Disorders of the urinary tract

What are disorders of the urinary tract?

Your urinary tract, made up of your kidneys, ureters, bladder and urethra, works as your body's drainage system, filtering waste and extra fluid out of your blood and removing it as urine. Disorders of the urinary tract are conditions that stop any part of this system working properly, ranging from infections and stones to problems with bladder control and kidney function.

Symptoms of urinary tract disorders

Symptoms depend on which part of the urinary tract is affected and what's causing the problem, but it's worth paying attention to any of the following, since they can be early signs of a urinary tract disorder:

• needing to pass urine more often than usual
• urine leaking (incontinence)
• difficulty starting to pass urine, or a weak stream
• feeling that you're not able to completely empty your bladder
• pain, burning or stinging when you pass urine
• blood in your urine
• pain in your back, side or abdomen.

Some urinary tract disorders, such as early diabetic nephropathy (kidney damage caused by diabetes) or small kidney stones, may cause no symptoms at all for a long time. Others, such as a bladder infection, tend to come on with clear symptoms like pain when passing urine and a frequent, urgent need to go.

Causes and who is at risk

Causes vary widely depending on which disorder you have. Some of the more common causes include:

• infection: bacteria, usually a type called E. coli, can infect the bladder (causing cystitis) or, less often, travel further to infect the kidney. Women are affected around four times more often than men, partly because the female urethra is shorter and closer to the back passage, making it easier for bacteria to reach the bladder
• long-term health conditions: diabetes and high blood pressure are common causes of gradual kidney damage over time, sometimes leading to kidney failure if not well controlled
• genetics: some kidney conditions, such as polycystic kidney disease, are inherited, and cysts can start forming in the kidneys at any point from infancy to adulthood
• kidney stones: these form from crystallised minerals in the urine, and are more likely if you don't drink enough fluids, eat a lot of animal protein, drink a lot of cola, or are overweight
• pelvic floor changes or an enlarged prostate: these are common causes of urinary incontinence, affecting women and men respectively.

Other risk factors that increase your chances of developing a urinary tract disorder include obesity, smoking, a family history of kidney problems, and, for bladder infections specifically, sexual intercourse and certain methods of contraception, such as a diaphragm or spermicide.

Are there different types of urinary tract disorder?

Yes, disorders of the urinary tract cover a wide range of conditions. Some of the more common ones include:

Kidney disorders

• diabetic nephropathy: progressive kidney damage caused by long-standing diabetes, which harms the tiny blood vessels inside the kidneys' filtering units
• polycystic kidney disease (PKD): an inherited condition in which multiple fluid-filled cysts develop in the kidneys, gradually affecting how well they work
• kidney failure: when the kidneys can no longer filter waste from the blood adequately, most often as a result of diabetic nephropathy, PKD, or long-term uncontrolled high blood pressure
• kidney stones: solid crystals that form from minerals in the urine, which can cause pain if they're large enough to block part of the urinary tract.

Bladder and lower urinary tract disorders

• bladder infection (cystitis): a common infection of the bladder, usually caused by bacteria
• stress incontinence: leaking small amounts of urine during activities that put pressure on the abdomen, such as coughing, sneezing or lifting, often linked to pelvic floor changes after childbirth
• urge incontinence, sometimes called an overactive bladder: leaking larger amounts of urine with little warning, caused by the bladder muscle contracting unpredictably
• incontinence linked to the prostate: in men, this is most commonly caused by an enlarged prostate gland, or as a result of treatment for prostate cancer.

How are urinary tract disorders diagnosed?

Diagnosis usually starts with a urine test called a urinalysis. A sample of your urine may be checked with a simple test strip that can pick up signs of infection, blood, protein or sugar in your urine. For example:

• cloudy urine, or nitrites picked up on a test strip, can suggest a urinary tract infection
• protein, such as albumin, in your urine can be a sign of kidney damage, including diabetic nephropathy, or kidney failure
• blood in your urine can point to an infection, a kidney stone, or occasionally something more serious that needs further investigation
• glucose detected in your urine, can be a sign of diabetes.

If an infection is suspected, a sample of your urine may be sent to a laboratory to identify the specific bacteria involved, which helps your doctor choose the most effective antibiotic. Depending on what's suspected, you may also need blood tests, or imaging such as an ultrasound or CT scan, particularly if kidney stones or a structural problem are suspected.

How are urinary tract disorders treated?

Non-surgical treatment

Treatment depends entirely on which disorder you have and how severe it is. Common non-surgical approaches include:

• antibiotics, the main treatment for a bladder or kidney infection
• medication to help control blood sugar and blood pressure, which is important for slowing kidney damage in diabetic nephropathy, alongside reducing salt intake
• pain relief, often enough on its own for a small kidney stone to pass naturally through your urinary tract
• pelvic floor (Kegel) exercises, to strengthen the muscles that support your bladder, particularly for stress incontinence
• medication to relax the bladder muscle, for urge incontinence (an overactive bladder)
• dialysis, if your kidneys can no longer filter your blood adequately. Haemodialysis filters your blood externally through a machine, usually for three to four hours, about three times a week, and is one of the most common procedures carried out in hospitals.

Surgical treatment

Surgery or other procedures may be needed for some conditions:

• lithotripsy: a non-invasive procedure using high-intensity ultrasound pulses to break a kidney stone into smaller pieces that can pass more easily; this can occasionally cause some damage to the kidney
• a ureteral stent: a small tube inserted into the ureter to hold it open, allowing urine, and sometimes the stone itself, to pass
• surgery to remove a large kidney stone directly, if other methods aren't suitable
• surgery to improve support for the bladder, in more serious cases of stress incontinence
• kidney transplant, for kidney failure or polycystic kidney disease, once the kidneys can no longer support the body's needs; this is currently the only way to cure polycystic kidney disease, since there's no other treatment for the underlying condition.

When should I see a doctor?

See your doctor if you notice any changes in your usual urinary habits, including needing to pass urine more often than usual, leaking urine, finding it harder to start passing urine, or feeling that you can't fully empty your bladder. These can be early signs of a urinary tract problem, and getting help promptly can help prevent it becoming more serious.

See a doctor urgently if you have severe pain, a high fever, or blood in your urine, since these can be signs of a more serious problem that needs prompt attention.