Announcer: Is it bad enough to go to the emergency room? Or isn't it? You're listening to "ER or Not" on The Scope.
Interviewer: You're having a hard time peeing. Is that a reason to go to the ER or not? Dr. Troy Madsen's an emergency room physician at University of Utah Health Care. Of course "ER or Not" is a game where we decide whether or not something is worth going to the ER or not, so having a hard time urinating. Like, I mean it's difficult to get a stream going. ER or not?
Dr. Madsen: So this is one where it really depends kind of on the context of this. If you're a 65-year-old male and you're having a hard time getting a stream going and you feel like your bladder is about to explode, then you absolutely need to go to the ER and this is a common thing we see in the ER where older men will get an enlarged prostate and then they just cannot pee. Nothing will come out, and then you push on their belly and it feels like they've got a basketball in their belly. It's just their bladder is so full and the bottom line is, these people need to have a catheter placed. Something up there to get the urine past that obstruction, past the prostate, get the urine flowing, and so it's absolutely a reason to go to the ER.
Interviewer: All right, so if it's your grandpa or your older dad? Yes. Not the case for women?
Dr. Madsen: Often not, and often in other people they're describing a sense that they have to pee and they just can't go, but in these individuals it's often because they are just going so frequently because they have a urinary tract infection and that creates a sense of just what we call . . . the medical term is urgency. It's exactly that. It's this urgent sense that you need to pee again and again and there's really nothing in there, and that's a pretty common thing with a urinary tract infection. That's something you can go to an urgent care, they can just do a quick urine test on you, say, "Yeah, you've got a urinary infection. Here you go. Here are some antibiotics. This will clear up in two or three days."
Interviewer: But that sensation of having a completely full bladder is not there. It's just the fact that you try to go and nothing comes out. People start to assume, "I must be blocked."
Dr. Madsen: Right. Exactly.
Interviewer: But it's just empty. It's just nothing there.
Dr. Madsen: It's empty.
Dr. Madsen: They just have this feeling like, "I need to go. I need to go," and then they just keep trying and trying and trying, but it's not like these individuals who come in who you push on their belly and, for a 65-year-old man, it feels like he's pregnant. He's got like this mass in his belly. We'll put a catheter in some of these individuals and get a full liter out. Just a huge volume of urine. It's just backed up in there causing lots of pain and discomfort and just nothing's coming out.
Interviewer: Other . . . So urinary tract infections, can that affect a man as well? So like somebody my age, in their 40s, has a hard time going?
Dr. Madsen: It can. It's less common in men, and usually when men get urinary tract infections, we think, "Could there be something else going on that's causing this?" Where in women, it's much more common, the reason being simple anatomy. The urethra is longer in men than in women. It's easier for bacteria to work their way up into the bladder for women, so that's why it's more common. So yeah it does happen, but often in men, especially older men, I start to think, "Could there be something else going on? Maybe an infection in the prostate." Start to think a little bit broader, rather than just saying, "Here's some antibiotics. This should talk care of itself."
Interviewer: What about other blockages, like stones or something like that?
Dr. Madsen: So kidney stones, the interesting thing with kidney stones, they start in the kidney and they cause pain as they work their way down the ureter -- down the tube that goes from the kidney to the bladder -- but once they hit the bladder, the urethra, so the tube that leads out from the bladder is bigger than the ureter, so once they get there it's really kind of weird and unusual that they would get stuck in the urethra and cause it so you can't pee.
Interviewer: Got you.
Dr. Madsen: So most people it's going to be in one of the ureters. You've still got the other side working. You've still got that kidney producing urine. The urine's still going to the bladder. So it's not quite so often I see with kidney stones where people say, "I just can't pee." I mean, usually they're just writhing around in pain because of the severe pain there, but they're still urinating regularly and I can't say I've ever seen where a stone's been so large that it made it's way down in the bladder and then got stuck in the urethra so they just couldn't get anything out.
Interviewer: All right, so just to be sure here, if somebody's having a difficult time peeing, if it's an older man it could be an enlarged prostate, definitely go to the ER. For everybody else, it's probably not a blockage. It's probably a urinary tract infection. Go to an urgent care.
Dr. Madsen: Probably.
Interviewer: And we've covered everything?
Dr. Madsen: Exactly, and you've got to, again, kind of take the whole thing in context. If you're talking about someone that has a lot of medical issues and you're thinking they can't pee because . . . they're just not peeing because they're in kidney failure, then that's another issue entirely. With those individuals it's not so much that they feel like, "I have to pee." It's more just like, "Hey, I'm not peeing."
Interviewer: Oh okay.
Dr. Madsen: It's just their body's not producing urine because their kidneys have stopped working.
Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with out physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at thescoperadio.com.
updated: September 21, 2018
originally published: November 7, 2016
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