urethral

The urethra is the tube that allows urine to pass out of the body. In men, it's a long tube that runs through the penis. It also carries semen in men. In women, it's short and is just above the vagina. Urethral problems may happen due to aging, illness, or injury. They include:

• Urethral cancer - a rare cancer that happens more often in men
• Urethral stricture - a narrowing of the opening of the urethra
• Urethritis - inflammation of the urethra, sometimes caused by infection

Urethral problems may cause pain or difficulty passing urine. You may also have bleeding or discharge from the urethra.

Doctors diagnose urethral problems using different tests. These include urine tests, x-rays and an examination of the urethra with a scope called a cystoscope. Treatment depends on the cause of the problem. It may include medicines and, in severe cases, surgery.

The prostate is a gland in the male reproductive system. It lies just below the bladder. It makes fluid that is part of semen.

An enlarged prostate is when your prostate gland becomes larger than normal. It's also called benign prostatic hyperplasia or BPH for short. Benign means not cancer. And hyperplasia means too much cell growth. BPH isn't cancer and it doesn't increase your risk of getting prostate cancer.

Usually, the prostate gland continues to grow during adult life. That's why BPH is the most common prostate condition in people over age 50. As the prostate gets bigger, it may press against the bladder and pinch the urethra. This can slow or block the flow of urine out of your bladder.

Over time, the bladder muscle may become weak from trying to pass urine through a narrow urethra. When this happens, your bladder may not empty completely when you urinate. A narrowed urethra and weak bladder cause many of the urinary problems you may have with BPH.

Researchers aren't sure why the prostate keeps growing. Some researchers think changes in hormones with aging may cause the prostate to get bigger.

You're more likely to develop BPH if you:

• Are age 40 or older. The chance of getting BPH increases as you get older.
• Have family members who have had BPH.
• Have certain health conditions such as:
  • Obesity.
  • Heart disease and problems with blood circulation.
  • Type 2 diabetes.
  • Erectile dysfunction.
• Don't get enough physical activity.

Symptoms of BPH include:

• Having a frequent or urgent need to urinate
• Waking up many times to urinate
• Having problems with urine flow, such as:
  • Trouble starting to urinate
  • A stream that's weak, slow, or stops and starts
  • Dribbling after urination
  • Urinary incontinence
  • Feeling that you can't completely empty your bladder
• Pain after ejaculation or during urination
• Urine with an unusual color or smell

It's important to see your health care provider if you have any of these symptoms because they could be from a more serious health problem.

You should get medical help right away if you:

• Can't urinate at all
• Have fever and chills with urination that's painful, frequent, and urgent
• Have blood in your urine
• Have pain in your lower abdomen (belly) and urinary tract

For most people, BPH doesn't cause other problems. But BPH increases your chance of developing serious conditions, including:

• Acute urinary retention. With this condition, you suddenly can't urinate at all. This a medical emergency. Acute urinary retention is common in older males and the chance of having it increases with age. It may be triggered by:
  • Taking certain over-the-counter cold or allergy medicines
  • Drinking alcohol
  • Cold temperatures
  • Not moving enough over a long period of time
• Urinary tract infections (UTIs)
• Bladder damage and bladder stones
• Kidney damage

To find out if you have BPH, your provider will:

• Ask about your medical history. Be sure to tell your provider about all the medicines you take, because certain medicines can make BPH symptoms worse.
• Ask about your family health history.
• Examine you. The exam may include a digital rectal exam (DRE) of your prostate. In a DRE, your provider inserts a gloved finger into your rectum to check if your prostate is large, tender, or irregular in any other way.
• Order medical tests, if needed, such as:
  • Urine tests.
  • A PSA blood test (prostate-specific antigen test).
  • Urodynamic testing to see how well you can hold and release urine.
  • Cystoscopy to look inside your urethra and bladder.
  • Ultrasound pictures of your prostate and urinary tract.
  • A prostate biopsy to diagnose or rule out prostate cancer.

Not everyone needs treatment for BPH. Treatment options depend on how much your symptoms bother you, your health, age, and the size of your prostate:

• Lifestyle changes may improve mild symptoms. They include:

  • Drinking less before bedtime or going out
  • Avoiding or cutting back on beverages with caffeine and alcohol
  • Bladder training and exercising the muscles that control urine flow
  • Preventing or treating constipation

• Medicines can help mild to moderate symptoms by:

  • Stopping the prostate from growing
  • Shrinking the prostate
  • Relaxing muscles to improve urine flow

  Sometimes combining 2 types of medicine helps more than taking just one type of medicine.

• Medical procedures can help improve moderate to severe BPH symptoms when medicines don't help enough. There are several different types of procedures. They all use an instrument inserted into the urethra to either:

  • Widen the urethra
  • Destroy part of the prostate with heat

• Surgery may be helpful when symptoms are severe, other treatments haven't helped, or you have another problem, such as bladder damage. Different types of surgery are used to:

  • Remove part or all of the prostate
  • Make cuts in the prostate to take pressure off the urethra

  Most BPH surgery is done with tools inserted into the urethra.

Your provider can explain the possible benefits and side effects of your treatment options so you can decide what's best for you.

Researchers haven't found ways to prevent BPH. You can take care of your prostate health by:

• Talking with your provider about your risk for developing an enlarged prostate
• Getting regular checkups
• Paying attention to your symptoms so you can get treatment early if you see signs of BPH

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Urinary incontinence (UI) is the loss of bladder control, or being unable to control urination. It is a common condition. It can range from being a minor problem to something that greatly affects your daily life. In any case, it can get better with proper treatment.

There are several different types of UI. Each type has different symptoms and causes:

• Stress incontinence happens when stress or pressure on your bladder causes you to leak urine. This could be due to coughing, sneezing, laughing, lifting something heavy, or physical activity. Causes include weak pelvic floor muscles and the bladder being out of its normal position.
• Urge, or urgency, incontinence happens when you have a strong urge (need) to urinate, and some urine leaks out before you can make it to the toilet. It is often related to an overactive bladder. Urge incontinence is most common in older people. It can sometimes be a sign of a urinary tract infection (UTI). It can also happen in some neurological conditions, such as multiple sclerosis and spinal cord injuries.
• Overflow incontinence happens when your bladder doesn't empty all the way. This causes too much urine to stay in your bladder. Your bladder gets too full, and you leak urine. This form of UI is most common in men. Some of the causes include tumors, kidney stones, diabetes, and certain medicines.
• Functional incontinence happens when a physical or mental disability, trouble speaking, or some other problem keeps you from getting to the toilet in time. For example, someone with arthritis may have trouble unbuttoning his or her pants, or a person with Alzheimer's disease may not realize they need to plan to use the toilet.
• Mixed incontinence means that you have more than one type of incontinence. It's usually a combination of stress and urge incontinence.
• Transient incontinence is urine leakage that is caused by a temporary (transient) situation such as an infection or new medicine. Once the cause is removed, the incontinence goes away.
• Bedwetting refers to urine leakage during sleep. This is most common in children, but adults can also have it.
  • Bedwetting is normal for many children. It is more common in boys. Bedwetting is often not considered a health problem, especially when it runs in the family. But if it still happens often at age 5 and older, it may be because of a bladder control problem. This problem could be caused by slow physical development, an illness, making too much urine at night, or another problem. Sometimes there is more than one cause.
  • In adults, the causes include some medicines, caffeine, and alcohol. It can also be caused by certain health problems, such as diabetes insipidus, a urinary tract infection (UTI), kidney stones, enlarged prostate (BPH), and sleep apnea.

In adults, you are at higher risk of developing UI if you:

• Are female, especially after going through pregnancy, childbirth, and/or menopause
• Are older. As you age, your urinary tract muscles weaken, making it harder to hold in urine.
• Are a man with prostate problems
• Have certain health problems, such as diabetes, obesity, or long-lasting constipation
• Are a smoker
• Have a birth defect that affects the structure of your urinary tract

In children, bedwetting is more common in younger children, boys, and those whose parents wet the bed when they were children.

Your health care provider may use many tools to make a diagnosis:

• A medical history, which includes asking about your symptoms. Your provider may ask you to keep a bladder diary for a few days before your appointment. The bladder diary includes how much and when you drink liquids, when and how much you urinate, and whether you leak urine.
• A physical exam, which can include a rectal exam. Women may also get a pelvic exam.
• Urine and/or blood tests
• Bladder function tests
• Imaging tests

Treatment depends on the type and cause of your UI. You may need a combination of treatments. Your provider may first suggest self-care treatments, including:

• Lifestyle changes to reduce leaks:
  • Drinking the right amount of liquid at the right time
  • Being physically active
  • Staying at a healthy weigh
  • Avoiding constipation
  • Not smoking
• Bladder training. This involves urinating according to a schedule. Your provider makes a schedule from you, based on information from your bladder diary. After you adjust to the schedule, you gradually wait a little longer between trips to the bathroom. This can help stretch your bladder so it can hold more urine.
• Doing exercises to strengthen your pelvic floor muscles. Strong pelvic floor muscles hold in urine better than weak muscles. The strengthening exercises are called Kegel exercises. They involve tightening and relaxing the muscles that control urine flow.

If these treatments do not work, your provider may suggest other options such as:

• Medicines, which can be used to
  • Relax the bladder muscles, to help prevent bladder spasms
  • Block nerve signals that cause urinary frequency and urgency
  • In men, shrink the prostate and improve urine flow
• Medical devices, including
  • A catheter, which is a tube to carry urine out of the body. You might use one a few times a day or all the time.
  • For women, a ring or a tampon-like device inserted into the vagina. The devices pushes up against your urethra to help decrease leaks.
• Bulking agents, which are injected into the bladder neck and urethra tissues to thicken them. This helps close your bladder opening so you have less leaking.
• Electrical nerve stimulation, which involves changing your bladder's reflexes using pulses of electricity
• Surgery to support the bladder in its normal position. This may be done with a sling that is attached to the pubic bone.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

The prostate is a gland in the male reproductive system. It lies just below the bladder. It makes fluid that is part of semen.

There are many types of prostate diseases:

• Prostatitis is inflammation (swelling and pain) in the prostate gland. It's the most common type of prostate problem in people under than age 50. There are different types:
  • Chronic prostatitis is also called chronic pelvic pain syndrome. It's the most common type of prostatitis.
  • Acute bacterial prostatitis starts suddenly from a bacterial infection and is treated with antibiotics. It is not common.
  • Chronic bacterial prostatitis happens when a bacterial infection keeps coming back. The symptoms usually start slowly. It may take longer to treat than acute bacterial prostatitis.
  • Asymptomatic prostatitis has no symptoms and usually doesn't need treatment. You may learn you have it after having tests for other health problems.
• Enlarged prostate is also called benign prostatic hyperplasia (BPH). The prostate gland tends to grow larger with age. That's why enlarged prostate is very common in older people and rare in those who are under age 40. When the prostate grows larger, it may press on your urethra and cause problems with urination.
• Prostate cancer happens when cancer cells form in the prostate gland. Prostate cancer is a common type of cancer in those aged 50 and older. Most prostate cancers grow slowly and may never cause health problems. But certain prostate cancers are serious.

Anyone with a prostate can develop prostate problems. But some people are at higher risk.

You may be more likely to develop prostatitis if you have:

• A lower urinary tract infection, also called a UTI. An infection in your lower urinary tract (bladder and urethra) may lead to acute or chronic bacterial prostatitis.
• Nerve damage in your lower urinary tract from surgery or an injury. This may lead to chronic prostatitis.
• Emotional stress, which can lead to chronic prostatitis.

You may be more likely to develop an enlarged prostate (BPH) if you:

• Are age 40 or older.
• Have family members who have had BPH.
• Have certain health conditions such as:
  • Obesity.
  • Heart disease and problems with blood circulation.
  • Type 2 diabetes.
• Don't get enough physical activity.

You may be more likely to develop prostate cancer if you:

• Are older than age 50.
• Have a parent, sibling, or child who has or had prostate cancer.
• Are African American.

The symptoms of prostate problems include:

• Needing to urinate a lot.
• Needing to rush to the bathroom, but not being able to urinate or only going a little.
• Leaking or dribbling urine.
• Having a weak urine stream.

Other symptoms depend on the type of prostate problem you have and may include:

• Not being able to urinate at all. This is a medical emergency.
• Any problems, starting or controlling urine flow.
• Waking up often to urinate.
• Blood in your urine or urine that has an unusual smell or color.
• Fever, chills, or body aches.
• Great discomfort or pain:
  • While urinating or after ejaculation.
  • In your abdomen (belly), between your scrotum and anus, or in your scrotum or penis.

Contact your provider if you have any of these symptoms.

To find out if you have a prostate problem, your provider will:

• Ask about your medical history and symptoms.
• Ask about your family health history.
• Do a physical exam. The exam may include a digital rectal exam (DRE) of your prostate. In a DRE, your provider inserts a gloved finger into your rectum to feel the general size and condition of your prostate.
• Order tests, if needed. Tests may include:
  • Blood and urine tests to look for infection.
  • Urodynamic testing to see how well you can hold and release urine.
  • Cystoscopy to look inside your urethra and bladder.
  • Ultrasound pictures of your prostate and urinary tract.
  • A PSA blood test (prostate-specific antigen test).
  • Prostate biopsy to diagnose or rule out cancer.

Treatment depends on what prostate disease you have and which symptoms bother you most.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Gonorrhea is a sexually transmitted infection (STI). It is most common in young adults. The bacteria that cause gonorrhea can infect the genital tract, mouth, or anus. You can get gonorrhea during vaginal, oral, or anal sex with an infected partner. A pregnant woman can pass it to her baby during childbirth.

Gonorrhea does not always cause symptoms. In men, gonorrhea can cause pain when urinating and discharge from the penis. If untreated, it can cause problems with the prostate and testicles.

In women, the early symptoms of gonorrhea often are mild. Later, it can cause bleeding between periods, pain when urinating, and increased discharge from the vagina. If untreated, it can lead to pelvic inflammatory disease, which causes problems with pregnancy and infertility.

Your health care provider will diagnose gonorrhea with lab tests. Treatment is with antibiotics. Treating gonorrhea is becoming more difficult because drug-resistant strains are increasing. Correct usage of latex condoms greatly reduces, but does not eliminate, the risk of catching or spreading gonorrhea. If your or your partner is allergic to latex, you can use polyurethane condoms. The most reliable way to avoid infection is to not have anal, vaginal, or oral sex.

Centers for Disease Control and Prevention

Sexually transmitted infections (STIs), or sexually transmitted diseases (STDs), are infections that are passed from one person to another through sexual contact. They are usually spread during vaginal, oral, or anal sex. But sometimes they can spread through other sexual contact involving the penis, vagina, mouth, or anus. This is because some STIs, like herpes and HPV, are spread by skin-to-skin contact.

Some STIs can be passed from a pregnant person to the baby, either during pregnancy or when giving birth. Other ways that some STIs may be spread include during breastfeeding, through blood transfusions, or by sharing needles.

There are more than 20 types of STIs, including:

• Chlamydia
• Genital herpes
• Gonorrhea
• HIV
• HPV
• Pubic lice
• Syphilis
• Trichomoniasis

STIs can be caused by bacteria, viruses, and parasites.

Most STIs affect both men and women, but in many cases the health problems they cause can be more severe for women. If an STI is passed to a baby, it can cause serious health problems.

STIs don't always cause symptoms or may only cause mild symptoms. So it is possible to have an infection and not know it. And even without symptoms, STIs can still be harmful and may be passed on during sex.

If there are symptoms, they could include:

• Unusual discharge from the penis or vagina
• Sores or warts on the genital area
• Painful or frequent urination (peeing)
• Itching and redness in the genital area
• Blisters or sores in or around the mouth
• Abnormal vaginal odor
• Anal itching, soreness, or bleeding
• Abdominal (belly) pain
• Fever

If you are sexually active, you should talk to your health care provider about your risk for STIs and whether you need to be tested. This is especially important since many STIs do not usually cause symptoms.

Some STIs may be diagnosed during a physical exam or through STI testing. Some tests involve a microscopic examination of a sore or fluid swabbed from the vagina, penis, or anus. Blood tests can diagnose other types of STIs.

Antibiotics can treat STIs that are caused by bacteria or parasites. There is no cure for STIs caused by viruses, but antiviral medicines can often help with the symptoms and lower your risk of spreading the infection.

It's important to get treatment if you have an STI. Some types of STIs can cause serious health problems if they are not treated.

The surest way to protect yourself against STIs is to not have sex.

If you do decide to have sex, you can lower your risk of getting an STI by:

• Having you and your partner tested for STIs before having sex.
• Using a condom every time you have sex. Correct usage of latex condoms greatly reduces, but does not completely eliminate, the risk of catching or spreading STIs. If your or your partner is allergic to latex, you can use polyurethane condoms.
• Reducing your number of sex partners. You might even consider "mutual monogamy" with just one partner. This means that you agree to be sexually active only with them, and they agree to be sexually active only with you. But first you should both get tested to make sure that you don't already have an STI.
• Getting vaccinated against HPV and hepatitis B.

The bladder is a hollow organ in your lower abdomen that stores urine. Bladder cancer occurs in the lining of the bladder. It is the sixth most common type of cancer in the United States.

Symptoms include:

• Blood in your urine
• A frequent urge to urinate
• Pain when you urinate
• Low back pain

Risk factors for developing bladder cancer include smoking and exposure to certain chemicals in the workplace. People with a family history of bladder cancer or who are older, white, or male have a higher risk.

Treatments for bladder cancer include surgery, radiation therapy, chemotherapy, and biologic therapy. Biologic therapy boosts your body's own ability to fight cancer.

NIH: National Cancer Institute

The bladder is a hollow organ in your lower abdomen that stores urine. Many conditions can affect your bladder. Some common ones are:

• Cystitis - inflammation of the bladder, often from an infection
• Urinary incontinence - loss of bladder control
• Overactive bladder - a condition in which the bladder squeezes urine out at the wrong time
• Interstitial cystitis - a chronic problem that causes bladder pain and frequent, urgent urination
• Bladder cancer

Doctors diagnose bladder diseases using different tests. These include urine tests, x-rays, and an examination of the bladder wall with a scope called a cystoscope. Treatment depends on the cause of the problem. It may include medicines and, in severe cases, surgery.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Chlamydia is a common sexually transmitted infection (STI). It is caused by bacteria called Chlamydia trachomatis. Anyone can get chlamydia. It often doesn't cause symptoms, so people may not know that they have it. Antibiotics can cure it. But if it's not treated, chlamydia can cause serious health problems.

You can get chlamydia during oral, vaginal, or anal sex with someone who has chlamydia. A pregnant person can also pass chlamydia to the baby during childbirth.

If you've had chlamydia and were treated in the past, you can get re-infected if you have unprotected sex with someone who has it.

Chlamydia is more common in young people, especially young women. You are more likely to get infected with chlamydia if you don't consistently use a condom or if you have multiple partners.

Chlamydia doesn't usually cause any symptoms. So you may not realize that you have it. But even if you don't have symptoms, you can still pass the infection to others.

If you do have symptoms, they may not appear until several weeks after you have sex with someone who has chlamydia.

Symptoms in women include:

• Abnormal vaginal discharge, which may have a strong smell
• A burning sensation when urinating

If the infection spreads, you might get lower abdominal (belly) pain, pain during sex, nausea, and fever.

Symptoms in men include:

• Discharge from your penis
• A burning sensation when urinating (peeing)
• Pain and swelling in one or both testicles (although this is less common)

If the chlamydia infects the rectum (in men or women), it can cause rectal pain, discharge, and bleeding.

There are lab tests to diagnose chlamydia. Your health care provider may ask you to provide a urine sample. Or your provider may use (or ask you to use) a cotton swab to get a sample from your vagina to test for chlamydia.

You should go to your provider for a test if you have symptoms of chlamydia or if you have a partner who has an STI. Pregnant people should get a test when they go to their first prenatal visit.

People at higher risk should get checked for chlamydia every year:

• Sexually active women 25 and younger
• Older women who have new or multiple sex partners or a sex partner who has an STI
• Men who have sex with men (MSM)

In women, an untreated infection can spread to your uterus and fallopian tubes, causing pelvic inflammatory disease (PID). PID can cause permanent damage to your reproductive system. This can lead to long-term pelvic pain, infertility, and ectopic pregnancy. Women who have had chlamydia infections more than once are at higher risk of serious reproductive health complications.

Men often don't have health problems from chlamydia. Sometimes it can infect the epididymis (the tube that carries sperm). This can cause pain, fever, and, rarely, infertility.

Both men and women can develop reactive arthritis because of a chlamydia infection. Reactive arthritis is a type of arthritis that happens as a "reaction" to an infection in the body.

Babies born to infected mothers can get eye infections and pneumonia from chlamydia. It may also make it more likely for your baby to be born too early.

Untreated chlamydia may also increase your chances of getting or giving HIV.

Antibiotics will cure the infection. You may get a one-time dose of the antibiotics, or you may need to take medicine every day for 7 days. It is important to take all the medicine that your provider prescribed for you. Antibiotics cannot repair any permanent damage that the disease has caused.

To prevent spreading the disease to your partner, you should not have sex until the infection has cleared up. If you got a one-time dose of antibiotics, you should wait 7 days after taking the medicine to have sex again. If you have to take medicine every day for 7 days, you should not have sex again until you have finished taking all of the doses of your medicine.

It is common to get a repeat infection, so you need to get tested again about three months after treatment.

The only sure way to prevent chlamydia is to not have vaginal, anal, or oral sex.

Correct usage of latex condoms greatly reduces, but does not eliminate, the risk of catching or spreading chlamydia. If your or your partner is allergic to latex, you can use polyurethane condoms.

Centers for Disease Control and Prevention

Most kinds of arthritis cause pain and swelling in your joints. Joints are places where two bones meet, such as your elbow or knee. Infectious arthritis is an infection in the joint. The infection comes from a bacterial, viral, or fungal infection that spreads from another part of the body. Symptoms of infectious arthritis include:

• Intense pain in the joint
• Joint redness and swelling
• Chills and fever
• Inability to move the area with the infected joint

One type of infectious arthritis is reactive arthritis. The reaction is to an infection somewhere else in your body. The joint is usually the knee, ankle, or toe. Sometimes, reactive arthritis is set off by an infection in the bladder, or in the urethra, which carries urine out of the body. In women, an infection in the vagina can cause the reaction. For both men and women, it can start with bacteria passed on during sex. Another form of reactive arthritis starts with eating food or handling something that has bacteria on it.

To diagnose infectious arthritis, your health care provider may do tests of your blood, urine, and joint fluid. Treatment includes medicines and sometimes surgery.