Symptoms

Haematuria

About this symptom 

Gross/ visible hematuria: a symptom that basically means the presence of blood in urine.

 

Microscopic/ non-visible hematuria: red blood cells are only visible upon microscopic examination of urine sample.

 

If your urine appears pink, red, brownish-red or tea-like in colour, this may indicate the presence of blood in your urine. Doctors term this as gross/visible haematuria. Sometimes, the presence of blood in urine is not visible when red blood cells in a urine sample can be seen under a microscope. Doctors term this as microscopic/non-visible haematuria. Since the causes of hematuria may be benign or malignant, investigations should be done to ascertain its cause. 

 

According to existing literature, 18.9% of patients with visible hematuria were diagnosed with urinary cancer after investigation; whereas only 4.8% of patients with non-visible hematuria were diagnosed with urinary cancer after urological investigations.


Reference:
Edwards et al, BJUI 2006 Feb;97(2):301-5; discussion 305.

 

 

 

Possible causes:

There are abundant causes for hematuria. Those more specific to urology include:- 

 

Other causes: 

  • Medications such as blood thinners (heparin, warfarin, aspirin)
  • Kidney injury resulting from an accident 

 

Your urine may also appear pinkish red because of red pigments from your daily intake, such as medication (e.g. pyridium, rifampicin) or food (e.g. beetroot). However, of note, this is only pseudo-hematuria. 

 

If you notice your urine is discoloured, or you have accompanying urological symptoms (e.g. dysuria or loin pain, it is best to seek doctor’s consultation at your earliest convenient time to prevent delaying diagnosis and treatment. 

A professional urologist has the opportunity to ask you these questions:
WHAT TO EXPECT DURING DOCTOR’S VISIT?

Taking history

Your doctor may ask:

  • whether you have other urinary symptoms
  • whether you have experienced fever or recent urinary tract infections
  • past medical, medication and family history

 

Examination

  • Your doctor may perform a general physical examination.

 

Investigation

  • Blood and urine tests:

- take a sample of urine, called urinalysis

- take bloods to assess kidney functions

 

  • Imaging and other diagnostic techniques:

- CT scan of your urinary tract

- Kidney ultrasound

- Cystoscopy

 

Loin Pain

Is it kidney pain or back pain?

 

Kidney pain, also termed ‘loin pain’, is often characterised by a constant ache that can be felt at the back under the rib cage. Kidney pain can often be mistaken for muscular back pain. There are some characteristics of kidney pain that can help differentiate from back pain. The definitive cause is determined by appropriate investigations.

 

Kidneys, each about the size of a fist, are located at the back below the rib cage on both sides of the spine. Pain can usually be felt on one side, occasionally on both sides.

 

Depending on the cause, loin pain can also be sharp and severe, radiating to the groin and abdomen. For example, if pain is caused by urinary stones, pain can be severe and comes in waves.

 

Back pain, on the other hand, is often persistent and associated with movement and relieved with rest. 

 

It is important to also look out for any signs of infection (fever, painful urination, foul smelling urine) and other urinary symptoms such as haematuria .

 

 

 

Possible causes:

  •   Infection of the kidney (pyelonephritis)
  •   Urinary stones – kidney stones or ureteric stones
  •   Cancer – kidney cancer, upper tract urothelial carcinoma
  •   Cystic disease - kidney cysts, polycystic kidney disease

You should seek medical advice if:

  • You feel a constant dull ache on one or both sides of your back, with or without fever, body ache and general tiredness
  • You see blood in urine that appears ranging from fresh red to dark-brown in colour (haematuria)
  • You have had any recent diagnosed urinary tract infections

A professional urologist has the opportunity to ask you these questions:
WHAT TO EXPECT DURING DOCTOR’S VISIT?

Taking history

- Your doctor may ask about the nature of the pain, including:

  • location of pain
  • when the pain first occurred
  • onset of pain, sudden or gradual
  • duration of pain, constant or intermittent
  • any spread/radiation of pain

 

- Your doctor may also ask:

  • whether you have other urinary symptoms, such as visible haematuria
  • whether you have experienced fever or recent urinary tract infections
  • past medical, medication and family history

 

Examination

Your doctor may perform a general physical examination.

 

Investigation

  • Blood and urine tests:

- take a sample of urine to look for any signs infections or urinary crystals

- take bloods to assess kidney functions

 

  • Imaging:

- X-ray of the kidneys, ureters, bladder

- Ultrasound of the urinary system 

- Computer tomography of the urinary system

Weak Urinary Stream

Symptom description:
This is a lower urinary tract voiding symptom. It may be associated with hesitancy, intermittency, straining and sense of incomplete emptying. Lower urinary tract symptoms are not exclusive to men, it can affect both men and women of all ages. Although it may be a result of an underlying disease, it can also be physiological - the speed of urine flow decreases as one ages.

 

Possible causes:
The bladder functions as both a reservoir and pump for urination. The urethra acts as a tube that connects the bladder to an external opening, allowing urine to leave the body during urination. In male, the urethra passes through the prostate.


The bladder muscle is either in a relaxed state, allowing urine to fill the bladder; or under contraction, where urine is being actively pumped out of the bladder. The switch between urinary storage and voiding is under tight regulation by an intact neurological system.


Weak stream may be caused by:-

  • Disease that cause ineffective pumping of urine out of the bladder
  • Disease that cause blockage in the outlet of the bladder
  • Disease affecting the neurological system that governs the urination


Due to anatomical differences between genders, there are different organs in the pelvis that might compress onto the outlet and block the outflow of urine.


In men, a common cause is an enlarged prostate, termed benign prostatic hyperplasia, an outlet obstruction of urine from the bladder.

You can always consult your urologist who can prescribe you with appropriate lifestyle modification and treatment for your lower urinary tract symptoms, thus improving your quality of life. You can try to complete a self assessment via our IPSS calculator to grade the severity of your lower urinary tract symptoms. The International Prostate Symptom Score questionnaire is commonly used in the urologist’s office for assessment. 

 

BPH treatment

A professional urologist has the opportunity to ask you these questions:
WHAT TO EXPECT DURING DOCTOR’S VISIT?

History taking

Doctor will take a history and ask about your symptoms to better understand what the underlying cause may be.

 

Examination

Your doctor may perform physical examination including abdominal and digital rectal examination. 

 

Investigations

  • Blood and urine tests:

- take a sample of urine for investigation

- take bloods to assess kidney functions

- Prostate Specific Antigen (PSA) blood test in well-informed male patients after discussion with their doctors

 

  • Bladder function and imaging:

- perform a urine flow test, a noninvasive assessment to look for measure flow

- perform a residual urine screening with ultrasound

- in selected suitable cases, perform urodynamic investigation, an invasive, catheter-based test the measures bladder sensation and contractility power

 

TREATMENT

Treatment depends on the diagnosis.

Urinary Frequency And Urgency

SYMPTOM DESCRIPTION:

Urgency describes a sudden strong sensation that urges you to urinate and is difficult to control. This may be accompanied by increased frequency as the sensation makes you feel like you need to pass urine more frequently, up to 8 or more times in 24 hours.

 

You may also experience an unintentional loss of urine, as well as the need to wake up during the night to urinate.

 

 

POSSIBLE CAUSES:

Think of the bladder being a balloon, when it is being filled by urine produced from the kidneys, it becomes stretched. Whenever the bladder is stretched, a nerve signal is sent to the brain to tell the brain that the bladder is reaching its maximum volume. As a result, you feel the sensation of urgency, and you have to pass urine in order to relieve your bladder.

 

There are conditions which makes you feel the sensation more frequently or more difficult to control, for example:

 

- Faster rate or increased volume of urine produced that increases the filling of bladder

  • Certain medications that increases in urine production or increases thirst and fluid intake
  • Excess consumption of caffeine or alcohol
  • Poorly controlled diabetes where you start to excrete sugar in urine causing the urine volume to increase as more water is required to dilute the urine

 

- External pressure added onto the bladder, causing it to stretch

  • Obesity
  • Enlarged prostate in males
  • Uterine prolapse in women

 

- Storage volume of bladder is reduced

  • Incomplete bladder emptying, leaving a residual volume in the bladder after urination
  • Bladder tumour or bladder stone

 

- Neurological condition

  • Stroke
  • Multiple sclerosis
  • Declining cognitive function due to ageing

 

Other common causes include urinary tract infections, postmenopausal hormonal change in women.

Increased frequency and urgency may be overlooked by patients, it is also understandable that it may not be easy to discuss your symptoms. However medical care should be sought if symptoms are disrupting your normal life and social activities. Please also look out for other urological symptoms as well.

 

A professional urologist has the opportunity to ask you these questions:
WHAT TO EXPECT DURING DOCTOR’S VISIT?

Taking History

Your doctor is likely to take a history to better understand the symptoms you are experiencing.

 

Examination

Your doctor may also perform physical including rectal and pelvic examinations; neurological examinations may be required as well.

 

Investigations

  • Blood and urine tests:

- take a sample of urine for investigation

- Prostate Specific Antigen (PSA) blood test in well-informed male patients after discussion with their doctors

 

Bladder function and imaging:

  • a urine flow test, a noninvasive assessment to look for measure flow
  • residual urine screening with ultrasound
  • urodynamic investigation in selected suitable cases, an invasive, catheter-based test the measures bladder sensation and contractility power
  • cystoscopy which involves an endoscope to identify any abnormalities in the urinary tract and bladder

 

TREATMENT:

Treatment may be orientated to treat underlying cause, which depends on the diagnosis.

 

Treatment can be behavioural, medical or surgical therapies.

 

Behavioural therapies may include:

  • to maintain a healthy weight
  • perform bladder training or pelvic floor muscle exercises
  • to set a schedule for urination
  • use of catheterisation or absorbent pads

 

Medications:

Antimuscarinics are medications that can relieve the symptoms, these include:

  • Tolterodine (Detrol)
  • Oxybutynin
  • Darifenacin (Enablex)

 

Alternative to antimuscarinics include Mirabegron.

 

Vaginal oestrogen therapy may be indicated for female patients with overactive bladder due to postmenopausal hormonal changes.

 

Surgical interventions:

  • Small doses of botox injections into bladder tissues
  • Nerve stimulation to regulate nerve signals to the bladder
  • Surgical intervention

Nocturia

SYMPTOM DESCRIPTION:

The need to wake up at night to urinate. This is common as you age, it also depends on the timing of your fluid intake.

 

 

POSSIBLE CAUSES:

Think of the bladder being a balloon, when it is being filled by urine produced from the kidneys, it becomes stretched. Whenever the bladder is stretched, a nerve signal is sent to the brain to tell the brain that the bladder is reaching its maximum volume. As a result, you feel the sensation of urgency, and you have to pass urine in order to relieve your bladder.

 

There are conditions which makes you feel the sensation more frequently at night and you feel the need to wake up for urination, for example:

 

  • Related to urology:
    • Faster rate or increased volume of urine produced that increases the filling of bladder
    • Certain medications that increases in urine production or increases thirst and fluid intake, especially taking them late in the evenings.
    • Excess consumption of caffeine or alcohol
    • Poorly controlled diabetes where you start to excrete sugar in urine causing the urine volume to increase as more water will be drawn into the urine
    • Drinking too much fluid before going to bed.
    • Storage volume of bladder is reduced
    • Incomplete bladder emptying, leaving a residual volume in the bladder after urination
    • Bladder tumour or bladder stone
    • Infection of the urinary tract

 

  • Related to neurological conditions:
    • Stroke
    • Multiple sclerosis
    • Declining cognitive function due to ageing

 

  • Related to cardiovascular conditions:
    • Swollen ankles and legs with excess fluid. At night when you lie down this excess fluid is reabsorbed into the blood stream and the kidneys then produce more urine.
    • Heart failure

Although it is a common symptom that we may experience as we age, it is important to seek medical advice if nocturia is affecting sleep and disrupts normal daytime energy levels.

A professional urologist has the opportunity to ask you these questions:
WHAT TO EXPECT DURING DOCTOR’S VISIT?

Taking history

If you notice symptoms of nocturia, you may record for two days how much fluids you’ve consumed, the time you consumed the fluids, and the number of times you have urinated. This may be information to aids the doctor’s diagnosis.

 

Doctor may also ask questions such as:

  • when did the change in urination habit begin?
  • the number of times you have to wake up at night to pass urine
  • is there change in the volume of urine?
  • amount of caffeine and alcohol consumption

 

Examination

Doctor may also perform a physical examination, a cardiovascular examination if indicated.

 

Investigations

Urine tests: Doctor may also take a sample of urine to look for any urinary tract infection.

 

TREATMENT

Conservative treatment options

  • Regulating fluid consumption, for example limiting intake in the evening and limiting caffeinated/alcoholic drinks
  • Leg elevation or wearing compression socks for patients with swollen ankles

 

Medications

  • Drugs that reduces urine production such as Desmopressin
  • Anticholingeric medications, such as Darifenacin (Enablex), Oxybutynin (Ditropan), Tolterodine (Detrol), Trospium Chloride (Sanctura), or Solifenacin (VESIcare).
  • Diuretics such as Bumetanide (Bumex), Furosemide (Lasix).

Urinary Incontinence

SYMPTOM DESCRIPTION:

Leaks of urine when you don’t intend to pass urine.

 

There are different types of urinary incontinence:

  •   Stress incontinence. Urine leaks upon exertion of pressure on your bladder due to movements such as coughing or sneezing.
  •   Urge incontinence. This type of incontinence is associated with other symptoms such as increased urinary urgency and frequency as well as nocturia. Urge incontinence may be caused by a minor condition, such as infection, or a more-severe condition such as a neurologic disorder or diabetes.
  •   Overflow incontinence. You experience frequent or constant dribbling of urine due to incomplete emptying of urinary bladder.

 

 

POSSIBLE CAUSES:

Related to urology

- Stress incontinence

This type of incontinence may be a result of damage or weakened control of pelvic floor muscles or urethral sphincter, which are both structures that control the exit of urine from the bladder.

Problems with these muscles may be caused by:

  •   damage during childbirth, especially if your baby was born not by caesarean section
  •   increased pressure on your abdomen due to obesity or pregnancy
  •   damage during previous surgery, such as the removal of the womb in women, or prostate gland in men
  •   neurological conditions such as Parkinson's disease or Multiple sclerosis
  •   connective tissue disorders such as Ehlers-Danlos syndrome
  •   drugs such as ACE inhibitors, diuretics, antidepressants or sedatives

 

- Urge incontinence

This type of incontinence is likely to be a result of a problem with the detrusor muscle, a muscle that controls the relaxation and contraction of your bladder.

Possible causes can be:

  •   excessive caffeine or alcohol consumption
  •   insufficient fluid intake, creating urine too concentrated that irritates the bladder wall and causes symptoms of urgency
  •   urinary tract infection
  •   constipation
  •   neurological conditions
  •   drugs such as ACE inhibitors, diuretics, antidepressants or sedatives

 

- Overflow incontinence

This type of incontinence is likely to be associated with incomplete urinary bladder emptying, possibly due to an obstruction or insufficient detrusor muscle contraction

Causes can be:

- for men, enlarged prostate gland

- bladder stones

- neurological condition

- drugs such as ACE inhibitors, diuretics, antidepressants or sedatives

Although it may be uneasy to discuss said symptom, you should seek medical care at once if you have experienced urinary incontinence.

A professional urologist has the opportunity to ask you these questions:
WHAT TO EXPECT DURING DOCTOR’S VISIT

Taking History

Your doctor is likely to take a history to better understand the symptoms you are experiencing.

 

Examination

Your doctor may also perform physical including rectal and pelvic examinations; neurological examinations may be required as well.

 

Investigations

   Blood and urine tests:

       - take a sample of urine for investigation

       - take bloods to assess kidney functions

       - Prostate Specific Antigen (PSA) blood test in well-informed male patients after discussion with their doctors

 

   Bladder function and imaging:

       - perform a urine flow test, a noninvasive assessment to look for measure flow

       - perform a residual urine screening with ultrasound

       - in selected suitable cases, perform urodynamic investigation, an invasive, catheter-based test the measures bladder sensation and contractility power

TREATMENT

Treatment is dependent on the type of urinary incontinence as well as the severity.

 

Conservative treatments

Options include lifestyle changes, bladder and pelvic floor muscle training.

Lifestyle changes include limiting caffeine and alcohol intake, as well as maintaining a healthy weight.

 

Medications

Antimuscarinics are medications that can relieve the symptoms, these include:

- Tolterodine (Detrol)

- Oxybutynin

- Darifenacin (Enablex)

Alternative to antimuscarinics include Mirabegron.

Otherwise, surgical intervention may be considered.

Dysuria

SYMPTOM DESCRIPTION:

Dysuria describes painful urination.

 

 

POSSIBLE CAUSES:

Related to urology

- Bladder or kidney stones

- Urinary tract infection, including sexually transmitted diseases (STDs)

- prostate problems in men

- a recent invasive urinary tract procedure

You should seek medical care if:

  •   Pain during urination persists or intensifies
  •   Fever
  •   Persistent dull ache at your back
  •   You have drainage or discharge from your penis or vagina
  •   Your urine is foul-smelling or cloudy, or you see blood in your urine which appears with a dark-brown colour
  •   You pass a stone during urination
  •   Pregnant

A professional urologist has the opportunity to ask you these questions:
WHAT TO EXPECT DURING DOCTOR’S VISIT?

Taking history

Doctor may ask you about the nature of pain and other symptoms, for example:

- sudden or gradual onset?

- whether pain sensation has intensified or extended to other areas

- whether pain is felt when you start to urinate

- whether there are other accompanying urological symptoms

- urine characteristics

 

Examination

Your doctor may also perform physical including rectal and pelvic examinations

 

Investigations

    Blood and urine tests:

        - take a sample of urine for investigation

        - Prostate Specific Antigen (PSA) blood test in well-informed male patients after discussion with their doctors

TREATMENT

Treatment is dependent on the underlying cause of the pain.

For urinary tract infections, a course of antibiotics is indicated.

Often for kidney stones, oral fluids will be encouraged to help the passage of stones. Larger stones that fail to pass naturally in urine may require surgical intervention.

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