Ah, the joyous tinkling in the toilet bowl, that ecstatic feeling we get when we absolutely have to go and finally make it to the bathroom to void... When the body wants to get rid of its waste products it carries them in the blood to the waste treatment center in the kidneys. The kidneys act like a selective sieve; letting the microscopic sludge, toxic chemicals, and excess liquid out, but retaining some fluid and important minerals. If something in our "plumbing system" goes wrong we can usually get clues as to the kind of problem, be it infection or otherwise, by analyzing the urine for what has leaked out.

The normal and most common color of urine is yellow. If it is clear, urine is usually diluted from too much fluid, i.e. the kidney is overloaded, or perhaps it just can't do its job as a filter and it lets everything through. Blood in the urine causes a different appearance. Just a drop of fresh blood changes urine to a pinkish color. This usually means irritation fairly low down in systems like the bladder. Dark amber urine, resulting from a moderate amount of bleeding, might indicate infection or inflammation of the kidneys or even small stones or gravel scraping the sides of the tubes that lead to the bladder. Bright red blood signifies a more drastic event such as erosion and bleeding from a tumor or perhaps the result of direct trauma.

On the other hand, people who take certain vitamins or medicines, or eat foods like beets, may also notice distinct color changes. The trademark of many vitamins is a bright yellow urine. Pyridium, a special anesthetic that coats the urinary tract, can also cause an orange-red tinge to urine, alarming if one is not aware of this peculiar side effect.

As unsavory as it may sound, the smell of urine is a very important diagnostic feature, used for centuries by my ancient colleagues. The ammonia-like smell most of us are accustomed to, is actually produced by bacteria in our urinary system that break down a major toxin. It's a good thing the bacteria are present in moderate amounts to help us or we would be insidiously poisoned. If for any reason the bacteria multiply to excessive numbers, the situation is no longer one of symbiosis but rather of infection, and the urine may be "smellier" than usual. Diabetics who can't use the sugar in their bodies properly sometimes produce urine with a "fruity" odor. Incidentally, the excess sugar in uncontrolled diabetes can spill over into the urine which can give the fluid a sugary taste. I don't speak from personal experience on this point, of course, and don't advise that you ever try this "taste test" yourself.

What do the laboratory technologists test in urine? Acidity is important. Acid urine is normal, but if it tests alkaline it usually means too many bacteria are partying, causing an infection. Protein in a specimen is revealing. If our bodies break down too much protein (as occurs in severe muscular damage) or the kidneys get sick and can't hold back the normal amount of protein in circulation, it spills in the urine and offers a first clue to a potentially serious problem.
The microscope is as valuable a diagnostic instrument now as it was centuries ago. Much can be learned when urine is examined in this fashion. The appearance of microscopic bacteria, blood, and/or inflammatory cells indicates infection or irritation. Under a trained eye, the nature or shape of these cells may actually pinpoint the site of the problem i.e. either in the kidneys or lower down in the system.

Also visible under the microscope are tiny jewel-like crystals that help diagnose a variety of other disorders. Gout, for example, (a problem caused by genetic and dietary predisposition to the formation of tiny needle like crystals in painful joints) produces little "diamonds," while "coffin shaped" crystals are related to the excessive production of ammonia in the body.
People often don't appreciate the difficulty and pain large folk endure in getting in and out of chairs, moving upstairs or ambulating long distances in public buildings in order to urinate. When mobility is a problem, some will attempt to hold back too long. A static and engorged bladder and kidneys can breed infection.

Any private detective will tell you that you can learn a lot about a person's problems by examining their refuse/waste. The same is true when your doctor orders a urine analysis. If the test is for suspected infection and you are a woman, you will be told to wipe your vulval area and void into a clean container. A fat-sensitive physician will ask a nurse or loved one to help you in this task or offer you the option of catheterization (passing a small tune into the urethra) in order to get a "clean catch." Catheterization is not as bad as it sounds, especially if it is done by an experienced professional.

You may also be asked to bring in a "fresh" morning specimen from home. It is usually best to let the first void go into the toilet when you get up in the morning, rather than collecting it as your specimen. This is because the urine will have likely been stagnating over night while you slept and therefore be unusually concentrated with bacteria and toxins. The same misleading bacterial multiplication will occur if you leave your specimen lying around in a warm environment for any extended period. Your doctor may want to analyze your true urinary tract picture and therefore it is the second morning void that is required. I advise that you follow your physician's instructions as they may vary depending on what s/he is looking for. If any of these options are not acceptable ask your doctor to give you a simple clinical trial of a short course of antibiotic which should take away the usual symptoms (frequent and/or painful urination and/or cramps) in a few days. If this does not work then further testing can be done.

I have received many requests to discuss urinary tract problems especially prevalent in large people. In the next edition of Dimensions I will address issues such as bladder control in both males and females of size. Keep in touch and be well. ß

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Heretic Physician