may be prescribed drugs or get Botox® injections into the bladder wall to relax it. The next step may be the insertion of a neuromodulating pacemaker-like device with tiny electrodes that calm the sacral nerves in the lower spine that control the bladder.

MYTH: People expect a hypersensitive bladder to be difficult to treat, yet often cutting caffeine and spicy foods may do the trick.

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