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UTIs in Men

Types and Symptoms

(What You Should Know*)

The farther into the urinary tract the infection progresses, the greater the number of symptoms. As the infection becomes more severe, the signs tend to be cumulative. The UTI symptoms can develop quite rapidly – over a matter of hours, or more slowly – nagging for several weeks.

Although not everyone with a urinary tract infection has symptoms, most people get at least some, such as:

  • a frequent urge to urinate – having to go a lot, feeling that you have to urinate immediately during the day and/or night (sometimes incontinence may occur);
  • a sharp pain or painful, burning sensation with itching in the area of the bladder or urethra during urination (dysuria).

Mild cases of acute urinary tract infection may disappear spontaneously without any treatment.

*Based on various sources.

Urethritis

In men, a bacterial infection or inflammation of the urethra (tube that carries urine from the bladder) is more frequent. It often sets the stage for the development of cystitis – also known as a lower urinary tract infection as it occurs lower in the urinary tract system than other infections.

Urethritis may cause burning in the penis, especially during urination. It also may be caused by microorganisms that are transmitted through sexual contact, including gonorrhea and chlamydia.

Cystitis

In male adults, the bacterial infection or inflammation of the urinary bladder is 50 times less common than in women. Relatively rare in younger men, the symptoms (mild to severe) of cystitis include:

  • unusually frequent urination,
  • an intense urge to urination,
  • awakening from sleep to pass urine,
  • bedwetting in a person who usually had been dry at night,
  • burning sensation or discomfort during urination,
  • back pain, usually mid-way up the back on one side, even when not urinating,
  • lower stomach, abdominal pain (over bladder), especially during urination,
  • abnormal urine color – dark, cloudy or milky,
  • foul or strong urine odor – stinky urine,
  • blood in urine – bloody, pink urine (hematuria),
  • inability to urinate – despite the urge, only a small amount of urine is passed,
  • slight fever – mild infections often will not cause fever, but moderate to severe bladder infections that involve the kidneys do cause fever,
  • painful or uncomfortable sexual intercourse,
  • malaise (general discomfort),
  • fatigue – feeling bad all over, tired, shaky, washed out,
  • mental changes: confusion and even dementia – especially in the elderly, mental status is often the only manifestation of a urinary tract infection; in this case bacteria in the urine are a reason to treat it, even without physical symptoms.

However, these symptoms do not necessarily mean there is a bladder infection. They just mean there might be a bladder infection.

Severe Infection

If the severe infection is present, it may inflame the bladder wall enough to cause blood in the urine (hematuria). Blood may make the urine look smoky or urine may even appear bloody with small clots.

Visible blood in the urine may also indicate more serious abnormalities of the urinary system and usually requires further medical evaluation.

In case of cystitis, whether or not it is caused by infection, if one or both kidneys are involved, then the condition is called nephritis. If pain is the predominant symptom, interstitial cystitis (IC) may be present.

Noninfectious Cystitis

When no bacteria can be identified as the cause of the symptoms, a non-infectious cystitis, also called abacterial, radiation or chemical cystitis, is usually assumed. In other words, this is an irritation of the bladder not caused by a UTI. Only the symptoms are similar to those caused by a urinary tract infection.

The exact causes of non-infectious cystitis, the most common type of cystitis in women of childbearing years, are often unknown. However, they may be due to:

  • radiation therapy to the pelvis area,
  • chemotherapy medications, and
  • some irritants, such as bubble baths, feminine hygiene sprays, sanitary napkins, or spermicidal jellies, etc.

Irritable Bladder Syndrome

The symptoms of irritable bladder are basically the same as interstitial cystitis. Yet again the main symptoms are:

  • frequency (having to urinate more often),
  • urgency (not being able to wait to urinate, a sudden, compelling urge to urinate),
  • bladder discomfort (aches and pains, soreness, tenderness, irritation),
  • pelvic pain (in the lower abdomen or urethra),
  • bladder instability (the bladder tries to empty before it has filled, and you cannot control it), nocturia (a frequent need to urinate at night).

Frequent emptying of the bladder can become a habit and this habit prevents the bladder from filling to its true capacity. It causes the bladder to become even more irritable and a vicious circle is established.

However, you can retrain your bladder by holding on by contracting your pelvic floor muscles. If “holding on” is difficult, you can try distracting your attention from your bladder by doing something. The feeling of urgency will subside as the bladder contraction dies away. Learn to hold your urine for longer periods. Start by choosing a time interval you are reasonably comfortable with.

People with painful bladder syndrome often find avoiding acids and caffeine in their diet helpful, as they can trigger flare-ups, sudden appearance or worsening of symptoms.

Urethral Syndrome

Urethral syndrome, also known as urethral pain syndrome, is the term for a group of symptoms that can occur when the urethra becomes inflamed and, therefore, irritated. A close examination reveals an inflammatory status of the bladder neck and trigone, described as trigonitis.

When the urethra becomes inflamed and irritated, it swells up and the tube narrows, which can make it more difficult for a person to pass urine.

Males with urethral syndrome may also experience discharge from their penis and symptoms relating to sexual function, such as swollen testicles, pain while ejaculating, and blood in the semen.

This is still an ill-understood disease responsible for lower urinary tract symptoms, as urinary frequency, urinary urgency, burning micturition (painful urination), hematuria (blood in urine), and pelvic pain associated with negative urine cultures, meaning no signs of a bacterial infection.

Diagnosis can be difficult because the symptoms are often similar to those of other conditions, such as UTI, cystitis, or urethritis, which can also affect the urethra. For this reason, urethral syndrome is most often misdiagnosed.

As patients have no bacteria in their urine, they do not respond to antibiotic therapy. It is not uncommon, then, for the diagnosis to be delayed until antibiotics have failed to cure the symptoms.

People can sometimes develop urethral syndrome after recently having a UTI. This is because the urethra can be very sensitive while recovering from an infection.

Therapies available today are mainly symptomatic. And most of them are not effective and do not significantly improve the quality of life of urethral syndrome sufferers. They also often do not respond to oral administration of conventional steroidal and non-steroidal anti-inflammatory drugs.

This is also the consequence of the fact that urethral syndrome has had several nicknames, which have led to much confusion over its existence and the treatment options.

Urethral syndrome can occur in both males and females. Most patients, however, are women, typically aged 30-50 years.

Interstitial Cystitis (IC)

Although less common in men than in women, the symptoms of a bladder infection can be mimicked by a chronic bladder disorder called interstitial cystitis (IC), also known as painful bladder syndrome (PBS).

  • pain in the pelvic area (the lower abdomen or urethra) – the predominant symptom;
  • urgent need to urinate often (up to 60 times a day);
  • painful sex.

As a matter of fact, a history of bladder infections have over two-thirds of all IC sufferers. In this disorder the bladder is overly sensitive. The major symptoms are:

The pain and urgency can be so severe that may make work, sexual activity and normal social functioning difficult or impossible.

Interstitial cystitis may stay about the same or get worse with time. Some people may go into remission for extended periods.

Unlike ordinary bladder infections, the cause or, rather, the causes of interstitial cystitis continue to baffle medical researchers. It is believed that IC may be the result of:

  • vascular (blood vessel) disease,
  • autoimmune disease,
  • an acid-alkali imbalance brought about by environmental factors and diet,
  • presence of abnormal substances in the urine,
  • an infection caused by a more elusive strain of bacteria, undetected by standard tests,
  • nerve function disorders,
  • defective cells in the bladder lining,
  • allergic reactions.

Currently, an estimated 700,000 – 1 million Americans suffer from this disease.

Other conditions that have symptoms similar to interstitial cystitis are bladder cancer, gonorrhea and/or irritable bladder.

Excruciating pain across the abdomen or the back may signal the presence of kidney stones. Therefore, you are strongly advised to act at the onset of any of these symptoms rather than take the “wait-and-see” approach. A professional diagnosis is essential.

Trigonitis

The trigone is the neck of the bladder – a triangular tissue located in the lower part of bladder. It is near the opening of the urethra. When it becomes inflamed, it is known as trigonitis, causing painful and inconvenient symptoms.

However, trigonitis is not always the result of inflammation. Sometimes it is due to benign cellular changes in the trigone called nonkeratinizing squamous metaplasia. This condition is known as pseudomembranous trigonitis. It is thought that female hormones estrogen and progesterone may play a role here.

Pseudomembranous trigonitis occurs in 40 percent of adult women (mainly of childbearing age) — but fewer than 5 percent of men who are undergoing hormone therapy, for example for prostate cancer.

The symptoms of trigonitis are similar to those for other bladder issues, such as:

  • an urgent need to urinate (urinary urgency),
  • pelvic pain or pressure (arising from reproductive organs),
  • difficulty urinating,
  • pain during urination (dysuria),
  • blood in the urine (hematuria).

The chances of trigonitis can be increased by:

  • Long-term use of a catheter (the longer a catheter stays in place, the higher the risk for irritation and inflammation).
  • Recurrent urinary tract infections (they can irritate the trigone, leading to chronic inflammation).

Trigonitis vs. Insterstitial Cystitis

While they share some of the same symptoms, trigonitis differs from interstitial cystitis (IC)in several ways:

  • The inflammation that occurs with trigonitis is only seen in the trigone region of the bladder. (IC can cause inflammation throughout the bladder).
  • Pain from trigonitis is felt deep into the pelvis, radiating to the urethra. (IC is generally felt in the lower abdomen).
  • Trigonitis produces pain upon passing urine. (IC is less likely to do so).

Kidney Infection (Nephritis)

Occasionally the bacteria causing a bladder infection with ascend up into the kidneys and cause a kidney infection (or inflammation), also known as upper urinary tract infection. This can be serious, since kidney infections can scar the kidneys.

Men are less likely to get a kidney infection as they usually do not suffer from recurrent urinary tract infections.

Here are signs, mild to severe, that a bladder infection has turned into a kidney infection:

  • lower back pain (below the ribs) or side pain – mid-way up the back, this is where the kidneys are located;
  • high fever accompanied by shaking chills and sweats – an indication of a possible kidney infection; unlike “viral infections” in which the fever fluctuates between normal and very high, with kidney infections the fever stays high (usually 101º F or higher) and you look and act progressively sicker;
  • nausea and vomiting – common symptoms when a kidney infection is present;
  • lower stomach, abdominal pain (over bladder), especially during urination;
  • an uncomfortable pressure above the pubic bone;
  • abnormal urine color – dark, cloudy or milky;
  • foul or strong urine odor (stinky urine);
  • blood in the urine – bloody, pink urine (hematuria);
  • inability to urinate – despite the urge, only a small amount of urine is passed;
  • painful or uncomfortable sexual intercourse;
  • malaise (general discomfort);
  • fatigue – feeling bad all over (tired, shaky, washed out);
  • mental changes or confusion – in the elderly, mental changes or confusion are often the only signs of a possible urinary tract infection.

Fortunately, most bladder infections do not turn into kidney infections, and a small scar in one kidney infection is harmless. But kidney infections must be taken very seriously and treated promptly. Left untreated, a kidney infection can lead to reduced kidney function and, in severe cases, possibly even to death.

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