Ask a Urologist: Dr Lee Fang Jann from Mount Elizabeth Orchard Hospital Singapore & Farrer Park Hospital Singapore

dr. Lee Fang Jann replied 2 years ago

Hi Sam,

The symptoms you have described are suggestive for urethritis. Urethritis is the inflammation of the urethra, the tube that carries pee from the bladder out of the body. It is usually caused by an infection such as urinary tract infection or a sexually transmitted infection such as chlamydia. I will advise you to seek medical attention from a sexual health clinic. Two typical tests done include a urethral swab test and a urine test. The doctor may offer you additional tests for other sexually transmitted diseases. You may discuss this with the doctor in the clinic if you wish. A course of antibiotics will treat the infection and your symptoms should improve within a week.

You should avoid having sex, including anal and oral sex, until you have finished your course of antibiotics. It is important that your past and current sexual partners are also treated to prevent any infection spreading to others.

If left untreated, the infection can progress to epididymo-orchitis, an infection of the testicles, leading to subsequent infertility. The infection can also lead to reactive arthritis (joint pain and stiffness) and conjunctivitis (eye inflammation).

dr. Lee Fang Jann replied 2 years ago

Dear Deden Ari,

It is unusual to have urethral discharge after urination. It may indicate an underlying urethritis (inflammation or infection of the urethra). I will advise you to see a doctor to have the discharge sent for testing followed by treatment if warranted.

dr. Lee Fang Jann replied 2 years ago

Dear Edi,

It is not possible to accurately diagnose the condition without a physical examination. Little raised painless bumps on the scrotum can range from benign conditions like sebaceous cysts, prominent hair follicles and angiokeratomas; to sexually transmitted diseases like genital warts and molluscum contagiosum.

A common condition that I see in the clinic that is often mistaken for sexually transmitted disease is Fordyce spots.

https://commons.wikimedia.org/wiki/Category:Fordyce%27s_spots_on_scrotum

They are visible sebaceous glands found commonly along the shaft of the penis, scrotum, outer edge of lips and inside the cheeks. They are whitish-yellow painless bumps and are harmless. No treatment is necessary for this condition. However, some patients do request for their removal for cosmetic reasons. Treatment options include topical ointment like bichloracetic acid and tretinoin, laser treatment and micro-punch surgery.

dr. Lee Fang Jann replied 2 years ago

Our body naturally reduces urine production when we turn in for the night, allowing us to get at least 6-8 hours of uninterrupted sleep. The medical term for excessive urination at night is nocturia. Nocturia affects our sleep cycle leading to fatigue, mood changes, impaired productivity, and increased risks of accidents.

The first thing to exclude is recent changes in lifestyle that may have played a part. You may have been drinking too much or too close to bedtime. Omit fluids 2 hours before you go to sleep. Caffeine and alcohol are known diuretics. Don’t have them late in the day. Have you been started on a new blood pressure medication? Some of these medications lower your blood pressure by making your kidneys produce more urine.

If you noticed that your feet and ankles are often swollen in the day, that may be edema. Underlying heart, liver, or kidney failure can lead to trapping of fluid in the dependent body tissue. Once you lie down to sleep, gravity no longer holds the fluid in your legs. It can re-enter your veins and be filtered by your kidneys, producing urine. If you are passing a large amount of urine day and night, you may have untreated diabetes.

Nocturia can also occur when you are not able to empty your bladder fully at every void. In men, this can be due to prostate enlargement or prostate cancer that obstructs the flow of urine. In women, this may be due to pelvic organ prolapse.

Nocturia can also be due to reduced bladder capacity from bladder cancer, bladder stone, recurrent bladder infection, or bladder overactivity.

It is important to remember that nocturia is often a symptom pointing to an underlying medical condition. Many are urological in origin, with some more serious than others. Unfortunately, I am still seeing patients who suffered from bothersome nocturia for years before seeing a doctor, only to be diagnosed with late-stage prostate cancer.

Consider seeing a doctor for a thorough evaluation and diagnosis.

dr. Lee Fang Jann replied 2 years ago

Dear Umar,

Pain in the lower abdomen at the end of urination can indicate a problem with the bladder or prostate. In some men, the pain can affect the penis too.

A common cause of the pain is cystitis (bladder infection). The urinary tract is normally sterile, but sometimes bacteria can sneak in through the urethra, which connects the bladder with the outside of the body. There may be additional symptoms if you have a bladder infection. These include burning pain in the penis during urination, urgent need to urinate, frequent need to urinate, cloudy urination, blood in the urine, and occasional fever. A bladder infection can easily be diagnosed by analysing a specimen of your urine to look for white blood cells, red blood cells and the presence of bacteria. Treatment is a course of appropriate antibiotics.

As men have longer urethras than women, they are less prone to bladder infections because bacteria need to travel a longer distance to reach the bladder. Additional checks are recommended after treatment to look for risk factors. The doctor will need to rule out underlying diabetes, bladder stones, an enlarged prostate or abnormal narrowing of the urethra that may affect your ability to empty the bladder completely.

If the cause of the pain is not a bladder infection, the doctor may recommend additional tests like imaging scans, blood tests, urine tests and a cystoscopy to rule out prostate infection, prostate cancer and bladder cancer.

Because bladder pain can have many possible causes, it is always a good idea to make an appointment with your doctor to have it checked out.

dr. Lee Fang Jann replied 2 years ago

Yes. Apprehensive feeling (worry, nervousness, fear) activates the stress response, which causes the body to secrete stress hormones into the bloodstream to enhance the body’s ability to deal with a threat.

Specific to urination, the stress response increases autonomic nervous system (the nervous system under involuntary unconscious control) activity, which can cause the brain to sense an urgent need to urinate.

This sudden urge to void is common and often experienced by stage performers and public speakers just before they are about to perform or present.

dr. Lee Fang Jann replied 2 years ago

The average adult bladder holds between 400 and 700mls of urine. The average 24-hour urine output is 1200 to 1500 mls. Normal patterns of urination differ between individuals but adults generally void 5-6 times daily with no more than one night time void. Your urinary frequency is much greater than the average and may indicate a problem. Urinary frequency can occur because of increased urine volume or reduced bladder capacity (ie. less than 200mls)

Increased urine volume can result from excessive fluid intake, undiagnosed diabetes or diuretic medication.

Decreased bladder capacity can result for anxiety, bladder outlet obstruction with resulting residual urine, bladder scarring from chronic infection or inflammatory conditions that increased bladder sensitivity (stone, tumour, infection)

Filling up a bladder diary (https://www.mhcs.health.nsw.gov.au/publications/ahs-9545-bladder-diary/ahs-9545-bladder-diary-indonesian) before consulting your doctor will allow him or her to better appreciate your problem, aids in the diagnosis and decide on how best to help you.

dr. Lee Fang Jann replied 2 years ago

Dear Moch,

Without more information on the indication, nature and outcome of the operation involved, I can only share with you some thoughts that cross my mind.

I assume she had an operation on the urinary bladder. If part of the bladder has been removed, the capacity will now be smaller. She will be passing urine more frequently and with smaller volume at each void. The urinary frequency will usually improve after 4-8 weeks. Wound pain can be expected after any major operation. How soon one recovers after an operation varies. Most patients can expect to make a full recovery by 4-6 weeks after surgery. She had an indwelling catheter in-situ to drain her urine for more than 2 weeks. If that has resulted in a bladder infection, that can explain for her soreness when she urinates.

I will suggest you get in touch with her surgeon who will be in the best position to advise you on the appropriate steps that need to be taken.

I wish her all the best in her recovery.

dr. Lee Fang Jann replied 2 years ago

Hello Albert,

A urethra stricture causes narrowing of the urethra and the most common symptoms are related to urination. You may experience slow urinary stream, pain during urination, the sensation of incomplete bladder emptying and post-void dribble. If left untreated, a urethral stricture can give rise to recurrent infections and irrecoverable kidney and bladder damage.

dr. Lee Fang Jann replied 2 years ago

Hi Seto,
Thank you for the question. Normal urine is clear, with a yellowish hue, with no blood or foam. The appearance of a single layer of large bubbles upon voiding, that quickly dissipates, can be considered normal. Foamy urine, on the other hand, is characterized by the appearance and persistence of multiple layers of small to medium bubbles in urine voided into a container, such as a toilet bowl.

Foamy urine is a sign of excessive protein in the urine, which in turn, indicates kidney disease. Kidney disease cause damage to the kidneys’ filters, allowing proteins to leak into your pee. The proteins in the pee has a soapy characteristic that cause them to bind together, causing a foamy appearance. Diabetes and high blood pressure are major causes.

If you think your foamy pee is a sign that something is wrong with your kidneys, see your doctor. They will do a physical exam and run blood and urine tests to figure out what’s going on. They may also do an imaging test like an ultrasound to see the physical state of your kidneys. Once your doctor is able to determine what’s behind your foamy urine, they should be able to help treat it.

dr. Lee Fang Jann replied 2 years ago

Hello Kamril,

It’s common for the penis to curve slightly to the left or right when it’s erect. But if you have a more significant bend in your penis, this may be Peyronie’s disease.
Peyronie’s disease is an abnormal wound healing condition that occurs in genetically predisposed men, after an injury to the structural layers of the penis. The abnormal healing leads to a fibrous inelastic scar that causes a palpable plaque, which, with an erection, causes curvature, shortening, narrowing or a hinge effect. This occurs because the affected part of the penis will not stretch with erection. As the condition progresses, it causes pain with erection, difficulty with sexual penetration and even erectile dysfunction.
There are many treatments for Peyronie’s disease, from medical management, intralesional therapy, or surgical therapies. The severity of the curvature and degree of a patient’s bother determine the best course of treatment.

dr. Lee Fang Jann replied 2 years ago

Hi Dhenok,

Creatinine is a waste product produced by muscles from the breakdown of a compound called creatine. Creatinine is removed from the body by the kidneys, which filter almost all of it from the blood and release it into the urine. Blood creatinine level is a fairly accurate indicator of kidney function. Elevated creatinine level indicates impaired kidney function or kidney disease.
Any condition that impairs the function of the kidneys is likely to raise the creatinine level in the blood. Recent elevations may be more easily treated and reversed. This can be due to dehydration, a transient intake of a large amount of dietary meat, certain medications, kidney infection or kidney obstruction from stone. Once the offending cause is treated, the kidney function will recover and the blood creatinine level correspondingly falls.
However if the cause is from chronic disease like poorly managed diabetes mellitus and hypertension, the kidney damage is often irreversible. It is important to visit your doctor for regular checks to monitor your condition and take medication as required. This will help slow the progression of kidney disease. If left untreated, kidney disease can progress to kidney failure. When the kidney stops working, dialysis or kidney transplant will be needed for survival.

You can do your part to prevent kidney failure:
– Maintain good control of your blood pressure.
– If you have diabetes, control your blood sugar.
– Restrict your dietary intake of protein.
– Keep a check on your salt intake.
– If you’re overweight, try to get down to a healthy weight. This usually means consuming fewer calories and being more active.
– Some over-the-counter pain relievers can cause kidney damage. Check with the pharmacist or doctor before consumption.
– If you smoke cigarettes, quit today.