Key Q&A

Acupuncture Allergies Alzheimer's Disease Androgen Anxiety Disorders Asthma Atherosclerosis Attention Deficit Hyperactivity Disorder Bacterial Vaginosis Biofeedback Bipolar Disorder Birth Control Pills Blood Donation and Transfusion Breast Augmentation and Reduction Breast Cancer Breastfeeding Breast Reconstruction Caregiving Cervical Cancer Chiropractic Chlamydia Cholesterol Chronic Fatigue Syndrome Clinical Trials Colon Cancer Contraception Depression Diabetes Dry Eye Syndrome Eating Disorders Endometriosis Epilepsy Estrogen Fibroids Fibromyalgia Fitness Flu/Colds Gastroesophageal Reflux Disease (GERD) Genetic Testing Genital Herpes Glaucoma Gonorrhea Health Insurance Heart Disease Hepatitis High Blood Pressure HIV/AIDS Homeopathy Human Papillomavirus Hypnosis Hysterectomy Incontinence Infertility Irritable Bowel Syndrome Legal Health Tools Liposuction Lung Cancer Lupus Macular Degeneration Medication Safety Menopause Menstrual Disorders Metabolic Syndrome Migraine Multiple Sclerosis Naturopathy Nonsurgical Aesthetic Procedures Nutrition Obesity Ocular Allergies Oral Health Osteoarthritis Osteopathic Medicine Osteoporosis Ovarian Cancer Overactive Bladder Pain Management Pelvic Organ Prolapse Pelvic Pain Peripheral Arterial Disease Polycystic Ovary Syndrome Pregnancy Premenstrual Syndrome Preparing for Surgery Progesterone Rheumatoid Arthritis Schizophrenia Scleroderma Sexual Dysfunction Sinusitis Sjogren's Syndrome Skin Cancer Skin Health Sleep Disorders Smoking Stress Stroke Substance Abuse Tai Chi Teen Health Thyroid Disorders Trichomoniasis Urinary Tract Conditions Urinary Tract Infection Uterine Cancer Varicose Veins Violence Against Women Vulvodynia Weight Management Yeast Infections Yoga

1. What conditions could lead to blood in my urine?

   The cause may be a serious one, such as bladder or kidney cancer, but more often the cause is relatively benign, such as a urinary tract infection. For example, exercise can cause an episode hematuria—the medical term for blood in the urine. Still, you should check with a health care professional any time you see blood in the urine.

2. Why am I having repeated incidences of kidney stones?

   A variety of factors can make a person susceptible to stones in the urinary tract. Risk for stones is higher in those with family histories of stones; those who have urinary tract infections, kidney disorders and metabolic disorders such as hyperparathyroidism, cystinuria (too much of an amino acid called cystine) and hyperoxaluria (excess production an oxalate salt); and those with a disease called renal tubular acidosis. Another risk factor is absorptive hypercalciuria, in which the body absorbs too much calcium from food and dumps the excess into the urine. High levels of urinary calcium lead to crystals of calcium oxalate or calcium phosphate, which can grow into painful stones.

   Various laboratory tests and a family history should allow your health care professional to determine a likely cause. You can then make dietary changes to prevent future stones.

3. My health care professional is concerned because I have protein in my urine, but I feel fine. Should I worry?

   Yes. Proteinuria is a sign of glomerulonephritis (inflammation of the glomeruli; see below), also called nephritis (inflammation of the kidney). Diabetes, hypertension and various kidney diseases can cause the inflammation, which can lead to renal failure and, ultimately, end-stage renal disease.

4. What is the connection between diabetes and kidney disease?

   Diabetes is the number one cause of end-stage renal disease (ESRD). If diabetes is undiagnosed or poorly controlled, excess sugar will circulate in the blood, leading to higher blood flow into the kidney and glomerular scarring. Diabetic nephropathy is the term used for such damage, which can be delayed or prevented by keeping blood sugar levels down.

5. What is the connection between high blood pressure and kidney disease?

   The number two cause of ESRD is high blood pressure. ACE (angiotensin-converting enzyme) inhibitors are the best medications for controlling the condition and preventing kidney damage. The drugs protect the kidneys more than other blood pressure medicines. Blood pressure should be kept below 125/75 mm Hg in people with proteinuria higher than 1 gram per 24 hours.

6. How can I protect my kidneys if I have diabetes?

   • Have your glycohemoglobin (hbA1c) checked regularly; the test measures your average blood sugar for the previous two to three months.

   • Adhere to your diabetes control regimen, including insulin injections and other medications, diet, exercise and blood sugar monitoring.

   • Have your blood pressure checked several times a year (at every visit to your health care professional) and follow any recommendations for reducing it. Ask your health care professional about ACE inhibitors.

   • Have your urine checked yearly for protein and microalbumin (a protein component).

   • Ask your health care professional whether you need to lower your protein intake.

7. How can I prevent recurrence of a cystocele?

   In postmenopausal women, hormone replacement therapy, used alone or in combination with other approaches, can help prevent future cystoceles by strengthening pelvic muscles. Hormone replacement therapy, or HRT, typically refers to a combination of estrogen and a synthetic form of the hormone progesterone (progestin). Estrogen replacement therapy, or ERT, refers to the use of estrogen alone.

   The safety of HRT and ERT for both short- and long-term use for a variety of menopause-related symptoms is now under close scrutiny by the federal government as a result of three major studies of HRT published in 2002. In January 2003, the U.S. Food and Drug Administration (FDA) announced that it would require a new, highlighted and boxed warning on all estrogen products for use by postmenopausal women. Some products currently on the market in the United States contain estrogen and progestin, while others contain estrogen alone. The so-called "black box" is the strongest step the FDA can take to warn consumers of potential risks from a medication. The warning highlights the increased risk for heart disease, heart attacks, stroke and breast cancer from supplemental estrogen.

   Ask your health care professional for more information about the latest research on ERT and HRT and how the risks and benefits of using these therapies apply to your personal health needs.

8. Is surgery the best option for a painful case of interstitial cystitis (IC)?

   No, the results of the various types of IC surgeries are unpredictable—new ulcers may form after old ones are removed, and IC may afflict bowel tissue used to augment or rebuild the bladder. Even a cystectomy—removal of the bladder—does not guarantee the end of IC symptoms; some patients experience phantom pain. Be sure to explore other options first.Health care professionals should only turn to surgery as a last resort.

9. What other treatment options are available for IC?

   Sometimes eliminating irritating food and beverages from the diet—such as tomatoes, coffee, spices and acidic foods—reduces symptoms of IC. Nonmedicinal approaches to relief include gentle stretching exercises and bladder training. Bladder training involves working with a health care professional to plan specific times at which to urinate and then using relaxation techniques and distractions to stick to the schedule. Patients keep a diary and over time try to extend the time lapse between scheduled urinations.

   Transcutaneous electrical nerve stimulation (TENS) is a relatively inexpensive treatment that appears to be most useful in the five to 10 percent of IC patients with Hunner's ulcers, star-shaped ulcers on the bladder wall with central ridges or scarring that may bleed. The therapy uses mild electric pulses administered through wires on the lower back or above the pubic area, although some devices are inserted into the vagina or rectum (in men).

10. What tests can I expect if I am having urinary system symptoms?

    Urinalysis and blood testing are standard. Depending on your particular symptoms and history, your health care professional may perform a cystoscopy, in which a view instrument is inserted through the urethra into the bladder; a biopsy, in which tissue is removed for evaluation; an intravenous pyelogram or a CT urogram, in which an x-ray is taken of the urinary tract enhanced with a radioactive dye; a urodynamic test, in which the bladder is filled with liquid and then emptied to measure function; imaging using magnetic resonance imaging or computed tomography techniques.