Pain occurs due to either obstruction (blockage in the passage of urine) or inflammation (infection/swelling) of the urinary system.
TUMOURS USUALLY DO NOT CAUSES PAIN, unless quite advanced.
A) Renal pain:
Starts from upper back (below 12th rib), goes across flank region to upper abdomen/umbilicus or to testis/labium of the same side. It may be quite severe, colicky and may be associated with nausea and vomiting.
Pain associated with fever and chills indicates infection with bugs and is an emergency.
B) Ureteral pain:
It starts suddenly, is usually quite severe, starts from flank and goes down to lower abdomen, testis/labium on the same side. The colicky pain does not afford rest to the patient even as he/she tosses and turns on the bed, and sometimes even after pain-killers. Patient may be nauseated and may puke.
The pain is a result of spasm of ureteric muscles as they go in hyperactivity to relieve of obstruction caused by stone or blood clot.
Any obstructing stone lower down the ureter may also cause symptoms of frequency/urgency/lower abdominal discomfort and feeling of inability to pass urine.
Any associated fever with chills indicates infection, which needs emergent evaluation with urologist.
C) Bladder pain:
Acute agonizing pain associated with lower abdominal fullness usually due to over distension of bladder due to obstruction of urine.
Intermittent lower abdominal discomfort usually due to urine infection. May be most severe when bladder is full or at the end of voiding. It may be associated with frequency and urgency of urine.
D) Prostatic pain:
It is due to infection and swelling of prostate. In acute condition, may be associated with fever and chills. Patient may have symptoms of lower abdominal discomfort, scrotal discomfort, frequency and urgency of urine and even obstruction of urine.
E) Penile pain:
Pain in flaccid penis is usually due to infection/swelling of urinary bladder or urethra.
Pain in erect penis may be due to Peyronie disease or priapism (persistent erection of penis for more then 4 hours, it is a urological EMERGENCY, which needs emergent consultation with urologist or patient may suffer from irreparable damage to the erectile function of penis.
F) Testicular pain
Sudden pain in testis/scrotum is due to infection of testis or torsion (wherein testis rotates on its axis, cutting off its blood supply). Any sudden scrotal pain, especially in sexually naïve teenager is a urological emergency, which may need surgery to save the testis. After the onset of pain, testis with torsion can get permanently damaged after 4 – 6 hours due to blocked blood supply.
Long-standing scrotal pain, usually dull aching/sensation of heaviness can be due to hydrocele (accumulation of water in testicular sac) or varicocele (dilation of testicular veins)
Hematuria (Blood in Urine)
Presence of blood in urine can be a sign of cancer and should never be ignored. This symptom demands complete evaluation under an urologist to rule out any ongoing sinister disease in the urinary tract.
In young patients, small amount of blood can be due to stones in urinary tract. In young women, it can be due to bacterial infection of urinary bladder.
Lower Urinary Tract Symptoms
A) Irritative Symptoms
A normal adult passes urine 5 – 6 times per day, with a volume of approximately 300 – 400 ml. Urinary frequency can be due to increased urinary output (polyuria) or due to decreased bladder capacity.
Polyuria can be due to Diabetes or excessive fluid intake
Decreased bladder capacity can be due to irritation of bladder (infection), neurogenic bladder (secondary to some disease of nervous system/spinal cord), or anxiety disorders.
A normal adult arise no more than twice at night to pass urine. Concentrating capacity of kidneys decline with age, therefore, urine production and frequency increases at night in elderly population.
Nocturia may occur in people who drink large amounts of liquids in the evening, like caffeinated or alcoholic beverages.
Painful urination caused by swelling/infection of urinary bladder. Usually manifests as burning sensation during passing urine or pain at the opening of urethra.
B) Obstructive Symptoms
1. Decreased force of urine:
Usually secondary to obstruction of bladder outflow
Commonly due to benign prostatic enlargement in elderly men or due to stricture urethra
2. Urinary hesitancy:
Delay in start of voiding
Involuntary start/stop of urinary stream
4. Post void dribbling:
Terminal release of urinary drops after end of voiding. This is usually due to small amount of urine in urinary passage, which is normally milked back in to urinary bladder. In men with bladder outlet obstruction, this urine leaks at the end of voiding.
Manually compressing the area between the anal opening and scrotal sac and blotting the urethral opening with a tissue can readily solve this problem.
Using of abdominal muscles to pass urine.
The severity of Lower urinary tract symptoms can be self-judged by patients by checking their IPSS (International Prostatic Symptoms Score). Various calculators are available online which can be searched by name “IPSS SCORE” on Google.
It is the involuntary loss of urine. A common problem in elderly population, especially in elderly females, it is a major social handicap. Fortunately, it is very much treatable. There are various types of incontinence
1. Continuous incontinence
It is usually due to an abnormal opening in urinary tract, which bypasses the urethral sphincter (valve that controls outflow of urine).
Usually secondary to gynecological surgery/radiation or obstetric trauma in females.
May be due to congenital (by birth) abnormality of urinary tract, usually manifests as the child crosses age of toilet training.
2. Stress incontinence
Sudden leakage of urine with coughing, sneezing, exercise, or other activities. It is most common in women after child bearing or menopause. It may occur in men after prostatic surgery.
Significant stress incontinence is difficult to manage with medicines and is usually best treated with surgery.
3. Urgency incontinence
Precipitous loss of urine preceded by a strong urge to pass urine. It is commonly observed in patients with bladder infection, or secondary to neurological disease or advanced bladder outlet obstruction.
These patients are best treated with medicines.
4. Overflow incontinence
It is secondary to advanced urinary retention with dribbling of small amounts of urine as bladder overflows.
Urinary incontinence occurring during sleep (bedwetting)
Normal up to 3 years of age.
Persists in 15% of children at 5 years of age and 1% of children at 15 years of age.
All children older then 6 years of age with bedwetting should undergo urological evaluation; majority will be normal.
A) Loss of libido:
Decrease in sexual desire. May be due to variety of medical illnesses that affect general health and well-being or depression. It can be secondary to hormonal disturbances. Patient needs to contact his urologist for further evaluation
Inability to achieve and maintain erection sufficient for sexual intercourse. Can by psychogenic or due to some underlying disease.
Can be side effect of certain medications like those used for control of blood pressure
C) Failure to ejaculate
Side effect of some medicines like those used for treatment of benign prostatic enlargement
Effect of long standing diabetes
D) Absence of orgasm
Side effect of certain drugs used to treat psychiatric drugs
E) Premature ejaculation
It is common for men to ejaculate within 2 minutes after initiation of intercourse.
If ejaculation occurs within 1 minute of start of intercourse, treatment is required.
Presence of blood in ejaculate
Usually non-specific causes, mostly resolves spontaneously within several weeks.
Hematospermia persisting beyond several weeks needs consultation with urologist for further evaluation
Passage of gas in urine.
Due to abnormal connection between intestines and urinary tract.
Most common symptom of sexually transmitted infection