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Urinary Complaints

In the range of minor illnesses, there is nothing worse than a bad urinary tract infection. If left untreated, this condition can cause extreme discomfort and stress. A simple infection can turn into a big problem in no time. If you have experienced frequent problems with this, never leave home without proper antibiotics prescribed by your family physician. In Mexico, prescription medicine is available over the counter. If you recognize your symptoms from previous experience, you can use MedToGo’s pharmaceutical guide to select the appropriate antibiotic and skip a visit to a physician.

Burning with Urination (Dysuria)

Burning with urination is likely the result of an infection of the bladder (men or women) or the prostate (men). (See Urinary Tract Infection, or Acute Prostatitis, below.)

Occasional burning may be due to irritation or infection of the urethra (the tube connecting the bladder to the outside world), causing urethritis. Sexually transmitted diseases, such as chlamydia or gonorrhea, may cause urethritis, which often produces a whitish or clear discharge.

In women in their fifties and sixties, genital irritation and burning with urination may be a symptom of menopause. With the normal loss of estrogen, the female genitals may become thin, inflamed, and irritated. You may use oral estrogen or vaginal cream to treat this problem. The decision to start oral hormone replacement is complex and should be discussed with a physician.

Increased Frequency of Urination (Polyuria)

Both men and women can experience increased frequency of urination (polyuria). In women: polyuria may be a symptom of bladder incontinence. (See “Incontinence of Urine,” below.)

When accompanied with pain or burning, it may indicate a bacterial urinary tract infection, or UTI. With a UTI, you may notice more frequent urination in much smaller amounts. The urine may be cloudy or foul smelling. Although isolated bladder infections do occur in men, they are less common. Infections of the prostate (Prostatitis; see below) are more frequent causes of burning with urination and polyuria.

Prostate Enlargement (In Men)

If polyuria has developed gradually, this may indicate an enlarged or diseased prostate, which is characterized by frequent but small amounts of urine and difficulty with urination.

Acute Prostatitis (in Men)

Polyuria may indicate an infection of the prostate (acute prostatitis) if accompanied by discomfort or burning with urination. Medical evaluation with a rectal/prostate exam is often necessary to differentiate between an infection of the prostate and an infection of the bladder (UTI). Determining the source of the infection is important, as the duration of antibiotic therapy is much longer for an infection of the prostate (one month) than it is for UTI (seven days in men).

Chronic Prostatitis

Some men complain of repeated discomfort or burning with urination along with symptoms that may include diminished stream, frequent urination, and/or waking repeatedly at night to urinate. On many occasions, long courses of antibiotics have been used as treatment, yet symptoms have tended to recur. This scenario describes a condition called “chronic prostatitis,” which occurs as a result of previous infection that has left the prostate inflamed and scarred. Although long-term antibiotics may assist with symptoms, many men find relief with terazosin or tamsulosin, described below under “Urinary Obstruction.”

Urinary Obstruction

In men, the problem of urinary obstruction is indicated by the following symptoms: poor urinary stream, difficulty starting urination, poor force of urine stream, dribbling, starting and stopping often, and waking to urinate during the night. Although this may be a normal process of aging, seek medical evaluation to exclude the possibility of cancer of the prostate.

Once cancer has been excluded, symptoms may be relieved with medications that relax the prostate muscle, such as tamsulosin (0.4 mg once 30 minutes after the same meal daily) or terazosin (1 to 5 mg orally at bedtime). Tamsulosin can be taken safely but terazosin may cause the rare yet serious side effect of extremely low blood pressure. Because of this, terazosin should be administered under the supervision of a physician.

Women generally do not have symptoms of urinary obstruction. Mild to moderate symptoms, although not urgent, should be evaluated by a urologist as soon as possible. A complete inability to urinate requires a trip to the emergency ward.

Urinary Discharge

In men: a urinary discharge is most often due to a sexually transmitted infection such as chlamydia or gonorrhea (see Sexually Transmitted Diseases). On occasion, an infection of the prostate may produce a penile discharge.

In women: due to their close proximity, it is often difficult to determine whether a discharge is from the urethra or the vagina. All discharges are thus described as vaginal. For a complete discussion, see Vaginal Discharges (below) or Sexually Transmitted Diseases.

Blood In the Urine (Hematuria)

There are several potential causes of visible hematuria. Hematuria with hip or groin pain may be the sign of a kidney stone. Hematuria with urinary burning may be the sign of a urinary tract infection. Finally, because hematuria can be the sign of a serious disease, you may need to be evaluated by a urologist who can perform specialized testing. This is especially true if you are over the age of 50, when cancers of the kidneys and bladder are more prevalent, or you have visible hematuria without evidence of kidney stones or infection.

Incontinence (In Women)

Urinary incontinence is the inability to hold urine until you get to the bathroom. In most cases it is temporary, resulting from an underlying condition. Because of pregnancy, childbirth, menopause, and the structure of the female urinary tract, twice as many women as men experience incontinence.

Stress Incontinence

With stress incontinence, you may notice the loss of urine with laughing, coughing, or sneezing. Incontinence of this kind is more common after childbirth, which may weaken the muscles of the pelvic floor. Treatment options include pelvic floor muscle retraining and strengthening exercises or, in severe cases, “bladder lift” surgery.

Urge Incontinence

Another type of incontinence, called urge incontinence, may occur randomly with the sudden feeling that you must run to the bathroom. This type of incontinence is best treated with anticholinergic medications such as oxybutinin (5mg taken orally twice or three times daily) or tolterodine (2mg taken orally twice daily). Do not use these medications if you have glaucoma, ulcerative colitis, gastrointestinal obstruction, urinary tract obstruction, or impaired kidney or liver function. Common side effects may include nausea, urinary obstruction, constipation, dry mouth, dizziness, headache, palpitations, decreased sweating, impotence, and restlessness.

Vaginal Discharge

Vaginal discharge may be caused by numerous factors, both infectious and non-infectious. The discharge from a yeast infection is typically white, thick, and non-odorous, while a discharge due to trichomonas, an organism transmitted during intercourse, is more frothy and malodorous.

Another common cause of vaginal discharge is bacterial vaginosis (overgrowth of common vaginal bacteria). A discharge from bacterial vaginosis is foul smelling and of a thin, milky texture. Each infection can cause itching and irritation of the vaginal region. It typically takes a skilled physician to discern the cause of a vaginal discharge.

However, women in monogamous relationships with prior yeast infections may prefer to self-treat a vaginal discharge with over-the-counter (OTC) vaginal creams or preparations such as Monistat or Femstat. Yeast infections commonly occur after antibiotic therapy or douching. In Mexico, a pharmacist may assist you in finding a medication to treat a yeast infection. A physician should always evaluate any discharge that does not respond to OTC anti-yeast preparations within two to three days.

If you have determined that you do not have a yeast infection, we recommend that you have an examining physician determine the exact nature of the vaginal discharge. Furthermore, we recommend that a doctor evaluate any discharge associated with abdominal or back pain, bleeding, fever, chills, or perspiration. In sexually active women, these signs may be an indication of pelvic inflammatory disease (see Female Pelvic Pain) that may require hospitalization and intravenous antibiotic therapy. Failure to treat PID early may result in pelvic scarring and infertility.

For travelers, condom use with unfamiliar partners is essential and medical evaluation should be sought early to minimize discomfort and inconvenience and to halt potential disease transmission to others.