Urology is the study of the urine system. The human urinary system starts at its source in the kidney. Urine from the kidney flows down the ureters into the bladder and outwards. Fluids are a considerable part of a Urologist life and urine production is directly affected by the fluids and food we take. We look at how typical food and fluid we take in daily can play a huge part in stones, foam, and staying home.
The presence of foamy urine is one of the most common questions I receive from patients. It is essential to understand many reasons that can cause foamy urine. Our kidney removes excess water, waste products, protein, and salts (solute) from our blood. Foamy urine occurs when a high concentration of solute (creatinine, urea, sugar, waste material, albumin) is dissolved in the urine. These products are dissolved in our urine and excreted out. We need not be overly alarmed as foamy urine can be normal. For example, the first-morning void is usually darker yellow and foamy due to the high solute concentration in a small amount of urine.
While it is normal to lose some protein every day, foamy urine can also be due to sugar (diabetes), renal problems (proteinuria), high blood pressure or simply due to concentrated urine. The most common type of foamy urine is intermittent and is due to inadequate water intake or excessive caffeine intake. Due to our hot climate, I recommend patients to take 6-8 cups or 2 litres (if you have no existing heart or kidney issues) of non-sugar/non-caffeinated fluid per day as a first step to solving this issue. Caffeine drinks are popular in Singapore but should be limited to 1-2 cups daily in the mornings or early afternoon. If the foamy urine persists, you should speak to your doctor to further explore the other causes of foamy urine, like diabetes, renal problems, or high blood pressure. An excellent place to start is a urine test or a kidney ultrasound which your doctor will be able to arrange.
The kidney ultrasound is a safe and simple test to look for any physical abnormalities in the kidney. It is used to detect conditions like kidney stones, swelling of the kidney (hydronephrosis) or kidney growth. These conditions can cause blood (RBC) to be seen in your urine. A urine test tells your doctor whether the foamy urine is due to poor kidney function or a non-serious cause like inadequate fluid intake. It would be best to discuss with your doctor how often you need to test your urine, depending on your health condition.
Kidney stones are also another common condition in our part of the world. Singapore is located along the stone belt, where kidney stones are more prevalent (common). While some countries have a low prevalence of stone disease, it can be as high as 16% in Southeast Asia and nearly 20% in Saudi Arabia. This is undoubtedly influenced by the climate, the fluid intake and the local, regional diet of choice. Combined with our love for caffeine in SouthEast Asia, kidney stones may be a painful occurrence waiting to happen. It is common to hear female patients tell me that renal colic is worse than childbirth!
Kidney stone formation is influenced by the balance between stone “promoters” and “inhibitors”. Diabetes, obesity, and metabolic syndrome, along with a high salt intake and dehydration level, are some well-known stone promoters. In contrast, a high citrate level, adequate hydration, and certain fruits inhibit stone formation. Excess stone promoters lead to a shift in urine pH that encourages stone formation and vice versa. The latest international guidelines recommend a generous fluid intake as the best way to prevent stone formation.
Calcium-based stones are the most common type of kidney stone. However, Calcium supplement intake is unlikely to cause your stones as long as you drink adequate water. There are many sources of dietary calcium in our diet. For most people, eliminating calcium is impossible, and we should not attempt it. If you drink enough fluid, your urine’s calcium(and other salts) remains diluted, and stone cannot form quickly. Meat, chocolate, roasted nuts, and ikan bilis (my favourite) contain high oxalate levels and should be consumed in moderation. Ascorbic acid (Vitamin C) is also converted to oxalate by our body and should be taken within the recommended dosage. A balanced diet with adequate hydration is the easiest way to prevent stone formation.
If you have kidney stones, you should discuss this with a Urologist and learn how to manage the stone best. While small stones (less than 4mm) can be flushed out of the kidney by drinking enough water, preventing the existing stone from growing bigger or new stones from forming is more critical. A common Urology saying goes, “Once a stone former, always a stone former”. Prevention is key for kidney stones patients as recurrence can be as high as 50% within five years.
Finally, overactive bladder is a common lower urinary tract syndrome. Overactive bladder is characterised by the sudden and unavoidable urge to void in the absence of urinary tract infections. There are various theories on the cause of OAB but central to these is the imbalance of inhibitory and excitatory neural pathways to the bladder/urethra.
While it can happen in both sexes, ladies are more likely to suffer from OAB due to a combination of previous pregnancy and shorter urethra. As a result, many sufferers of OABs avoid going out of their homes as it can be mentally stressful when outside the comfort of their own homes. Often, it is stressful for sufferers to venture out of the house due to the need to know where the nearest toilet is located. Overseas travel is taboo which can lead to social isolation in many instances.
While there are many reasons for OAB, caffeine is a bladder stimulant that can worsen OAB. Besides being a weak diuretic, caffeine may stimulate the bladder and worsen the situation. Patients with OAB need to understand that caffeine control should be practised. Where it is not possible, patients with OAB should plan their schedule accordingly to facilitate overactive episodes for 1-2 hours after caffeine intake. Fluid restriction is another common method used by patients with OAB. While this may improve symptoms, any benefits may be negated by the increased risk of stone formation and urinary tract infections. Your Urologist can help you clarify these issues.
