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Bladder and urinary tract disease

Category: Illness or disabilities

Type

Involuntary

Introduction and description

1. Human urinary system: 2. Kidney, 3. Renal pelvis, 4. Ureter, 5. Urinary bladder,
6. Urethra. (Left side with frontal section), 7. Adrenal gland,  8. Renal artery and vein
9. Inferior vena cava, 10. Abdominal aorta, 11. Common iliac artery and vein
12. Liver, 13. Large intestine, 14. Pelvis

 

 

The Urinary system consists of the kidneys, the ureter which leads down to the bladder and the urethra. 

The kidneys and kidney disease has its own entry on the site, thus this section will concentrate on the bladder and the two ‘pipes’ leading to and from the bladder.

Types of disease

Bladder diverticulum -  Balloon-like growths on the bladder commonly associated with a chronic outflow obstruction, such as benign prostatic hyperplasia. Usually found in pairs on opposite sides of the bladder, bladder diverticula are often surgically removed to prevent infection, rupture, or even cancer.

 Cystitis  - is urinary bladder inflammation that results from any one of a number of pathogens.  It is commonly caused by bacterial infection.  Cystitus appears to be on the increase - the following is base on ADRs from drugs, however, the trend is significant:

Trend of Cystitis reports

Bladder tamponade -  is obstruction of the bladder outlet.  It may be due to a heavy blood clot formation or it may be due to a cyst, polyp or tumour, or other ‘foreign material’, kidney or bladder stones. It generally requires surgery.  It too may be caused by a pathogen, and can lead to cancer.

Bladder cancer-  is any of several types of cancer arising from the epithelial lining (i.e., the urothelium) of the urinary bladder. Rarely the bladder is involved by non-epithelial cancers, such as lymphoma or sarcoma.  It is a disease in which abnormal cells multiply without control in the bladder.  Also apparently on the rise, the following is a survey fom ADRs, to show trends:

Trend of Bladder Cancer reports

Bladder rupture - may occur if the bladder is overfilled and not emptied.  This can be caused by an obstruction in the ‘outlet pipe’ but as Wikipedia gleefully says “This can occur in the case of binge drinkers who have consumed large quantities of fluids, but are not conscious of the need to urinate due to stupor. This condition is very rare in women, but does occur”.  Indicating perhaps that men are more prone to binge drinking. 

A bladder stone (also called a vesical calculus or cystolith) is a calculus (stone) found in the urinary bladder

Urinary tract infection – is an infection that affects part of the urinary tract – ureter and urethra, as the bladder is in-between these two it too is generally also infected as such the term cystitis is often used to apply to all three. When it affects the lower urinary tract it is known as a simple cystitis and when it affects the upper urinary tract it is known as pyelonephritis – that is related to the kidney. Trends as follows:

Trend of Urinary tract infection reports

Urinary urgency -  a sudden, compelling urge to urinate. It tends to increase with age. When uncontrollable, it causes urge incontinence.

Urinary incontinence (UI),  - also known as involuntary urination, is any leakage of urine. It is ‘a common and distressing problem’, which may have a large impact on quality of life. Enuresis is often used to refer to urinary incontinence in children, such as nocturnal enuresis (bed wetting).  There are four main types of incontinence:

  • Urge incontinence due to an overactive bladder
  • Stress incontinence due to poor closure of the bladder
  • Overflow incontinence due to either poor bladder contraction or blockage of the urethra
  • Functional incontinence due to medications or health problems making it difficult to reach the bathroom

Trend of Incontinence - urinary reports

Polyuria -  is a condition usually defined as excessive or abnormally large production or passage of urine (greater than 2.5 or 3 L over 24 hours in adults). Polyuria often appears in conjunction with polydipsia (increased thirst), and is a symptom of diabetes

Nocturia (derived from Latin nox, night, and Greek [τα] ούρα, urine), also called nycturia (Greek νυκτουρία), is defined by the International Continence Society (ICS) as “the complaint that the individual has to wake at night one or more times for voiding.

 Symptoms

Nocturia, polyuria, urinary urgency and urinary urgency are classified as both illnesses and symptoms.  In addition to these we have the extra symptoms of:

  • Painful more frequent urination -  The most common symptoms are burning with urination and having to urinate frequently (or an urge to urinate) in the absence of vaginal discharge and significant pain. These symptoms may vary from mild to severe and in healthy women last an average of six days.
  • Pain - Some pain above the pubic bone or in the lower back may be present. People experiencing an upper urinary tract infection, or pyelonephritis, may experience flank pain.
  • Fever and nausea - People experiencing an upper urinary tract infection, or pyelonephritis, may experience fever, or nausea and vomiting in addition to the classic symptoms .
  • Blood or pus in urine -  Rarely the urine may appear bloody or contain visible pus in the urine.

Causes

 

If there is anything wrong with the kidneys, or any parts of the system leading to the kidney, then this will in turn lead to problems 'downstream', as such the cause may be some other organ failure or disease elsewhere.

Extreme emotion

We are all aware that extreme emotion can have a major impact upon such things as urinary continence. 

The action of mental anxiety or suspense (not fright) in causing a copious discharge of pale fluid is familiar enough to all, especially to the medical student about to present himself for examination, the amount being in a pretty direct ratio to his fear of being plucked.

butit is not widely known that various emotions cause a change in the chemical composition of urine.  Indeed "The odour of urine may be affected by the emotions, in man as in animals", which means its smell is a diagnostic aid to illness.

Dr. Carpenter, as long ago as the 1800s,  referred to the increase of alkaline phosphates in the urine after much ‘wear of mind’, whether emotional or intellectual, and alludes to

Human Physiology. By Dr. Carpenter. 4th Edit. 1853

"more than one case of this kind occurring among young men, whose anxiety for distinction had induced them to go through an excessive amount of intellectual labour during their student life, and who found themselves forced to pay the penalty of that excess in a subsequent prolonged abstinence from all mental occupation involving the slightest degree of effort " (p. 352).

Surgery

The layout of the organs of our body is extremely critical and the removal of any organ without an extremely good cause is ill advised.  One of the causes of urinary urgency and incontinence is the hysterectomy.  As it says below, the uterus supports the bladder and the bowel thus if it is removed, there is pressure on the bladder and bowel from other organs and this causes urinary urgency - the need to go to the loo very quickly.  As the uterus shrinks in old age it too can have the same effect, providing less support than before. 

 

To Do Or Not To Do (about the hysterectomy) Dr Muhammad El Hennawy Ob/gyn specialist

One of the most commonly performed operations in the World, Hysterectomy has long been regarded as an operation performed by "hyster-happy," mostly male, surgeons.  Hysterectomy is the second most common major operation performed in the United States today, second only to cesarean section; 600,000 hysterectomies are performed each year or one hysterectomy every minute. By the age of 60, one out of every three women in the U.S. has had a hysterectomy.
In the United Kingdom, women have a one in five chance of having a hysterectomy by the age of 55.
Nine of every 10 hysterectomies are performed for non-cancerous conditions.
In many of these, no disease is present and the term dysfunctional uterine bleeding is used to describe these cases. When there is disease it is commonly limited to the uterus and, in most parts of the world, is more likely than not to be a leiomyoma.

 in other words, the majority of hysterectomies performed on women have been  unnecessary.

Pregnancy or organ distention

As an extension to the explanation given above, any increase in the size of an organ, for example the uterus as a result of pregnancy or even the liver as a result of cirrhosis or fatty liver disease, will put pressure on the bladder and thus increase the likelihood of urinary incontinence.  Thus one of the symptoms of Benign Prostatic Hyperplasia, which is swelling of the prostate also causes urination problems.

In the case of pregnancy, you just have to grin and bear it, although exercise can occasionally help, but in the case of other organs, then there is value in treating the cause in these organs.

Bacterial infection

E. coli is the cause of 80–85% of community-acquired urinary tract infections, with Staphylococcus saprophyticus being the cause in 5–10%.

Acute uncomplicated urinary tract infection is one of the most common problems for which young women seek medical attention and accounts for considerable morbidity and health care costs. Acute cystitis or pyelonephritis in the adult patient should be considered uncomplicated if the patient is not pregnant or elderly, if there has been no recent instrumentation or antimicrobial treatment, and if there are no known functional or anatomic abnormalities of the genitourinary tract.
Most of these infections are caused by E. coli, ...... PMID: 9378923

 

But where do these bacteria come from?  If the bacteria has been ingested, it has to run the gamut of the saliva in the mouth, and the acid in the stomach, as well as the immune system.  Of course if we take antacids or PPIs, use anti-histamines or bacterial mouthwashes and compromise our immune system by using immunosuppressants, this is a clear route.  The bacteria have no opposition whatsoever, but let us assume we have not been this stupid.

If the bacteria have not reached this last part of the digestive system by coming top down, then their other route is 'bottom up', which means they enter the urinary tract near its exit point and work upwards.

The urethra is very close to the entrance to the female vagina and during sexual intercourse a man who has not washed his penis effectively may easily pass bacteria still on his penis both into the vagina and because of the amount of secretions present near the urethra. 

Urinary tract infection (UTI) is an extremely common health problem, with an unpredictable history. Members of enterobacteriaceae family such as Escherichia coli, which are normal inhabitants of human intestines, account for the majority of these uncomplicated infections. ...There is a close correlation between loss of the normal genital microbiota, particularly Lactobacillus species, and an increased incidence of genital and bladder infections. PMID: 21901556

 In other words a mucky penis can affect the vagina and the urinary tract.  The answer seems to be for all women to get a stiff scrubbing brush and ensure their men are clean [I jest - or maybe I don't].

So the cause of illness in women is the dirty men they associate with!

Bacterial infection from Hospital ICUs

Healthcare-associated urinary tract infections involve a much broader range of pathogens including: E. coli (27%), Klebsiella (11%), Pseudomonas (11%), the fungal pathogen Candida albicans (9%), and Enterococcus (7%) among others. Urinary tract infections due to Staphylococcus aureus typically occur secondary to blood-borne infections. Chlamydia trachomatis and Mycoplasma genitalium can infect the urethra but not the bladder.

Reports from several countries indicate that nosocomial urinary tract infections frequently complicate the course of patients admitted to intensive care units. Virtually all patients who develop an intensive care unit-acquired urinary tract infection have indwelling urinary catheters; other factors associated with the development of these infections include increased duration of urinary catheterization, female sex, intensive care unit length of stay, and preceding systemic antimicrobial therapy. The most frequent pathogens include Escherichia coli, Pseudomonas aeruginosa, enterococci, and Candida albicans; both the species distribution and rates of resistance vary considerably among institutions and regions. Secondary bloodstream infections are uncommon. Although acquisition of an intensive care unit-acquired urinary tract infection has been associated with a prolongation of intensive care unit length of stay, higher cost, and a higher crude case fatality rate, they do not appear to independently increase the risk for death.  PMID:  16374221

which brings us on to a major cause.

Pharmaceuticals

 

There is a clear link between the use of pharmaceuticals and the incidence of urinary tract problems.  Antibiotics in particular have an extremely poor record for creating and not solving the problem.  In the first place the bacteria which are supposedly the cause are becoming 'resistant' , meaning that the antibiotics do not work, but in addition to this the disruption of the intestinal flora results in bacteria entering the bloodstream and other organs such as the kidneys and migrating down to cause further infection.  Thus the use of antibiotics can cause infection due to viruses, fungi and parasites if they are present in the intestines.

There is also the added complexity of the bacteriophage - viruses that use bacteria like a trojan horse to enter the host system.  E. coli is capable of being used by bacteriophage, as such it may be the bacteriophage causing the problems and not the bacteria per se.  Many of the bacteria mentionned above exist without any problems in our intestine, they should not cause infection, because they are a part of us....

human enteric pathogens are part of a small group of bacterial families that belong to the Proteobacteria: the Enterobacteriaceae (E. coli, Yersinia spp., Salmonella spp., Shigella spp.), the Vibrionaceae (Vibrio cholerae) and the Campylobacteriaceae (Campylobacter spp.). In general, members of these families (be it commensals or pathogens) only constitute a minority of the intestinal microbiota.  PMID:  26185088

there thus appears to be a real likelihood that it is the infected bacteria - those with bacteriophage - that are the problem.

The eHealthme site collects the Adverse Drug reports submitted by doctors to the FDA and SEDA in the USA.  It then summarises them for ease of use.  We originally provided a direct link to all the various forms of illness within this category that were on eHealthme, along with the pharmaceuticals that can cause each one:

  • Cystitis
  • Bladder irritation
  • Urinary tract disorder
  • Urinary bladder polyp
  • Bladder diverticulum
  • Bladder discomfort
  • Bladder cancer
  • Bladder stones
  • Urinary incontinence

 but the eHealthme developers frequently reorganise the web-site and thus break the links.  Thus in order to find out which pharmaceuticals are implicated:

  • Follow the LINK to the eHealthme website
  • Using the ‘All conditions’ index find the appropriate entry
  • Now scroll down until you get to the section marked ‘Drugs that could cause

The list shows you all the drugs implicated in CAUSING each condition as well as the number of people who have made a complaint to their doctor and had their case reported by him.  Note that it is up to the doctor whether he reports or not.

To provide an example, as of October 2016, about 1,700 pharmaceuticals were implicated in producing urinary incontinence alone.

 Viral infection

A number of viruses are implicated in urinary tract infection.  The following is an interesting paper as it shows that viruses have the potential to go the 'up' route in men too, even though this is a paper about women. 

 

Hypospadias refers to a birth defect of the urethra in the male where the urinary opening is not at the usual location on the head of the penis. It is the second most common birth abnormality in boys, affecting approximately 1 of every 250.  In approximately 90% of cases, the opening is on or near the head of the penis (glans), referred to as distal hypospadias, while the remainder have proximal hypospadias.  In most cases the foreskin is also underdeveloped and does not wrap completely around the penis, leaving the underside of the glans penis uncovered.  There is thus the rather intriguing though that circumcision may also be a cause of infection in boys.

Female hypospadias presenting as a misplaced urethral opening is a common cause of chronic recurrent cystitis. Cystitis occurs when urogenital infection and anaerobic bacteria enter the urethra and bladder from the vagina. The authors argue that chronic infections of the lower urinary tract in women with hypospadias should be treated surgically .... They present a study confirming the role of ...antivirals ...  in ....patients with a history of viral infection (human papillomavirus and herpes). PMID: 26665761

 Other viruses are implicated, but in many cases there appears to be a link with the use of immunosuppressants..........

Hemorrhagic cystitis is a common stem cell transplantation-related complication. The incidence of early-onset hemorrhagic cystitis, which is related to the pretransplant conditioning regimen, has decreased with the concomitant use of mesna and hyperhydration. However, late-onset hemorrhagic cystitis, which is usually caused by the BK virus, continues to develop. PMID: 25653684

Parasites including Mites

 Parasitic infections pose a significant health risk in developing nations and are a major cause of morbidity and mortality worldwide. It has long been known that parasites can cause bladder cancer, for example.  There are some encouraging initiatives being taken in countries with high infestation.  For example, in the Republic of Tanzania, the CDC estimates that 51.5% of the population is infected with one or more intestinal parasites. The following study was undertaken to establish whether medical students could be used to detect chronic parasitic infection using ultrasound:

A total of 59 patients were enrolled in the study. Students reported a sensitivity of 96% and specificity of 100% for the presence of a dome shaped bladder, a sensitivity and specificity of 100% for bladder thickening, a sensitivity and specificity of 100% for portal hypertension and ascites. The sensitivity was 81% with a specificity of 100% for presence of portal vein distention. The sensitivity was 100% with a specificity of 90% for dilated bowel…… CONCLUSIONS: Ultrasound has shown a promise at helping to identify pathology in rural communities with limited resources such as Tanzania. Our data suggest that minimally trained first year medical students are able to perform basic ultrasound scans that can identify ultrasonographic markers of parasitic infections.  PMID: 26693265

 Fungal infection

Again often exacerbated by the use of antibiotics

Fungus ball and fungal emphysematous cystitis are two rare complications of fungal urinary tract infection. A 53-year-old male patient presented with these complications caused by Candida tropicalis simultaneously. The predisposing factors were diabetes mellitus and usage of broad-spectrum antibiotics. The fungus ball, measuring 3.5 × 2.0 cm on the left wall of the urinary bladder, shrank significantly to 1.6 × 0.8 cm after 5 days of intermittent irrigation with saline before surgery. PMID:  26425243

Toxins

 Toxins include nanoparticles, smoke, air pollution, insecticides, fungicides, plus a number of other industrial chemicals, for example

Bladder cancer is a malignancy that affects mainly the elderly and males. Up to 90% of these cancers originate from urothelial epithelial cells and therefore they are called Transitional (Urothelial) Cell Carcinoma (TCC). Another types are: Squamous Cell Carcionoma (SCC), which involves about 5% of cases and Adenocarcinoma (less than 2%). The factors that may lead to the development of bladder cancer include:

  • genetic disorders,
  • environmental exposures,
  • industrial carcinogens,
  • chemical contaminants and
  • chronic cystitis.

his article depicts the current state of diagnostics of bladder cancer, with particular focus on urine-based tests…. There is some evidence that NMP22 protein is particularly important in high-risk groups, e.g. among tobacco smokers. PMID:  26098648

 

How it works

Why do people get hallucinations from urinary tract infections?

From the observations we have gathered so far it is extremely rare for anyone to have hallucinations from the infection, but it appears to be relatively common for people to get them from their medication.  Urinary tract infections may be caused by a number of pathogens and yet it seems the standard treatment given is antibiotics.  This in itself will cause problems.  But antibiotics have their own serious disadvantages.

The healthy human intestine is colonized by as many as 1014 bacteria belonging to more than 500 different species forming a microbial ecosystem of unsurpassed diversity, termed the microbiota. The microbiota's various bacterial members engage in a physiological network of cooperation and competition within several layers of complexity…………
An increasing number of human disease conditions, such as inflammatory bowel diseases (IBD), type 2 diabetes, obesity, allergies and colorectal cancer are linked with altered microbiota composition. ……………
A general feature of a normal, healthy gut microbiota can generate conditions in the gut that disfavor colonization of enteric pathogens. This is termed colonization-resistance (CR). Upon disturbance of the microbiota, CR can be transiently disrupted, and pathogens can gain the opportunity to grow to high levels. This disruption can be caused by

  • exposure to antibiotics,
  • changes in diet,
  • application of probiotics and drugs, and
  • a variety of diseases.

Breakdown of CR can boost colonization by intrinsic pathogens or increase susceptibility to infections. One consequence of pathogen expansion is the triggering of inflammatory host responses and pathogen-mediated disease.
Interestingly, human enteric pathogens are part of a small group of bacterial families that belong to the Proteobacteria: the Enterobacteriaceae (E. coli, Yersinia spp., Salmonella spp., Shigella spp.), the Vibrionaceae (Vibrio cholerae) and the Campylobacteriaceae (Campylobacter spp.). …… proteobacterial "blooms" are a characteristic trait of an abnormal microbiota such as in the course of antibiotic therapy……PMID:  26185088


In other words if you disrupt the intestinal microbiota with antibiotics you effectively disrupt the immune system – because the intestines are part of the immune system response – and open yourself to more pathogens.  Some bacteria, if they have been colonised by bacteriophages are able to eat through the intestinal wall and enter the blood stream.  Once they are in the blood stream they can, in certain circumstances cross the blood brain barrier and then attack the brain causing hallucinations.

Vaccines containing aluminium as the adjuvant, for example, can destroy the blood brain barrier.

The primary lesion in Alzheimer's disease and dialysis dementia has been postulated to be an impaired blood-brain-barrier (BBB) permeability that allows neurotoxins …to reach the central nervous system. The present study shows that aluminium itself affects the permeability of the BBB …. Thus, aluminium can affect the BBB in ways that might be involved in dementia.  PMID:  6139573

In effect, the combination of a blood brain barrier destroyed by aluminium [in vaccines or otherwise] and the use of antibiotics, enables pathogens to enter the blood stream and then the brain and it is this that causes the hallucinations.

References and further reading

  • Eye (Lond). 2013 May;27(5):676. doi: 10.1038/eye.2013.29. Epub 2013 Mar 1.  Routine use of topical cyclopentolate as a predisposing factor to recurrent urinary tract infections in a susceptible adult.  Banerjee PJ, Elgohary MA, Charteris DG.  PMID: 23449511
  • Psychosomatics. 2011 Sep-Oct;52(5):472-4. doi: 10.1016/j.psym.2011.01.037.  Moxifloxacin-induced delirium with hallucinations.  Tasleem H1, Viswanathan R.  PMID: 21907069
  • Microbiol Spectr. 2015 Jun;3(3). doi: 10.1128/microbiolspec.MBP-0008-2014.  The Roles of Inflammation, Nutrient Availability and the Commensal Microbiota in Enteric Pathogen Infection.  Stecher B.
  • Urologiia. 2015 Jul-Aug;(4):29-32.  [VIRAL INFECTIONS: HUMAN PAPILLOMAVIRUS AND GENITAL HERPES TYPE 1 AND TYPE 2 AS A CAUSE OF CHRONIC RECURRENT CYSTITIS WITH SEVERE DYSURIA IN WOMEN WITH URETHRAL HYPERMOBILITY AND HYPOSPADIAS].  [Article in Russian] Derevjanko TI, Ryzhkov VV.Korean J
  • Pediatr. 2014 Dec;57(12):514-9. doi: 10.3345/kjp.2014.57.12.514. Epub 2014 Dec 31.  BK virus-associated hemorrhagic cystitis after pediatric stem cell transplantation.  Han SB1, Cho B2, Kang JH1.
  • J Egypt Soc Parasitol. 2007 Dec;37(3):775-84.  Intestinal parasites in school aged children and the first case report on amoebiasis in urinary bladder in Tripoli, Libya.  Ben Musa NA1.  1Department of Medical Parasitology, Faculty of Medicine, Al Fateh University, Tripoli, Libya. najla_bm@yahoo.com
  • Parasites in the etiology of cancer--bilharziasis and bladder cancer. - Elsebai I.  CA Cancer J Clin. 1977 Mar-Apr;27(2):100-6.  PMID: 402987

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