GENITOURINARY DISORDERS - Medicine for Mountaineering and Other Wilderness Activities - page 292

Back pain is often indicative of kidney disease, particularly when located to one side of
the vertebral column at the point where the lowest ribs join. However, the pain frequently
radiates to the sides just above the pelvis and around to the groin.
A burning sensation with voiding is unmistakable, is often described as the sensation of
passing gravel, and usually results from infection or inflammation of the urinary bladder,
prostate, or urethra.
Bleeding can be obvious or may produce only cloudy or “smoky” urine. If the urine is
allowed to stand so the cells can settle out, a red sludge often can be seen at the bottom of
the container, confirming the presence of blood. Surprisingly small amounts of blood can
be detected in this way.
Changes in urinary volume, except for very large deviations, usually go unnoticed un-
less the urinary output is measured. In the wilderness, dehydration is by far the most com-
mon cause for a change in urinary output. However, some renal diseases can result in total
or near total cessation of kidney function. Uncommonly, a larger volume of very dilute ur-
ine is excreted. The color of the urine is a reliable indicator of the state of hydration, par-
ticularly dehydration, which typically results in dark yellow or orange urine.
Cystitis
Cystitis is inflammation of the urinary bladder that occurs with or without infection.
This disorder is rare in young males but fairly common in females. When cystitis is associ-
ated with acute pyelonephritis, symptoms of the latter usually predominate.
The principal symptom of cystitis is burning or pain during voiding. The pain may in-
crease somewhat as the bladder is emptied but disappears gradually after flow has stopped.
The frequency of voiding may be increased because the irritated bladder feels full with a
smallerurinevolume.Feverorothersymptomsarerare.Slightbleedingsometimesoccurs;
rarely, bleeding may be severe enough to make the urine obviously bloody.
Cystitis should be treated because it usually is the result of an infection. Ciprofloxacin
(Cipro®) or Trimethoprim-sulfamethoxazole (TMP-SMX) may be administered.
Cephalexin(Keflex®andothers)isanalternative.Thesedrugsareexcretedbythekidneys
and reach high concentrations in the urine. If symptoms persist after three days of drug
therapy, the medication should be changed. Abundant fluids must be consumed.
Pyelonephritis
Pyelonephritis, an infection of one or sometimes both kidneys, is characterized by the
rather sudden onset of high fever, often with chills, and pain over the kidney. The indi-
vidual often feels and appears ill. Pain of moderate severity is usually present. Pressing or
gentlepoundingwiththefistjustbelowthelowerriboneithersideofthevertebralcolumn
reveals tenderness. Symptoms of cystitis are often present, and slight to moderate bleeding
may occur.