Common Bladder Control Problems

Tonight we’re going to talk about bowel and bladder control primarily. So Dr. Graves and I both actually trained together at the University of Pennsylvania in Philadelphia and we’ve been each practicing for close to 10 years. And we’ve had five years of urology training in residency and med school before that.

And the topic tonight is something that we do have a lot of focus in and enjoy taking care of and have specialty in. All right so there’s three kind of categories to kind of simplify this about bladder control issues. One is stress incontinence and I’ll describe that more in the next slides. The second is urinary retention which is the inability to actually get urine out where the urine is trapped in the bladder and you can’t fully empty the bladder and the third is overactive bladder. 

So stress incontinence is the kind of incontinence that some patients can have in which when you increase the pressure on the bladder it overcomes the ability of the sphincter to control the urine. So sneezing, coughing, laughing, standing up real quick after you’ve been sitting for a while, climbing up things like stairs, exercising and then you get a dribble or even sometimes a full emptying of the bladder as you do those activities so that’s deemed stress incontinence. And that is an issue typically with the sphincter itself and the pelvic floor with the inability to control the bladder from emptying. And that’s an issue that some women have with age or after childbirth that can occur. In regards to men that would be something that sometimes we see after prostate type procedures and then also you know something with the age that can occur. In regards to urinary retention that’s when you can’t fully empty your bladder. Sometimes patients will show up with to the emergency room or our office with the inability to empty their bladder and they need a catheter put in to drain the bladder. Other times it could be a slow chronic situation where they don’t empty the bladder fully and it builds up into a inability to empty. That’s actually dangerous because you’re not able to clear all the toxins out of your body and you can get infections or kidney failure, this is something that’s important to tease out. Usually in these cases you can have leaking but the main symptom is difficulty emptying and a weak stream. And then overactive bladder is is a quite common situation in which you have a bladder that isn’t able to hold urine for the amount of time it should in between urination. So you get frequent trips to the bathroom with strong urges to pee even though you just urinated, went to the bathroom and peed you know 20 minutes 30 minutes later you feel like you got to go again and are heading back to the bathroom. And that can sometimes progress into urge incontinence which is a type of leaking of urine as opposed to the stress incontinence where you sneeze cough strain and leak this is where you get a strong urge to pee and you can’t hold it back and then you end up having a leak before you make it to the bathroom in time.

And then a different kind of incontinence would be this fecal incontinence which is basically bowel incontinence and this is not urinary incontinence but a situation in which you have control issues with having bowel movements. So you can actually have loss of control where you have accidents with your stool sometimes that could be this like a strong urge that you cannot control or other times it’s a loss of feeling that you have to go and you can have either small accidents or a full incontinent episode with fecal incontinence

What’s the healthiest urine color?

Urine is liquid waste made by your kidneys as they filter toxins and potentially harmful waste from your blood. 

It is primarily made of water, chemicals (ammonia, creatinine, urea, uric acid), inorganic salts, pigments, and electrolytes (like potassium and phosphorous). 

Its color depends on a variety of factors, including illness, food, and medications. And it can give a picture of your overall health.

So what is the healthiest urine color?

Generally, the healthiest urine color is pale or light yellow to gold. The yellow color is due to the pigment urochrome, an end product of the breakdown of hemoglobin found in blood. Of course, the level of urochrome in the urine will make the urine appear either light yellow or dark yellow. 

When the urine is clear or has no color, it typically means you’re drinking excessive liquid or perhaps taking a drug known as a diuretic which stimulates your body to get rid of fluid. 

With clear urine indicating over-hydration and your body attempting to get rid of excess water, you only need to stop drinking too much and to drink only when next you feel thirsty for your urine to return to light yellow.

Dark yellow, honey-colored, or brown-colored urine indicates that you’re probably dehydrated and need to drink more fluid. Though it could also be a warning that you have a liver problem and need to see your doctor if it does not get better in a few days. 

Equally, dark yellow urine is common in the morning because you’ve perhaps taken too long without hydrating. When you have dark yellow urine, drink some water and limit dehydrating foods and drinks.

What urine colors are abnormal?

  1. Orange

Orange urine color may be a sign that you are dehydrated. But it can also be the result of high-doses of vitamins B12 and C, the urinary tract infection drug phenazopyridine, the antibiotic isoniazid, or a problem with your liver or bile duct. 

Speak with your doctor if your urine is constantly orange colored. Also, be aware of the medications and vitamins you’re taking.

  1. Blue or green 

A green or blue colored urine is often a side effect of certain vitamins, food dyes, the anesthetic propofol, the asthma medicine promethazine, or the medicine methylene blue. 

Only a few rare medical conditions turn urine green or blue in color so inform your doctor about a blue or green urine color that doesn’t go away.

  1. Red or pink

Unless you’re taking a drug like antibiotic rifampin or the UTI drug phenazopyridine or you’ve eaten beets, carrots, blackberries, or rhubarb recently, having pink or red urine indicates blood in urine. In fact, if the urine has a thick, blood-like consistency, then that is abnormal and requires urgent attention. 

Generally, anything red should be alarming and could be a sign of kidney stones, kidney disease, prostate problems, urinary tract infection, or a more serious problem like bladder cancer. Of course, for women, when menstruating, then menstrual blood can mix with urine.  But with red or pink urine, you should call your physician or urologist immediately to be examined. 

  1. Brown urine

When urine is brown, it might indicate fistula between the urinary tract and the rectum or bowels. It may also mean blood in urine, kidney disease, liver disease, or an infection. Speak with your doctor about brown urine color that doesn’t go away.

  1. Turbid or foamy urine

No matter the color of your urine, you should visit your doctor if it is foamy, frothy or cloudy. Turbid urine may be a sign that you have protein in your urine, which may mean a problem with your kidneys. Or it may indicate that you have an infection. 

Nevertheless, smelly or cloudy urine alone should not be interpreted to mean urinary tract infection, as only a visit to your doctor and a subsequent analysis can reveal that.

When should you seek medical help?

You should never be afraid to bring up questions with your doctor when you have abnormal urine color. If you believe the alarming urine color is due to a new supplement or medication, your doctor will change it or instruct you to stop taking it. Then, your doctor will encourage you to track your urine to see if or how its color changes.  Your doctor will also request for a sample of your urine for analysis, particularly if it is pink, brown, red, or smells strangely.

Make sure to inform your doctor about any new symptoms, especially if it lasts more than a day or comes with a fever, vomiting, back or side pain, discharge, or feeling very thirsty. For more information on the diagnosis and treatment of urinary issues, visit the site “St Pete Urology.”

Ways to Keep Your Kidneys Healthy

Having healthy kidneys is important for your general health and well-being. The kidneys are vital organs that filter out waste products, excess water and other impurities from your blood. Once removed from blood, the wastes are temporarily stored in your bladder before expulsion in urine. 

But your kidneys also regulate your blood pH, control body potassium levels, and produce hormones that control red blood cell production and blood pressure regulation. Plus, your kidneys activate a form of vitamin D that helps in absorption of calcium for regulating muscle function and building bones.

So it’s important to keep your kidneys healthy in order to filter and expel waste properly and to produce the necessary hormones for proper body function.

Here are 8 ways to keep your kidneys healthy

  1. Drink plenty of water

Drinking enough water regularly and consistently helps you stay hydrated. It also promotes waste removal in urine and ensures healthy kidneys. 

Likewise, with more water intake, you’ll clear up sodium and toxins from your kidneys and reduce your risk of chronic kidney disease.

Although the amount of water you need depends on your lifestyle, overall health, climate, gender, exercise level and whether you’re pregnant or breastfeeding, you should aim for 1.5 to 2 liters of water per day. 

And if you’ve previously had kidney stones, you need to drink even more water to prevent future stone formation.

  1. Eat a healthy diet and monitor your weight

For healthy kidneys, you need a balanced diet that is low in sodium, processed meats, and other kidney-damaging foods. 

In fact, a focus on fresh ingredients with low sodium content, such as whole grains, fish, blueberries, and cauliflower will help reduce the risk of kidney disease.

Likewise, maintaining a healthy weight will help avoid issues such as heart disease and diabetes that can result in kidney damage. That’s because people who are obese or overweight have higher risk of kidney damage than the rest of the population.

  1. Maintain an active lifestyle and a physically fit body

Regular exercise helps to reduce the risk of chronic kidney disease. Plus, it lowers blood pressure and boosts heart health, both of which prevent kidney damage. 

Whether you have a demanding daily routine or not, you can still find an activity that you enjoy and can do frequently.  You can walk, run, cycle, or dance for 15-30 minutes every day for at least 3 days a week and help to keep your kidney healthy.

With exercise and physical fitness, the key is finding an activity that you can stick to, no matter how simple. In the long run, it will be good for your kidneys.

  1. Control your blood sugar level

Diabetes and other conditions characterized by high blood sugar may result in kidney damage. The consistently excess sugar in your blood will compel your kidneys to work extra hard to filter your blood, causing an exertion that can lead to life-threatening kidney damage. 

So cut your daily sugar intake. Undergo regular blood sugar tests to monitor your sugar level. And if your sugar level is constantly high, follow the treatment regime prescribed by your doctor. 

  1. Check your blood pressure

Having a normal blood pressure is good for your kidney. High blood pressure can cause kidney damage, especially if it occurs alongside other health issues like heart disease, high cholesterol, or diabetes.

A healthy blood pressure is 120/80 while pre-hypertension is 120/80 to 139/89. When your blood pressure is consistently above 140/90, you may have hypertension.

Make sure to check your blood pressure regularly. Speak with your doctor about a constantly elevated blood pressure and ask for advice on the dietary and lifestyle changes you need to make to lower it.  Your doctor may also prescribe medication to help you manage your blood pressure.

  1. Avoid smoking

Smoking damages blood vessels and results in slower blood flow throughout your body and to your kidneys. In turn, this can cause kidney damage. Smoking also increases the risk of kidney cancer. 

If you’re already smoking, you need to quit. If you find quitting difficult, seek for help. By quitting smoking, you improve your kidney health and reduce the risk of chronic health disorders.

  1. Minimize over-the-counter pills

Taking over-the-counter (OTC) medications regularly increases the risk of kidney damage. 

For instance, non-steroidal anti-inflammatory drugs (NSAIDs), such ibuprofen and naproxen, may trigger kidney damage when taken regularly for arthritis, headaches, and chronic pain.

 So if you have an issue that requires regular intake of pain-relieving and other medicines, you should speak with your doctor about kidney-safe options. 

  1. Undergo kidney function tests 

Early detection of kidney disease or damage helps to prevent further damage and complications. Hence, if you’re at high risk of kidney problems, it is prudent to have regular kidney function tests.

 The tests will help indicate your current kidney health and reveal possible changes, helping you to take remedial measures to slow or prevent further damage.

You should undergo regular kidney testing if you:

  1. Are over 60 years or older
  2. Are obese
  3. Have a family history of high blood pressure
  4. Have cardiovascular disease
  5. Have family history of cardiovascular disease
  6. Believe that you have kidney damage
  7. Were born at a low birth weight

What health problems are commonly associated with kidneys?

More than 10-percent of Americans over the age of 20 years have some kind of kidney disease. Unfortunately, some forms of kidney issues are progressive, getting worse over time.  

The most common kidney problems include:

  1. Urinary tract infections

This is a bacterial infection of any part of your urinary system, but most frequently in the urethra and bladder. 

Most urinary tract infections are easily treatable and have few, long-term complications. But when untreated, the infections can spread to the kidneys and result in kidney failure.

  1. Kidney stones

When minerals and other substances in the blood reach high levels in urine, they may crystallize in the kidneys to form solid particles, called stones. 

Passing the kidney stones can be extremely painful, but rarely cause significant problems.

  1. Glomerulonephritis

Glomerulonephritis is inflammation of the glomeruli—microscopic structures inside the kidneys that filter blood. 

The inflammation can be due to infections, congenital abnormalities, drugs, and autoimmune diseases. Glomerulonephritis may heal without treatment, but may sometimes require medications.

  1. Polycystic kidney disease

This is a genetic disorder that leads to many cysts—round sacs of fluid—to develop inside and on the surfaces of the kidneys. The cysts interfere with kidney function and are usually a more serious medical problem.

  1. Chronic kidney disease

This is the most common kidney problem and often results in deteriorated kidney function, even to levels where they no longer properly perform their functions and may require dialysis. 

Chronic kidney disease is majorly caused by high blood pressure and diabetes. With high blood pressure, the kidneys are forced to process at least 20-percent of the total volume of blood every minute. 

As a result, there is increased blood on the glomeruli, which eventually damages the filtering apparatus and leads to a decline in function. With uncontrolled blood sugar due to diabetes, there is damage of the functional units of the kidney, resulting in kidney failure.

Enhancing kidney health

When your kidneys are unhealthy, they eventually reach a stage where they may no longer remove waste from blood, a condition called kidney failure. Also, the buildup of waste due to kidney malfunction can cause other serious problems, and ultimately result in death.

When your kidneys fail, your doctor may recommend that your blood be filtered artificially through dialysis. Alternatively, you may need to undergo a kidney transplant.  Both options are demanding and costly, hence the need to maintain healthy kidneys so you don’t end up having to face these options.

At St Pete Urology, we encourage our patients to appreciate the vital role of their kidneys in their lives. We also promote deliberate actions that ensure healthy kidneys, including maintaining an active, health-conscious lifestyle.

If you’re looking for ideas on how to keep your kidneys healthy or are concerned about a bothersome issue you associate with your kidneys, visit us today for help. 

During your visit, we will speak with you about the signs and symptoms of chronic health conditions that can increase your risk of kidney damage or disease.  Plus, we will share ideas on keeping your kidneys and other vital organs healthy.

Come begin a close working relationship with a trustworthy, experienced urologist, which will help you prevent serious health issues in future. For more information on kidney problems and other urinary issues, visit the site “St Pete Urology.”

Is blood in the urine serious?

Blood in the urine, medically referred to as hematuria, should always be taken seriously because any blood in urine can indicate an elevated risk of severe health problems even if it occurs once. 

For instance, it can indicate an infection, kidney disease, cancer or a rare blood disorder.  So if you see blood in your urine, no matter how minor, you should never ignore it and immediately see a urologist. 

What are the different types of hematuria?

Blood in the urine can occur in two ways. It can present itself as gross hematuria or as microscopic hematuria. Gross hematuria means that your urine has significant elevation of blood and its color appears red or pink. Or your urine has spots of visible blood.

Microscopic hematuria means the amount of blood in your urine is so small that it can’t be seen with the naked eye. So your urine is not red or pink in color but a lab test can detect the blood or blood cells in the urine can be detected when a sample of the urine is examined under a microscope.

What are the causes of hematuria?

  1. Urinary tract infection

A bacterial infection somewhere in your urinary tract, kidneys or bladder can cause hematuria. An infection occurs when bacteria enters your urethra and moves and multiplies in the bladder or kidneys. The infection may result in pain, frequent urination, and bleeding that can eventually lead to gross or microscopic hematuria.

  1. Stones

Stones are crystals that form from minerals and other substances in your urine, especially when they are at high concentration. The stones form in the bladder or kidney and may lead to pain and bleeding as the stones pass through the urinary tract. Larger stones typically block the urinary tract and cause significant pain and hematuria.

  1. An enlarged prostate

For men who are middle-aged and older, the prostate gland tends to get bigger, compress the urethra, make it difficult to urinate, and may result in urinary tract infection (UTI). When an enlarged prostate causes UTI, blood in urine is often one of the symptoms of the infection.

  1. Kidney disease

When a kidney is inflamed, infected or damaged, bleeding may occur, resulting in blood in urine. Kidney disease can occur on its own or as part of another disease, like diabetes.  

For instance, in children aged 6-10 years, the kidney disease known as post-streptococcal glomerulonephritis, which tends to develop 1-2 weeks after untreated strep infection, usually causes hematuria. It is nowadays quite rare because antibiotics effectively treat strep infections.

  1. Cancer

Blood in urine can be due to bladder, prostate, or kidney cancer, typically as a symptom of advanced-stage tumor. Because blood in urine is rarely an early sign of cancer, you should see your doctor immediately to rule out the possibility of cancer.

  1. Medications and rare conditions

Hematuria can be caused by drugs like aspirin, penicillin, blood thinners (like heparin and warfarin), and cyclophosphamide (a drug used to treat certain cancers). Rare blood disorders like hemophilia, Alport syndrome, and sickle cell anemia also cause hematuria. 

Plus, you can have blood in your urine after strenuous exercise, a trauma to the kidneys, or if blood is coming from a different source, such as from bowel movement, the vagina in women, or the ejaculate in men.

When should you seek medical attention?

Blood in urine may be a sign of a grave underlying condition, so you should speak with your doctor as soon as possible. You must never ignore hematuria, even if only a small amount of blood occurs in the urine. 

Visit your doctor immediately if you see blood clots as you urinate or if you have hematuria along with nausea, vomiting, fever, chills, or pain in your abdomen, back or side. 

Also, speak with your doctor if you don’t see blood in urine but experience frequent pain, difficulty urinating, or have abdominal or kidney pain, as these could indicate microscopic hematuria.

During your visit, your doctor will ask you about when and the amount of blood you see during urination.  The physician will also want to know how frequently you urinate, any pain or blood clots in the urine, and any medications you’re taking. 

The doctor will then perform a physical exam, obtain a sample of your urine for analysis, and may order imaging tests, like CT scan or cystoscopy.

The treatment offered after the tests will depend on the underlying cause of the hematuria. For instance, if it is due to urinary tract infection, your doctor will prescribe antibiotics. 

For hematuria caused by an enlarged prostate, your doctor may prescribe 5-alpha reductase inhibitors, alpha blockers, or surgery.

Do you have blood in urine? 

For more information on the diagnosis and treatment of urological problems, visit the site “St Pete Urology.”

What Can Cause Poor Bladder Control?

Loss of bladder control, called urinary incontinence, is a common and usually embarrassing problem. It may manifest as leaking of urine when coughing, sneezing, jumping, or during other physical activity. But it can also occur as a sudden, strong, uncontrollable urge to urinate or wake up several times at night.

While the problem tends to occur more commonly in older people, it isn’t an unavoidable consequence of aging. In fact, you don’t have to live with urinary incontinence because you are aging.

So if urinary continence is disrupting your social life and daily routine or affecting your quality of life, speak with your doctor about it. Your urologist will usually begin with a conservative approach of recommending simple lifestyle and dietary changes to help you get relief from the symptoms. Or in some cases the doctor may recommend more aggressive medical treatments to free you from the condition.

Causes of Poor Bladder Control image

Types of urinary incontinence:

  1. Stress incontinence
    Stress incontinence occurs if exerting direct pressure on your bladder results in urine leakage. The urine leaks linked to stress incontinence typically occur when you cough, sneeze, laugh, exercise or lift a heavy item.
  2. Urge incontinence
    Urge incontinence manifests itself if you frequently experience a sudden, intense, uncontrollable urge to pass urine which results in urine leakage. With the strong urge, most find themselves urinating several times per day including throughout the night.
    Urge incontinence may be due to a minor condition, such as urinary tract infection. But it some cases it can be the result of a more severe condition such as diabetes or a neurological disorder.
  3. Overflow incontinence
    Overflow incontinence is when you experience frequent dribbling of urine. Usually the dribbling of urine is due to the inability to fully and completely empty the bladder.
  4. Functional incontinence
    Functional urinary incontinence is the result of physical or mental impairments that makes it difficult to hold urine and for many to even reach the toilet in time to relieve themselves. So many have urine leaking from their bladder as they struggle to reach the bathroom. 
  5. Mixed incontinence
    Mixed incontinence is if you suffer from more than one type of urinary incontinence. Most often mixed incontinence is a combination of urge and stress incontinence.

What can cause poor bladder control?

Many experience urinary incontinence due to an underlying medical condition, a physical problem, or a change in lifestyle.  The incontinence may be temporary if due to a change in daily habits and in those cases is an easily treatable condition. But if the condition is persistent when related to a medical condition or physical problem, undergoing a thorough evaluation by your doctor will help determine the cause of your incontinence.

Causes of temporary urinary incontinence:

  • Urinary tract infections
    Urinary tract infections may also lead to a strong urge to urinate. The urge may be too intense to the point of urine leakage before you can reach the bathroom. With the treatment of the source infection, the incontinence typically disappears.
  • Constipation
    Since the rectum is located near the bladder and shares many nerves with the bladder, having hard, compacted stool in the rectum can cause the nerves controlling the bladder to be overactive. In turn, increased urinary frequency may occur, resulting in incontinence. The incontinence usually resolves when the constipation ends.
  • Drinks that act as diuretics
    Some drinks have the ability to stimulate the bladder and increase urine volume. As a result, urine may leak due to the overwhelming volume in the bladder. Reducing the intake or avoiding these drinks helps to prevent incontinence.

    The drinks include: 

    • a. Caffeine
    • b. Alcohol
    • c. Artificial sweeteners
    • d. Chocolate
    • e. Carbonated drinks and sparkling water
    • f. Chili peppers
    • g. Large doses of vitamin C
    • h. Sedatives, muscle relaxants, and heart and high blood pressure medications
    • i. Foods with too much sugar, spices, or acids, particularly citrus fruits

Causes of persistent urinary incontinence:

  • Pregnancy
    Pregnancy is accompanied by hormonal changes and increased weight of the fetus. These changes may cause stress incontinence.
  • Childbirth
    During vaginal delivery, the muscles that control the bladder may weaken. The nerves and supporting tissues may also be damaged.  Due to the weakening of bladder muscles and damage of nerves and tissues, a prolapse (dropped) may occur in the pelvic floor. 
    Following a prolapse—where the bladder, rectum, uterus or small intestine is pushed down from the normal position and protrudes into the vagina—bladder control diminishes, resulting in incontinence.
  • Aging
    With age, the bladder muscles weaken and bladder control reduces. Also, as you get older, involuntary bladder contractions become more common, increasing the likelihood of incontinence.
  • Menopause
    The production of estrogen—a hormone that keeps the lining of the urethra and bladder healthy—reduces after menopause. As a result, the bladder and urethral tissues deteriorate, causing or aggravating incontinence. 
  • Enlarged prostate
    Benign prostatic hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland. As the prostate enlarges, it puts more pressure on the bladder, which in turn loses control. Thus, an enlarged prostate often triggers urinary incontinence.
  • Prostate cancer
    Untreated prostate cancer can cause stress incontinence in men. Also, urinary incontinence may be an adverse effect of prostate cancer treatment.
  • Urinary tract obstruction
    Overflow incontinence can occur when there is a blockage of the normal flow to urine along the urinary tract. The obstruction may be due to a tumor somewhere in the urinary tract or a urinary stone.
  • Neurological disorders
    Disorders that interfere with the nerves involved in bladder control may trigger urinary incontinence. Neurological issues commonly associated with urinary incontinence include stroke, multiple sclerosis, Parkinson’s disease, brain tumor, and spinal injury.

When should you see a doctor?

Please see a doctor if urinary incontinence is too frequent, embarrassing, and is affecting your quality of life. Your doctor will identify the underlying cause of the problem and administer appropriate treatment. 

Plus, you should see a urologist when the incontinence:

  • Causes you to restrict your social interactions and daily activities.
  • Adversely affects your esteem, confidence, and quality of life.
  • Is accompanied by other symptoms, such as pain or blood in urine.
  • Could pose other risks, such as the risk of falls as you rush to the toilet.
  • Is suspected to be a symptom of a more serious underlying condition.

At St Pete Urology, we have a team of urologists that boasts a rich knowledge and wealth of experience in treating urinary incontinence.  Our urologists conduct a thorough physical exam and take comprehensive medical history before requesting appropriate tests to help identify the underlying cause of incontinence.

We are proud of our tailored treatments and the remarkable results we achieve with all our patients. For more information on urinary incontinence and other urological problems, visit the site “St Pete Urology.”

What Can Cause Incontinence

Tonight we’re going to talk about bowel and bladder control primarily. So Dr. Graves and I both actually trained together at the university of Pennsylvania in Philadelphia. And we’ve been each practicing for close to 10 years and we’ve had five years of urology training in residency and med school before that. And the topic tonight is something that we do have a lot of focus in and enjoy taking care of and have specialty in. So what causes incontinence of urine or stool there’s a huge host of things that something your doctor can figure out but sometimes it could be something you know is simple. If it’s mild like what you’re eating an excess amount of caffeine it can do that. Some people will be drinking an excessive amount of coffee, you know, I talk to some patients they’re drinking a pot of coffee a day. Other times it really has nothing to do with their diet, medications can do that certain diuretics can predispose to issues with urinary control. If you’re not as physically fit bedridden have other physical mobility issues sometimes that can deal with causing incontinence. And then other things can increase your risk like radiation of the pelvis before a prior injury to the spinal cord or your pelvic floor, certain pregnancy issues or childbirth like such as vaginal deliveries sometimes can have something to do with that. Complicated in terms of regards to different causes but something that is often easy to figure out when you see a physician.

What is the most common treatment for bladder cancer?

If you are diagnosed with bladder cancer, there are several effective treatment options including chemotherapy, radiotherapy, and surgery. Your doctor will recommend the best treatment for you depending on your age, the stage of the cancer, the severity of the symptoms, and your overall health.

At St Pete Urology, we use a shared decision-making approach in dealing with bladder cancer. Shared decision-making means that you and your urologist work together to arrive at a personalized treatment. We are very confident in the outcomes that we achieve through this approach.

So what is the most common treatment for bladder cancer?

Surgery is the most common treatment for bladder cancer. In fact, most people with the cancer need to undergo some form of surgery.  And it is only because surgery may not remove all the tumor cells that the other treatments—chemotherapy, radiation, immunotherapy, targeted therapy—may be necessary along with or instead of surgery.

For early stage bladder cancer, the most common surgical procedure is transurethral resection of bladder tumor (TURBT), also called transurethral resection (TUR). During the procedure, the surgeon inserts a cystoscope through the urethra into your bladder and then uses a tool with a tiny wire loop, a laser, or high-energy electricity (fulguration) to remove the tumor.

If the bladder cancer is detected late, your surgeon may opt for cystectomy—a type of surgery that involves the removal of part of the bladder (partial cystectomy) or the whole bladder (radical cystectomy). Partial cystectomy is the ideal option for cancer that is still small and has spread only slightly to the muscle layer of the bladder.

But for cancer that is large or has spread deeper into the bladder muscle or to more than one part of the bladder, radical cystectomy is the go-to option. It is the removal of the whole bladder together with nearby tissues, organs and lymph nodes. In men, this may include the removal of the prostate gland, seminal vesicles, vas deferens, and part of the urethra. And in women, it can mean the removal of the uterus, ovaries, fallopian tubes, and part of the vagina.

Treatments used together with or instead of surgery

  1. Using medicines

Certain medications are effective in destroying cancer cells. Medications used to treat bladder cancer are usually in the form of chemotherapy, immunotherapy or targeted therapy.

  1. Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells. The drugs are administered in two ways: local (Intravesical) and whole-body (systemic). 

For Intravesical chemotherapy, a prescribed drug is delivered to the bladder through a catheter inserted via the urethra.  The drug destroys superficial tumor cells that come into contact with it, but may not be effective for deeper tumor cells or cancer cells that have spread to other organs. The most frequently used local therapy drugs are mitomycin-C, gemcitabine (Gemzar), docetaxel (Taxotere), and valrubicin (Valstar). 

Systemic chemotherapy means that a drug or combination of drugs is taken orally or injected into the veins. The drug travels through the bloodstream to various parts of the body and shrinks, slows down or kills cancer cells that may have spread beyond the bladder. 

Whole-body chemotherapy is done in cycles to give the body time to recover between treatments. Every cycle lasts a few weeks, while a complete treatment may take several months. Plus, systemic chemotherapy is often done before surgery to help shrink tumors, make them easier to remove, make surgery safer, and minimize the likelihood of a recurrence. 

The drug cisplatin is the most commonly used systemic chemotherapy drug to treat bladder cancer, particularly for the most frequent type of the cancer, known as urothelial carcinoma. The drug damages the DNA of tumor cells so they can’t reproduce. Cisplatin is typically used in combination with other drugs. The most common combinations are:

  1. Methotrexate, vinblastine, doxorubicin (Adriamycin), and cisplatin (MVAC)
  2. Gemcitabine and cisplatin (GC)

iii. Cisplatin, methotrexate, and vinblastine (CMV)

  1. Paclitaxel, gemcitabine, and cisplatin (PGC)
  2. Dose-dense (DD)-MVAC, which has mostly replaced MVAC. It has the same regimen as MVAC, has a growth factor support, and administered with short time between treatments.
  3. Immunotherapy

The treatment exploits the body’s own immune system to attack cancer cells. The attack on cancer cells is triggered by materials made either by the body or in the laboratory. There are two types of immunotherapy: local and systemic.

In local immunotherapy, the doctor injects an immune-boosting germ, usually interferon or BCG (Bacillus Calmette-Guerin) into the bladder via a catheter. The material draws the body’s immune cells to the bladder and activates the cells to fight cancer cells.

Systemic immunotherapy is primarily focused on immune checkpoint inhibitors. The drugs used, such as Atezolizumab (Tecentriq), Avelumab (Bavencio), Nivolumab (Opdivo) or Pembrolizumab (Keytruda), have the ability to block the protein PD-1 found on the surface of T cells.  Since protein PD-1 usually stops the immune system from destroying cancer cells, blocking it empowers the immune system to better eliminate cancer cells.

  1. Targeted therapy

The treatment involves using drugs that can target and destroy specific proteins, genes or tissues that enable the growth and survival of cancer cells. Drugs used, such as Erdafitinib (Balversa), Enfortumab vedotin—ejfv (Padcev) and Sacituzumab govitecan (Trodelvy), have the ability to block the growth and spread of cancer cells.

Before targeted treatment, the doctor runs genomic tests to identify the genes, proteins, and other factors contributing to the tumor. This helps to find the most specific molecular targets. 

  1. Radiation therapy

It is the use of high-energy x-rays or other particles to destroy cancer cells. The treatment is administered in the form of external-beam radiation, which is radiation given from a machine located outside the body. The alternative, called brachytherapy or internal radiation therapy, which uses implants, is not ideal for bladder cancer. 

A radiation therapy regimen, or schedule, consists of a specific number of treatments delivered over a set period of time.  

For bladder cancer, radiotherapy is used:

  1. When you have early-stage bladder cancer
  2. When you have early-stage cancer but can’t have surgery
  3. As a follow-up to TURBT or partial bladder removal surgery
  4. To prevent or treat symptoms of advanced bladder cancer

Safe, unparalleled bladder cancer treatment

Are you experiencing bladder cancer symptoms? Or are you worried that your urinary symptoms could be due to bladder cancer?

At St Pete Urology, we have a team of urologists that are skilled, knowledgeable and experienced in bladder cancer diagnosis and treatment. So you can trust us to detect the cancer in its early stages and to administer the most appropriate treatment. 

Through our collaborative, compassionate, multidisciplinary approach, we ensure that our patients get the best possible bladder cancer care. Visit us today for an accurate, timely diagnosis.

For more information on bladder cancer risks, prevention, signs and symptoms, diagnosis and treatment, visit the site “St Pete Urology.”

How Is Bladder Cancer First Diagnosed?

Early diagnosis of bladder cancer is crucial for successful treatment. Unfortunately, there is no specific test available for screening asymptomatic people for the disease. So diagnosis of the cancer primarily relies on the presence of symptoms.  

Working from symptoms

In fact, most cases of bladder cancer are diagnosed when patients report having blood in urine to their doctors. It is at this point that a urine test, called urinalysis, is often ordered to confirm the presence of blood in urine.  

Of course, having blood in urine does not necessarily imply that there is bladder cancer since bleeding can also be due to urinary tract infections, kidney stones, bladder stones, kidney disease, or a non-cancerous tumor. Hence, when blood is present, the urologist will go the extra mile to find out the underlying course.

Apart from blood in urine, your doctor may also suspect bladder cancer if you have urinary symptoms, such as frequent urination, burning sensation during urination, weak urine stream, nocturia, or inability to urinate.

Although occurrence of symptoms is usually the first basis for suspecting bladder cancer, it has various limitations. For instance, there are no symptoms that are specific to the cancer. This may lead to a misdiagnosis of the cancer as another disease with similar symptoms.

Also, many cases of bladder cancer show no symptoms in the early stages. So by the time you’re going to a doctor because of some symptoms, it may already be too late and the cancer could have spread to various organs and become difficult to treat.

Urinary tests

Regular urinary tests can help to detect early-stage bladder cancer. For when there is persistent blood in your urine, your urologist will be prompted to order for further tests.  Usually, when there is any amount of blood in your urine, your doctor will recommend a urine cytology test.

Urine cytology testing uses a random urine sample to check if the urine contains tumor cells. The sample is examined under a microscope to look for the cancer cells. Alternatively, the urine sample can be subjected to molecular analysis, which will detect the presence of various proteins or genes associated with cancer cells. 

Cystoscopy

This is a key bladder cancer diagnostic procedure that allows a urologist to see inside the body with the help of a thin, flexible, lighted tube called a cystoscope.  The cystoscope is inserted into the bladder through the urethra and has a camera to help the doctor clearly view the bladder. 

Apart from assessing the bladder, a cystoscope can be used to take a small tissue sample (biopsy) or to treat early-stage tumors without surgery.  Cystoscopy is a simple outpatient procedure performed in the doctor’s office, and is quite effective in detecting growths in the bladder and determining if there is need for biopsy or surgery.

Biopsy

If your doctor finds abnormal growth in your bladder during cystoscopy, a biopsy is the next and most definitive step. Also called transurethral resection of bladder tumor (TURBT), a biopsy involves the removal of a small amount of tissue from the bladder for examination under the microscope.

Usually the tumor, together with a sample of bladder muscle near the tumor, is removed. But additional biopsies of other parts of the bladder may also be necessary depending on the cystoscopy results. The tissue samples obtained during TURBT are analyzed by a pathologist to confirm bladder cancer, identify the type of tumor, and to find out how deeply it has spread into the layers of the bladder.

What are the warning signs of bladder cancer?

Because the bladder holds urine produced by the kidneys, the warning signs of bladder cancer usually relate to urination. Urine is made in the kidneys and moves down the ureters to the bladder, which then stores the urine to allow for an infrequent, controlled urination.

Blood in urine

The earliest warning sign of bladder cancer is blood in urine, also called hematuria. The blood may be present in the urine regularly or appear sporadically over the course of days or weeks. Plus, it may change the color of urine to orange, pink or dark red—though sometimes there may be no apparent urine color change.

Blood in urine is a critical sign of the cancer because early-stage bladder cancer does not often cause pain or other symptoms except bleeding. In fact, bladder cancer is usually diagnosed after patients tell their doctor about having urine in their blood.

Gross hematuria is when blood is present in urine in such a large quantity that the patient can see it. But sometimes, there may be microscopic hematuria, whereby the blood is present is such a small amount that it can’t be seen by the naked eye, though can be detected by a urine test. 

Nevertheless, blood in urine is not always an indicator of bladder tumor. It could be due to other less serious conditions, such as urinary tract infections, bladder stones, kidney stones, kidney disease, or non-cancerous tumors. Plus, in women, blood from menstruation may appear in urine and could cause a false-positive test result.

Urinary symptoms

While changes in urination are often a sign of less serious conditions, such as urinary tract infections, overactive bladder, benign tumor, bladder stones, or in men, an enlarged prostate, they may also be an early warning sign of bladder cancer.

Urinary symptoms that may indicate bladder cancer include:

  1. Pain or burning sensation during urination
  2. Frequent urination
  3. Nocturia—having to urinate many times throughout the night
  4. Feeling the urge to urinate even when the bladder is not full
  5. Having the urge to urinate, but being unable to pass urine
  6. Weak urine stream
  7. Lower back pain, often on one side of the body

When experiencing these changes, it is advisable to speak with your doctor as soon as possible. Your doctor will do a medical exam and order specific tests to help identify the cause of the symptoms. The doctor will also be able to rule out the cancer or run further tests to diagnose the cancer so that you are put on early treatment.

Advanced bladder cancer warning signs

Not everyone with early-stage bladder cancer will have symptoms. In some people, the first warning signs appear when the cancer has already grown too big or has spread beyond the bladder. 

Warning signs of advanced bladder cancer include:

  1. Pelvic pain
  2. Lower back pain, usually on one side
  3. Fatigue or general body weakness
  4. Inability to urinate
  5. Swelling of the feet
  6. Bone pain
  7. Unexplained weight loss
  8. Loss of appetite

For bladder cancer that has spread to other parts of the body, the symptoms typically depend on the affected organ. For instance, if the cancer has spread to the lungs, it may produce shortness of breath or persistent coughing.

Equally, if the cancer has spread to the liver, it may cause jaundice (yellowing of the skin or eyes) and abdominal pain. And if the cancer has spread to bones, it may lead to bone pain or a broken bone (fracture).

Timely diagnosis and treatment

If you are having blood in urine, urinary symptoms or other disturbing changes, speak with your doctor about them. The doctor will seek to establish how long, how severe, and how often you have been experiencing the symptoms. 

Together with performing a physical examination and ordering lab tests, the doctor will try to figure out the problem. If bladder cancer is suspected, your doctor will request for further tests to confirm the diagnosis.

 For more information on bladder cancer, its signs and symptoms, risks and prevention, and diagnosis and treatment, visit the site “St Pete Urology.”