Transcription:

Caitlin Whyte: Urinary issues are very common as men and women age. So in this episode, we will explore the signs of an unhealthy urinary tract and how you can work towards a better flow. Joining us for this discussion are urogynecologist, Dr. Carey Andreoiu, and urologist, Dr. Matei Andreoiu. And yes, if you were wondering, they're married.

This is Putting Your Health First. I'm your host, Caitlin Whyte. So we're going to be going over urinary issues in both men and women today. So Dr. Matei, I'll start with you discussing men's urinary care. What are some common issues or complaints that patients come in for?

Matei Andreoiu, M.D.: Well, I think, you know, a lot of the patients that I see obviously are men. And when you talk about urinary issues in men, I think you have to start with the lower urinary tract and that the main organs there are bladder and prostate. And prostate problems affect a very large percentage of men, especially over the age of 50. And what happens is that as we age as men, our prostates slowly increase in size. In some men, it starts earlier and in some men, it occurs much more rapidly into a greater extent. And, with this age-associated growth in the prostate, what happens is that the prostate tissue gets in the way of urinary flow and makes it harder for the bladder to empty itself. And that can create a host of issues and symptoms, which can include difficulty starting a stream, having an interrupted stream, having difficulty emptying your bladder as well as irritated symptoms such as having trouble controlling your urination, having trouble holding it essentially, going to the bathroom too frequently. And even in extreme cases, not being able to hold your urine and having incontinence. In turn, having a chronic history of these kinds of symptoms secondary to obstruction can lead to bladder and even kidney problems down the road. And so the urologist's role is to diagnose these issues and determine the best way to go about addressing them and preventing more longterm complications.

Caitlin Whyte: So then what are some of the common diagnoses that end up here?

Matei Andreoiu, M.D.: We see a lot of enlarged prostate causing various symptoms. Sometimes they come in presenting with just a diagnosis of enlarged prostate. Sometimes they come in with a diagnosis of isolated symptoms, which ultimately are found to be secondary to enlarged prostate. Again, a large majority of men with urinary issues, particularly beyond the age of 50, ultimately are mostly due to benign enlargement of the prostate. Now, sometimes there can be other causes such as infections, including of the prostate; stones, including bladder stones; as well as even potentially tumors of the lower urinary tract, including prostate cancer, which of course is the most common cancer in men. That can also affect urinary function. But by and large, in many of the cases, it's due to an enlarging prostate.

Caitlin Whyte: Now, I know we're covering multiple issues here, kind of a broad urinary subject. But overall, what does treatment look like for conditions like these? Is it mostly stuff we can take home and take care of ourselves? Or are there bigger treatment plans?

Matei Andreoiu, M.D.: Well, so initially we generally run a few basic tests such as look at the urine to assess for the presence of blood or signs of infection. Sometimes we'll run a test to look at the flow and also bladder emptying to see if the bladder is emptying properly. Sometimes we'll do a test to look at the kidneys to see if there's been any impact on the kidneys from lower tract problems. And sometimes we'll screen for prostate cancer to make sure that there isn't maybe an element of prostate cancer, as well as look for evidence of blood that might indicate more serious underlying issues.

In most cases where the problem is just a straightforward, age-related enlargement of the prostate, we usually try to see if there's anything we can modify and improve just through a conservative management sort of including modifying fluid intake, making sure that they're not consuming excessive amounts of certain beverages that can irritate the bladder such as coffee, tea, soda, and alcohol. Sometimes they may need to go to the bathroom more frequently. They may need to take a greater amount of time urinating and not over straining. But if those measures don't work, sometimes we need to go ahead with medical therapy and there are several medications out there that can alleviate an obstructive prostate and improve urinary flow, thereby improving those symptoms that are related to that. And if medications do not prove effective or are initially effective, but stop being effective after a certain period of time, then there are procedural treatment options as well, some less invasive than others, which would involve essentially alleviating the obstruction that there's different ways to do that. And I'm not going to go into detail, but there are multiple procedures. Most of them are outpatient procedures, meaning that the patient does not have to stay in hospital overnight. And most of them are very safe, have a quick recovery period and ultimately lead to very good long-term outcomes.

Caitlin Whyte: Well, what are some ways that we can keep our urinary system functioning and healthy and try to avoid all these problems?

Matei Andreoiu, M.D.: Yeah. So first and foremost, I think obviously we can't stress this often enough, lot of water intake and making sure that you're keeping yourself well-hydrated, flushing out the system, that helps just prevent, reduce the risk of infections. Also, clearing out bodily waste and also in patients with kidney stones, also reducing crystallization in the urine that could lead to kidney stones. At the same time, you do not want to over hydrate yourself. Some people go too far and drink excessively large amounts of water. So I generally advise anywhere from 70 to 100 ounces of water daily, I think would be optimal, obviously a little bit more for patients that are more active, sweat more and do more physical exertion. So that would be first and foremost. As I mentioned earlier, avoiding some of these substances that can be irritating to the bladder and can promote certain symptoms such as, you know, symptoms of overactive bladder, such as frequent urination and very urgent urination, such as artificial sweeteners, soda, highly caffeinated teas, and coffee and alcohol as well. Trying not to hold your urine is also important, not overstretching or overdistending your bladder. And just practicing overall good health and getting plenty of sleep, eating right and exercising regularly.

Caitlin Whyte: So as we wrap up our section talking about men's urinary health here, what are some symptoms that are maybe red flags, things that you shouldn't try and treat at home, you should head to your doctor before they become bigger issues?

Matei Andreoiu, M.D.: Sure. So, firstly, I think that anytime you notice blood in the urine, that's an important indicator that there may be something wrong. And there can be plenty of benign causes for either microscopic levels of blood or frank visible blood in the urine. But certainly, we do always need to rule out potentially serious underlying causes and blood in the urine to any significant level does require a full urologic workup, again to rule out things like tumors or stones. If you have recurrent infections, I think that does raise the possibility that there may be an underlying anatomic issue in your urinary tract that could be predisposing you to infections and something that needs to be assessed urologically, as well if you are having significant retention, which could impact the kidneys, that would definitely be an indicator for further neurologic workup. If you're having significant trouble urinating, a very weak stream or feeling like you're not emptying properly, as well as if you're having a recent onset or chronic onset of incontinence, essentially not being able to hold your urine, leaking urine, that could be an indicator of something more serious going on. So those are the major sort of urinary signs that should prompt a visit to your primary care and eventually to the urologist.

Caitlin Whyte: Great. Well, doctor, is there anything that we missed or that you want to add focusing on men's urinary care?

Matei Andreoiu, M.D.: Well, I think probably my main message to men, especially those over the age of 50 is pay attention to your body. Be proactive with your health. As we know, a lot of men tend to not seek care as, as frequently as they should and often dismiss or ignore potentially serious symptoms or clinical signs. So my suggestion would be that to not ignore those signs. If your gut instinct tells you that something might be wrong, then you need to follow up on that and make sure it does get investigated. Follow a healthy lifestyle as I said, exercise, eat a well-balanced diet and be on the lookout for any unusual or unexpected or progressive urinary symptoms like I described earlier.

Caitlin Whyte: Absolutely. Well, Dr. Matei, thank you so much for covering men's health. Now, we are going to Dr. Carey to focus on women's urinary systems. Just the girls now. So please, Dr. Carey, start us off with some common issues or complaints that you see your female patients come in with.

Carey Andreoiu, D.O.: The two most common urinary complaints that I see would be probably stress incontinence and overactive bladder. So, you know, urinary incontinence and we can kind of divide them into whether it's a muscle problem or a nerve problem. And then, I also see a lot of recurrent urinary tract infections because that becomes more common as women get older. And then as part of my specialty, I also see a lot of women with prolapse where, you know, the internal organs in the vagina, uterus, bladder can start to fall which can make it difficult to fully empty your bladder, leading to either retention, not emptying or, you know, frequency, just having to go so often, especially at night because they're just not able to fully empty.

Caitlin Whyte: And then what are some common diagnoses that those issues end up being?

Carey Andreoiu, D.O.: Under urinary incontinence, you know, the two primary ones are either overactive bladder or stress incontinence. And quite often in women, they happen both simultaneously. So, you know, there are some different tests and exams that we do in the office to find out where on the continuum they are with maybe overactive bladder and stress incontinence, because they're caused by different mechanisms. Therefore, the treatment options for both are different, so it's important to differentiate. And then, you know, I see a lot of prolapse as well. So difficulty emptying their bladder can be one. And then, you know, lastly because of menopause and the decrease in estrogen levels, recurrent urinary tract infections become an issue as you get older. And so I see a lot of women who either maybe got one or two in their 40s and 30s, and now they're getting them every other month or, you know, things like that. So I think those are the most common.

Caitlin Whyte: Walk us through those treatments, starting with home care options, moving towards something that might need to take place in the office.

Carey Andreoiu, D.O.: So for both overactive bladder and stress incontinence, as well as actually recurrent urinary tract infections, topical estrogen cream is very helpful. One of the things that happens in menopause is that the tissue in the bladder and the vagina becomes very thin and very sensitive. So it can lead to bladder irritability. It can lead to weakness in the muscles, which can cause stress incontinence, and then it can also lead to an increase in urinary tract infection. So that's an easy medication. It doesn't get absorbed into the bloodstream. It's just twice a week and it can make a big difference.

The other thing that can be very helpful is there are several pelvic floor physical therapists in the area that it's not an at-home treatment, but, you know, a lot of times when women try to do Kegel exercises, what they're doing is contracting the butts, the thighs, but they're not really isolating the muscles that they need to. So having somebody show them how to do those exercises and isolate those muscles correctly, and then they can do the exercises at home, so that can also be very helpful. And then for urinary tract infections, there are some over-the-counter supplements that can be helpful. One of which is D-mannose and you can get that of any drug store, Target, Amazon, and it can really help if you take it daily.

Caitlin Whyte: Beautiful. So again, what are some things that we can do to avoid these issues and stay healthy?

Carey Andreoiu, D.O.: You know, I think just starting early with the topical hormone cream so that the muscles, the tissue doesn't get weak, it doesn't become thin, you know, that's very helpful and you can avoid a lot of the urinary tract infections and bladder irritability that can come along with. I think what Matei was mentioning for men is also true for women. So watching what you eat and drink, you know, the same way that if you have heartburn, it can cause your heartburn to exacerbate, everything that you eat and drink is going to end up in the bladder, urine. And so, you know, just because you could drink seven cups of coffee in your 20s doesn't mean that in your 60s, it's not going to impact and, you know, make your frequency worse. So I think those two are probably the big ones. Just sort of, you know, watching diet, topical estrogen cream. And also kind of intervening early, you know, if you have some minor urinary frequency or minor leakage, working on those muscles, getting into physical therapy, it can make a big difference to sort of push off any sort of intervention that you would need.

Caitlin Whyte: And then wrapping up our segment here on women's issues, talk about some red flags, some symptoms that are really concerning that you should definitely get in touch with your doctor about.

Carey Andreoiu, D.O.: I think that it's very similar across the board. What Matei was talking about for men rings true for women too. So, you know, anytime you see blood in your urine, or if you go to, you know, your primary care, they do a clean catch urinalysis and they see microscopic blood in the urine, that warrants some kind of a workup. So it can be a benign process, but you want to rule out that there's something more going on. And I think anytime there's an abrupt change in symptoms, so you didn't have urinary tract infections and now you're having them every other month or you didn't have leakage and now you're having pretty substantial leakage, wetting through your clothes. I mean, anytime there's a big change, you know, because things should sort of change gradually. And then, you know, anytime you feel like you're not able to empty your bladder, that can lead to some long-term issues as far as it backing up into your kidney, stretching the bladder, things like.

Caitlin Whyte: Great. Well, doctor, again, are there anythings when it comes to women's urinary care that we missed or that you want people to know?

Carey Andreoiu, D.O.: I think the only thing that I would tell women is that, especially for the two most common, you know, stress incontinence and overactive bladder, I think a lot of people think that, you know, you have to have surgery or some kind of procedure, and there are a lot of conservative office, at-home things that you can do, especially if it's still in the mild range to fix that, to make it better, to not have to do anything substantial.

Caitlin Whyte: Well, thank you both so much for covering these issues and keeping our community informed. We appreciate your time. If you think you may have a urinary issue, we encourage you to schedule an appointment by calling 321-434-3131. That's 321-434-3131. Or visit hf.org/schedule. This is Putting Your Health first. I'm your host, Caitlin Whyte. Thanks for tuning in.