BLADDER INFECTION

Bladder infection (cystitis, sometimes called “urinary tract infection,” or UTI) occurs frequently in females, because the shorter female urethra does not protect the bladder from bacteria as efficiently as does the male organ. A person with a bladder infection complains of discomfort (sharp pain, cramping, or burning) on urination, urge to urinate (“urgency”), frequent urination, difficulty initiating urination, lower abdominal cramping, and sometimes bloody urine, which may be as severe as small clots. Similar symptoms may be suffered by males who harbor infections in the prostate gland.

Treatment involves the administration of an antibiotic and increased oral fluid intake. Because many antibiotics are well concentrated in the urine, there are a number of acceptable treatment regimens. For the sake of simplicity, the female victim may be treated with trimethoprim-sulfamethoxazole (Bactrim or Septra) in one double-strength tablet twice a day for 3 days, or two double-strength tablets in one dose; ciprofloxacin 250 mg twice a day for 3 days, or 500 mg in one dose; ofloxacin 200 mg twice a day for 3 days, or 400 mg in one dose; norfloxacin 400 mg twice a day for 3 days; lomefloxacin 400 mg, trovafloxacin 100 mg, or levofloxacin 250 mg once a day for 3 days; cefpodoxime 100 mg twice a day for 7 days; amoxicillin-clavulanate 500 mg/125 mg twice a day for 7 days; nitrofurantoin monohydrate/macrocrystals (Macrobid) 100 mg capsule twice a day for 7 days with meals; nitrofurantoin macrocrystals 50 to 100 mg four times a day for 7 days; or fosfomycin tromethamine (Monurol) 3 g in a single dose. If the victim is diabetic or older than 65 years of age, or if the symptoms do not completely resolve or they recur within a few days of therapy, use the same or a different drug for 7 to 10 days. If the victim is pregnant, use amoxicillin, ampicillin, nitrofurantoin, cephalexin, cefadroxil, or trimethoprim-sulfamethoxazole.

Chlamydia are bacterium-like “germs” that are increasingly the cause of reproductive tract infections in women and genitourinary tract infections in men. Because the penicillins (such as ampicillin) are not effective against Chlamydia, any male with a bladder infection should be treated with tetracycline (500 mg four times a day), doxycycline (100 mg twice a day), or trimethoprim-sulfamethoxazole (one double-strength tablet twice a day) for 10 days, or with azithromycin 1 g in a single dose. Any male who develops a bladder or prostate infection (see page 297) should be seen by a physician when he returns from his journey.

The incidence of bladder infections in older women may be decreased by a daily 8 oz (237 mL) glass of cranberry juice. It takes several weeks of juice drinking before this effect begins to occur.

It may not be convenient for a woman to squat in order to urinate outdoors. There are devices available to facilitate a woman’s urinating while standing or squatting. The Whiz Freedom is advertised as the world’s first hydrophobic (repels water), antibacterial, and ecofriendly urine director. This device fits over the pudendal region so that urination can be accomplished when standing or sitting outdoors (or indoors) in such a manner that the urine stream is captured and directed away from the body. Another product intended for the same purpose is the “Lady J.”

KIDNEY INFECTION

Kidney infection (pyelonephritis) is considerably more serious than bladder infection. Symptoms may include all of those for bladder infection, as well as flank or lower-back pain, severe abdominal pain, fever, chills, nausea and vomiting, weakness, and cloudy urine with or without a foul odor. The pain is characterized as aching, and may become exquisite if you punch the victim gently just under the ribs adjacent to the spine on the affected side.

The field treatment is the same as for bladder infection, except that the chosen antibiotic must be at a higher dose and continued for at least 14 days. Begin the victim on trimethoprim-sulfamethoxazole (one double-strength tablet twice a day), ciprofloxacin (500 mg once or twice a day), norfloxacin (400 mg twice a day), ofloxacin (200 to 300 mg twice a day), lomefloxacin (400 mg once a day), levofloxacin (250 mg once a day), amoxicillin-clavulanate (875/125 mg twice a day), or cefadroxil (500 mg twice a day). Continue the antibiotics for 10 to 14 days. By definition, the victim is more ill and may require hospitalization for an intravenous antibiotic(s). Therefore, anyone who is suspected to have a kidney infection should be evacuated immediately.

KIDNEY STONE

See page 135.

BLOOD IN THE URINE

Blood in the urine is caused by bladder or kidney infection, the passage of a stone(s), blunt or penetrating injury to the flank (kidney region), bleeding disorder, or tumor of the genitourinary tract. After heavy exertion or high fever, a person may break down a small amount of muscle tissue and release myoglobin (an oxygen-carrying protein found in muscle) into the bloodstream. In cases of burns, severe injury, or certain infections, red blood cells can be destroyed and will release their oxygen-containing protein (hemoglobin) into the bloodstream. Hemoglobin and myoglobin are filtered through the kidneys and may be concentrated in the urine, giving it a pink to reddish-brown hue. If the urine is not made dilute (by drinking large amounts of fluid to increase its volume), the concentration of these pigments in the kidney can clog the filtration system and cause sudden kidney failure. Although after vigorous exercise some individuals may normally pass a small amount of reddish urine, anyone who develops darkened urine after fever or exertion should be placed at maximum rest, cooled to a normal body temperature (see page 322), encouraged to drink as much fluid as possible, and rapidly transported to a medical facility. If you are more than 24 hours away from a doctor, the urine rapidly clears with rest and increased fluids, and the victim appears in good health, the journey may continue.

Urine can also be discolored by the ingestion of chemical agents, such as urinary tract anesthetics (blue-green or orange), beets (pink-red), or bile pigments (brown, seen with hepatitis).

ACUTE URINARY RETENTION

There are rare occasions when a person cannot urinate and the bladder becomes distended with urine. This is seen more often in males than females, because a common cause is obstruction of the urethra where it passes through the male prostate gland. If the gland is enlarged (benign prostatic hypertrophy, or BPH), which occurs in elderly males almost exclusively, the passageway for urine can be narrowed to the point where it becomes obstructed. Early symptoms, which develop as the passage narrows, are difficulty initiating a stream, a weak stream, dribbling (leakage of urine), and urinating small amounts. On occasion, it may become painful to urinate. If the obstruction becomes complete, it causes urine to collect in the bladder, which becomes painfully distended and can be felt as a hard mass in the lower abdomen. Unless the obstruction can be relieved, this is an emergency. The usual treatment is to pass a small tube (catheter) through the penis directly into the bladder. This can be difficult and should only be attempted by someone trained in the technique. It is a good idea for someone properly trained to carry a urinary catheter(s) and lubricant on any expedition that will include elderly males as participants.

If a male has an enlarged prostate, drugs that are anticholinergic (such as certain antispasmodics) or that contain atropine and its derivatives can precipitate acute urinary retention. For instance, an elderly male with BPH on a diving expedition who takes anti–motion-sickness medication may suffer urinary retention as a side effect of the medication. A medication that relieves the symptoms of BPH in some men is tamsulosin (Flomax 0.4 mg capsule once daily), which relaxes the prostate muscles around the urethra, allowing urine to flow more freely out of the bladder. This medication can create its own side effects of dizziness and low blood pressure on arising, similar to what is seen with dehydration. Therefore, it is important for people using this medication to stay well hydrated and avoid situations in which a dizzy spell or fainting might create a serious injury.

PROSTATE INFECTION

Bacterial infection of the prostate gland (prostatitis) is usually abrupt in onset, with fever, urgency and frequency of urination, pain on urination that may radiate to the lower back, chills, weakness, and sometimes urinary retention. Until the diagnosis is confirmed, the victim should begin to take an oral antibiotic such as ciprofloxacin, ampicillin, or trimethoprim-sulfamethoxazole. On a prolonged journey, if an antibiotic appears to be effective within a few days, it should be continued for a minimum of 3 weeks.