• Painful Urination
• Trouble Emptying the Bladder
• Trouble Controlling Urine
• Urinating at Night

Difficulties with urination are very common problems caused by several different conditions. During adulthood women are often bothered by urinary tract infections (UTIs). Young men sometimes have irritation of their prostate (prostatitis); older men notice a change in their ability to urinate (prostatism). Older adults of either sex may develop trouble controlling urine. This problem is called incontinence (in-CON-ti-nents).

Evaluation and treatment of a probable urinary tract infection depends on several factors:

• How sick you are. High fever, shaking chills, nausea, or pain in the sides of your lower back are worrisome. You should contact a doctor immediately.
• How often you have had this problem. If the problem comes back many times, long term or preventive treatment may be needed.
• Whether you are pregnant or have (sugar) diabetes. Persons with these conditions are at risk for problems and must be carefully evaluated.

In general, most UTIs in women are easily managed by increasing fluid when the discomfort is noted and, if the problem does not improve in 24 hours, using antibiotics. Cranberry juice is promoted as a natural antibiotic. It does act like a weak antibiotic. An eight ounce glass each day may prevent UTI recurrences. However, a quart or two of water has the same effect.

Over-the-counter pyridium will make the burning less noticeable but will not treat the infection.

The length of time antibiotics are needed will depend on the type of infections. Some women notice that UTIs occur after sexual activity. Urinating immediately after intercourse seems to reduce the risk for infection.

Because urinary infections are rare in men, a doctor should be contacted when painful urination or blood in the urine occurs. The causes in men are most often sexually transmitted disease (a discharge from the penis is noticed) and prostatitis. Prostatitis often returns so long term antibiotic treatment may be required.

If you decide to try medicines, "alpha blockers" are a good choice because you will feel if they are going to work for you within a few weeks. You will also notice if they are causing you problems. If the alpha blocker you are using is affordable and is giving you good relief, you may decide to use it for many years. (Once in a while, it is safe to try not using the pills for a few months to see if the problem comes back. Sometimes it won't. But please talk to your doctor if you are going to stop the pills.)

Surgery is useful for men who are bothered by these urinary difficulties. The prostate is usually removed, cut or "heated" by passing a tube through the penis. Men who have this surgery usually recover completely within a few weeks. The surgery does not seem to cause problems with erections, but some types of surgery may cause the semen to go backwards into the bladder.

Many men worry that their urinary problem is caused by prostate cancer. Small collections of prostate cancer cells can be found in 10% of men who have surgery for an enlarged prostate. However, prostate cancer seldom is the cause for difficult urination.

Persons with incontinence often withdraw from social life and try to hide the problem from their family, friends, and even their doctor. These reactions are unfortunate, because in many cases incontinence can be treated and controlled, if not cured.

If you have problems controlling urine, you should talk to your doctor about it so that your doctor can determine the cause and decrease the chance of other problems. For example, incontinence is sometimes the first and only symptom of a urinary tract infection. Curing the illness usually will relieve or clear up the incontinence.

Even when incontinence cannot be completely cured, modern products and methods of managing the condition can ease the discomfort and inconvenience it causes.

These are the most common forms of urinary incontinence:

* Stress incontinence is the leakage of urine during exercise, coughing, sneezing, laughing, lifting heavy objects, or other body movements that put pressure on the bladder. It occurs most often in women.

* Urge incontinence is the inability to hold urine long enough to reach a toilet. It is often found in people who have conditions such as stroke, dementia, Parkinson's disease, and multiple sclerosis, but it can occur in otherwise healthy older persons.

* Overflow incontinence is the leakage of small amounts of urine from a bladder that is always full. In older men this type of incontinence occurs when an enlarged prostate blocks the flow of urine from the bladder. Another cause is loss of normal bladder contractions in some persons with diabetes.

* Functional incontinence may occur in persons who have normal urine control, but who have difficulty reaching a toilet in time. Since the urinary system is not really the problem, the approach must be to improve access to the toilet or schedule voiding to prevent an ineffective rush to the toilet.

Your doctor will usually talk to you about your type of incontinence and your history of related problems. Your doctor will perform a physical examination that focuses on the urinary and nervous systems and reproductive organs. Your doctor will usually want to check urine samples. In special situations your doctor may perform additional tests to measure the amount of urine in your bladder and its ability to hold urine when stressed. Your doctor will explain these special tests to you.

Your doctor will tailor the treatment of urinary incontinence to your needs. As a general rule, the options include:

* Behavioral techniques. This includes scheduled voiding, pelvic muscle exercises, and biofeedback. They are often very effective in reducing episodes of stress and urge incontinence. These behavioral techniques benefit most persons who try them. (See Women's Issues)

* Medications. Although they can be effective, drugs may cause side effects such as a dry mouth, eye problems, dizziness, and buildup of urine. Therefore, they must be used carefully under a doctor's supervision.

* Surgery. Incontinence that is related to a structural problem such as an abnormally positioned bladder or blockage due to an enlarged prostate can be improved or even cured. Artificial devices that replace or aid the muscles controlling urine flow have been tried in persons with incontinence. Many of these devices require surgery.

* Catheters. Incontinence may be managed by inserting a flexible tube known as a catheter into the urethra and collecting the urine in a container. However, catheters are difficult to manage and greatly increase the chances for bladder infection. Self-catheterization is very effective.

You should avoid taking liquids (and alcohol) within an hour of bedtime and empty your bladder completely after lying in bed for about 30 minutes. If nighttime urination is a big problem for you, please discuss it with your doctor and make sure that you have no hazards in the path from your bedroom to the bathroom!

We have tried to make the How's Your Health error-free. However, those involved in its preparation can not warrant that all of the information is accurate and complete. When you use How's Your Health as a guide for your health and medical care, be sure to discuss any questions about it with your doctor, nurse, or other health care worker.