Groin-Female

Urination pain

• Urination pain (dysuria) is the symptom of pain while passing urine.

• Urination pain (dysuria) can be described as:
· burning with urination
· burning or pain of the urethra (the tube in which urine passes out of the body)
· aching discomfort in the pelvis.

• Urination pain (dysuria) can be cause by:
· Urinary tract infection
· prostatitis
· urethritis (infection, inflammation of the urethra)

• Urination pain (dysuria) can also be symptom of interstitial cystitis, an inflammatory reaction in the bladder which may be an allergic reaction to food or an auto-immune reaction.

• Urination pain (dysuria) can be a sign of a serious condition and should be evaluated by your doctor.

Read more – April 21, 2009

Chronic Bacterial Prostatitis

by Julie Chacko, M.D.

• Definition: Recurrent or persistent bacterial infection of the prostate gland.

• Overview:
· This is the most common source for recurrent urinary track infection (UTIs) in men.
· The most common organism being E. Coli.

• Causes:
· Incomplete treatment of an episode of acute bacterial prostatitis can contribute to the onset of chronic bacterial prostatitis.
· Often there are calcifications within the prostate that harbor the organism and prevent complete clearance with antibiotics.

• Symptoms:
· The typical symptoms include burning with urination, frequency of urination and pain in any number of areas including the low back, perineum (between the anus and scrotum), low abdomen and increased pain with ejaculation.
· Patients with chronic bacterial prostatitis tend not to be as acutely ill as those with acute prostatitis and fever, lethargy and fatigue are usually not present.

• Complications:
· The recurring infections can lead to fertility issues and occasionally to prostatic abscess formation.

• Clinical Findings/signs:
· The prostate is tender on examination.
· Prostatic massage may be performed to try to obtain a specimen from the prostate itself.
· If a drop of fluid is obtained from the prostate (EPS) or the urine immediately after massage is collected, it usually demonstrates elevated numbers of white cells and will be positive for an organism when cultured.
· PSA (prostate specific antigen) blood test will usually be elevated as well.

• Treatment:
· Lifestyle: There are no lifestyle modifications to treat chronic bacterial prostatitis.

· Medication: The primary treatment is antibiotic therapy for a prolonged course, often 3-6 months, in an effort to eradicate infection. During the treatment course anti-inflammatory medications may be useful in controlling pain related symptoms. If burning on urination is present, bladder analgesics such as Prosed* or Pyridium* may be prescribed.

· Surgery: Surgical management is rarely indicated for chronic bacterial infection. Transurethral resection of the prostate can be performed in an effort to remove prostatic calculi but may not be successful in eradicating infection.

• Prognosis:
· Clearance of the infection can be difficult.
· The prognosis depends on whether clearance of infection is attainable.
· If not, persistent symptomatology is the norm and frequency and control of symptoms is variable.

Read more – April 16, 2009

Acute Bacterial Prostatitis

By Julie Chacko, M.D.

• Definition: Bacterial infection of the prostate gland.

• Overview:
· Tends to be diagnosed in younger men.

• Types:
· Acute bacterial prostatitis is one of a number of inflammatory conditions that can affect the prostate. See Chronic Bacterial Prostatitis and Non-bacterial prostatitis as well.

• Symptoms:
· Usually presents with fever, urinary frequency or urgency, pain with ejaculation, discomfort in the perineum (the area between the back of the scrotum and anus), and may have associated general fatigue.
· There may be associated difficulty emptying the bladder which may be perceived due the the irritative symptoms or actual due to obstruction of urinary flow due to the swollen gland.

• Complications:
· Bacteremia (infection spreading into the bloodstream) is a possible complication which, if not treated promptly, can result in sepsis.
· Prostatic abscess can form even when treated with appropriate antibiotics.

• Clinical Findings/signs:
· Fever is generally present.
· The prostate is warm and tender on examination.
· Bloodwork reveals an elevation in the white blood cell count as well as the PSA if it is checked during infection.
· The most common organism is E. Coli and the organism can be cultured from the seminal fluid and usually from the urine as well.
· When the infection has spread to the bloodstream blood cultures will also be positive.
· Imaging is usually not necessary to make the diagnosis though a CT or prostate ultrasound may be ordered if the clinical course warrants further evaluation.

• Treatment:
· Lifestyle: There is no lifestyle modification that can treat acute bacterial prostatitis though using a barrier method during anal intercourse may help reduce infection rates.

· Medication: Antibiotics are the mainstay of treatment. Depending on the severity of infection, admission to the hospital to start IV antibiotics may initially be indicated. The antibiotics are generally taken for at least four to six weeks to ensure complete eradication of the infection. Anti-inflammatories and fever reducing agents such as Tylenol* may alleviate symptoms. Stool softeners may be helpful as well.

· Surgery: If the patient is unable to urinate, a tube may be placed through the abdomen directly into the bladder (called a suprapubic tube). Otherwise, surgical intervention in rarely indicated unless a prostatic abscess forms.

• Prognosis: Prognosis tends to be good if caught early.

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Acute Pyelonephritis

by Julie Chacko, M.D.

• Definition: Infection of the kidney.

• Overview:
· More common in women than in men.
· Infection of the kidney can occur due to organisms spreading to the kidney from the bladder (ascending infection) or from the bloodstream.
· Ascending infection is more common.
· E. Coli is the most common organism.
· Abnormalities of the heart valves can be the source of organisms being spread by the bloodstream.

• Types:
· Bacterial
· Fungal

• Symptoms:
· Typically the patient experiences flank pain (pain in the back just below the ribcage), fevers and often nausea and vomiting.
· The pain can be located in the upper right abdomen as well.
· Kidney infection may or may not be accompanied by symptoms of bladder infection (see acute cystitis) and on occasion the urine will have blood that is visible.

• Complications:
· If not treated completely and in a timely manner an abscess can form in the kidney or in rare cases the infection can get into the bloodstream and make one very ill requiring hospitalization.
· If pyelonephritis develops as a patient is passing a kidney stone, immediate intervention may be necessary to decompress the kidney and allow proper drainage of the kidney for infection to clear.

• Clinical Findings/signs:
· Pyelonephritis remains a clinical diagnosis. The findings on examination include flank or upper abdominal tenderness, fever and usually a positive urine analysis and culture for bacteria. Nausea and vomiting are often present. If the bladder is infected there may be tenderness of the lower abdomen overlying the bladder as well. Imaging with ultrasound, CT or other modality can be used when there is suspicion of a stone or other complicating factor. Patients can have a wide range of symptoms including septic physiology (critically low blood pressure and unstable vital signs) if the infection has spread to the bloodstream.

• Treatment:
· Lifestyle – there are no lifestyle modifications to decrease the chances of pyelonephritis unless one is prone to recurrent bladder infections.

· Medication – Antibiotics are generally used to treat the infection. The length of time the patient is on antibiotics depends upon the specific antibiotic and the clinical situation. Though most pyelonephritis episodes can be treated on an outpatient basis, admission to the hospital may be warranted for IV antibiotics.

· Surgery: Surgical intervention may be necessary if the pyelonephritis is complicated by renal abscess or a urinary stone. The type of surgery or intervention depends upon the clinical situation. Occasionally the intervention can be performed by the radiologist without going under an anesthetic.

• Prognosis: The prognosis for acute bacterial pyelonephritis is good assuming that there is no complicating factor such as abcess, sepsis or stone. In children, whose kidneys are still developing, bacterial pyelonephritis can cause scarring of the kidney tissue and, if recurrent, can lead to overall decreased kidney function later in life.

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Cloudy urine

• Cloudy urine is the symptom of a whitish discoloration of urine.

• Cloudy urine can be a sign of:
· a urinary tract infection
· Chyluria (lymph fluid in urine)
· Alkaline urine

• Cloudy urine that persists or worsens should be evaluated by your doctor.

Read more – December 11, 2008

Burning during urination

• Burning during urination is the symptom of inflammation of the bladder or ureter (tube that urine passes)

• Burning during urination is a sign of an infection in the bladder or kidneys.

• Burning during urination may also represent interstitial cystitis.

• Burning during urination should be evaluated by your doctor.

Read more – November 25, 2008

Blood in urine

• Blood in urine is the symptom of urine with a reddish, pink or brown discoloration.

• Blood in urine can be a sign of:
· infection of the bladder or kidney
· kidney stone
· autoimmune disorder
· cancer of the bladder, cervix, kidney, prostate, or uterus
· inflammation of the kidney
· normal menstration
· necrosis (cell death) of the kidney associated with using NSAIDS (nonsteroidal anti-inflammatories drugs)
· an infection with Schistosomiasis

• Blood in urineshould always be evaluated by your doctor

Read more – November 21, 2008

Urinary pain

• Urinary pain (dysuria) is the symptom of pain while passing urine.

• Urinary pain (dysuria) can be described as:
· burning with urination
· burning or pain of the urethra (the tube in which urine passes out of the body)
· aching discomfort in the pelvis.

• Urinary pain(dysuria) can be cause by:
· Urinary tract infection
· prostatitis
· urethritis (infection, inflammation of the urethra)

• Urinary pain (dysuria) can also be symptom of interstitial cystitis, an inflammatory reaction in the bladder which may be an allergic reaction to food or an auto-immune reaction.

• Urinary pain (dysuria) can be a sign of a serious condition and should be evaluated by your doctor.

Read more – September 24, 2008

Incontinence

• Incontinence the symptom of inability to voluntarily control urine flow (urinary incontinence) or bowel movements (fecal incontinence)

• Urinary incontinence may be a symptom of:
· urine infection
· age related changes to the pelvic muscles
· spinal injury
· overflow incontinence

• Fecal incontinence can be a symptom of:
· nerve dysfunction or spinal cord injury
· Multiple sclerosis
· stroke

• Bowel incontinence may be due to:
· temporary loss of control of large amounts of diarrhea or gas
· a weakening of the muscles of the floor of the pelvis (usually occurring in elderly women who had many or difficult vaginal births)

• Urinary or fecal incontinence should be evaluated by your doctor

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Frequent urination (male)

• Frequent urination is the symptom of is the symptom of relative excessive urination frequency.

• Frequent urination in a man can be obstructed urine flow or incomplete bladder emptying due to:
· enlarged prostate
· prostate cancer
· prostatitis (infection or inflammation of the prostate)
· cystitis (inflammation or infection in the bladder)

• Frequent urination (Polyuria) can also be a symptom of:
· Diabetes mellitus
· Diabetes insipidus
· Hypercalcemia
· Psychogenic polydipsia (this is associated with psychosis)
· Hyperaldosteronism

• Urinary frequency should be evaluated by your doctor.

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