Problems women see a urologist for
- Urine infections, especially infections that come back two or three times a year
- Leaking urine when you cough, sneeze, laugh, lift or exercise
- A sudden, strong urge to pass urine, going very often, or not reaching the toilet in time (overactive bladder)
- Kidney and ureter stones, including stones found during pregnancy
- Blood in the urine, even once, and even without pain
- Pain or pressure over the bladder that does not go away with antibiotics
- A weak stream, straining, or a feeling that the bladder has not emptied
- Getting up many times at night to pass urine
- Urine leaking all the time after a difficult delivery or an operation, which can be a sign of a fistula
Urine infections that keep coming back
Many women have a urine infection at some point. When infections keep returning, it is worth finding out why rather than taking one course of antibiotics after another. Common reasons include not emptying the bladder fully, constipation, low oestrogen after menopause, diabetes, a stone, and infections linked to intercourse.
The doctor checks your urine culture reports to see which germ is causing the infections and which antibiotics work against it. An ultrasound shows whether there is a stone or urine left behind in the bladder. Depending on what he finds, the plan may include simple habits, treatment of constipation, vaginal oestrogen after menopause, or a low-dose preventive course for a few months.
Habits that help many women:
- Drink enough water through the day that your urine stays pale
- Pass urine when you feel the need, and do not hold it for hours
- Pass urine soon after intercourse
- Wipe from front to back, and avoid scented washes and douches
Leaking urine and overactive bladder
There are two main kinds of leak, and they are treated differently, so the doctor first works out which one you have, or whether you have both.
- Stress leakage happens with coughing, sneezing, lifting or exercise. It is usually caused by weak pelvic floor muscles and support tissues, often after childbirth.
- Urge leakage comes with a sudden strong need to go, when you cannot hold on long enough to reach the toilet. It is part of an overactive bladder.
Pelvic floor exercises done properly every day help many women with stress leakage. Bladder training, which slowly stretches the time between visits to the toilet, helps an overactive bladder, and medicines can calm the bladder further. If these are not enough, the doctor explains the procedures that can be done in hospital. You can read more on our urinary incontinence page.
Pregnancy, after childbirth and after menopause
During pregnancy, a urine infection needs prompt treatment, even if it causes few symptoms, and kidney stone pain needs careful assessment. The doctor works with your gynaecologist and chooses tests and medicines that are safe in pregnancy.
After childbirth, some leaking is common in the first weeks. If it carries on beyond a few months, or if urine leaks all the time, see a doctor rather than waiting.
After menopause, the tissues around the urethra become thinner, which can bring urgency, burning and repeat infections. These symptoms often improve with treatment once the cause is clear.
What happens at your visit
- You describe your symptoms in Hindi, English, Bhojpuri or Gujarati, in private. You can bring a family member with you if you wish.
- The doctor asks about your periods, pregnancies, deliveries, past operations and medicines, because each can affect the bladder.
- He looks at any urine reports and scans you bring. An examination is done only if it will help, and only with your consent.
- He explains what he thinks is causing the problem, which tests he advises, and the treatment options.
You are welcome to bring a family member or friend with you. If you would prefer a woman to be present during any examination, please say so when you book.
Tests the doctor may advise
- Urine routine test and urine culture, ideally before antibiotics are started
- Ultrasound of the kidneys and bladder, including how much urine is left after you pass urine
- A bladder diary, in which you note what you drink and when you pass urine for three days
- Uroflowmetry, a simple test in which you pass urine into a machine that measures the flow
- Blood sugar and kidney function tests
- In some women, urodynamic studies or a look inside the bladder with a thin camera (cystoscopy), which is done in hospital
The doctor will tell you which of these tests you need and where each one can be done.
Treatment options after evaluation
- Lifestyle and bladder habits, such as fluid timing, cutting down on tea and coffee, and treating constipation
- Pelvic floor exercises and bladder training, explained step by step
- Medicines for infection, for an overactive bladder, or to help pass a small stone
- Preventive treatment for repeat infections, chosen from your culture reports
- Procedures in hospital when needed, such as stone removal, treatment for stress leakage, or repair of a fistula
When not to wait
Go to the nearest emergency department if you have fever with shivering, pain in the back or side, or vomiting along with urinary symptoms. This can be a kidney infection. The same applies if you cannot pass urine at all, pass heavy blood or clots, or are pregnant with fever and urine symptoms.
Related: urine infection (UTI), urinary incontinence and kidney stones.
