Pee: A Girl's Guide to Plumbing

Your urine may be 95 percent water, but it can reveal whether you're pregnant, have diabetes, are taking painkillers, or even ate asparagus for lunch. It contains an awe-inspiring number of elements, including proteins, enzymes, minerals, hormones, electrolytes, and vitamins. Researchers say that someday urine may help doctors diagnose cancer.

The system of organs that manufactures your pee is equally remarkable -- until something goes wrong. More than half of all women suffer from incontinence, compared with a mere 14 percent of men, according to one large study. And you're also more likely to suffer infections and other pee-related problems than your guy (at least until middle age, when men's prostate problems start to swell). Adding insult to ­injury, you can't even pee standing up.

On history's stage, pee has had some pretty wacky roles. The Aztecs cleaned wounds with it and ancient Romans used it to whiten their teeth. Some World War I soldiers used pee-soaked cloths as gas masks, and more recently the U.S. military developed dried meals that can be rehydrated with urine. The practice of ingesting or applying the stuff, known as urine therapy, purportedly wards off disease, though peeing on a jellyfish sting probably won't stop the pain. Read our guide and you'll come away with a whole new appreciation for your urinary system.

Get This Potty Started

1. Pee production starts in your kidneys (nature gave you two in case you lose one). About 400 gallons of blood flow through your kidneys every day, producing an impressive two quarts of urine.
2. Nephrons in the kidneys separate waste products, which flow on to the bladder, from nutrients and useful chemicals, which return to your bloodstream.
3. Ureters are the flume ride pee takes down to the bladder.
4. As pee's holding tank, the bladder is often described as a balloon, but it's really a muscle.
5. Your urethra is a mere two inches long, only about a quarter the length of a man's, so it's much easier for bacteria from your anus and vagina to travel to your bladder and infect it. Penis envy now?

Now or Never How do we know when it's time to go? Nerves in the bladder sense how full it is and send a message to the brain: toilet, now. Or, a little later, Toilet now! "Peeing is complicated," says ob-gyn Sandy Culbertson, MD, at the University of Chicago. "Three sets of muscles must work in coordination: The pelvic floor muscles and the urethra must relax, then the bladder must contract."

Can You Drink Your Own Pee?

The answer is yes -- and no. If you're stranded or, say, shipwrecked, experts say drinking urine could extend your life by a day or two. There are famous examples of people who have done it, like Aron Ralston, who cut off his arm to save his life while trapped in a Utah canyon. But the chemicals in urine are toxic enough that even the military has advised soldiers not to drink it. There's a reason it's meant to be waste.

Common Pee Problems

Women suffer more than men from urinary tract infections, overactive bladder, interstitial cystitis (now often referred to as bladder pain syndrome), and two kinds of incontinence, while men get more bladder cancer. Here are the facts.

Urinary Tract Infections
Symptoms
If you're having trouble peeing even though you feel you need to, that's a warning sign of a UTI. Burning or pain with urination are also symptoms, says Ziya Kirkali, MD, senior scientific adviser in the division of kidney, urology, and hematology at the NIH. Your doctor will do urinalysis to determine the source of the trouble. The most common culprit is E. coli, which causes up to 90 percent of UTIs. Unfortunately, for many women, having one means getting many more. No one knows why some women are more vulnerable, but several factors contribute. Bacteria stick to the lining of some people's bladders more easily, and they can't just pee it out. When your estrogen decreases after menopause, that makes the tissues of the urethra and bladder more fragile and a less effective barrier to infection. ?And for many women, having sex puts them at risk," Dr. Culbertson says, explaining that it's probably a matter of mechanics. Because women's urethras are short, bacteria from the vagina can get pushed up into the bladder by sex (hence the term "honeymoon cystitis").

Treatment
Only antibiotics can cure the infection, but there are ways to ward off recurrences. You may not be drinking enough water, or you're waiting too long to pee. Dr. Culbertson recommends that you drink five to eight glasses of water a day and pee every two hours. If your tissues have thinned after menopause, a vaginal estrogen cream can help. Wendy Cohan, RN, author of The Better Bladder Book, points out another preventive measure: ?You need to wipe correctly, from front to back. Surprisingly, some people don't." While this one may sound a bit fussy, Cohan also recommends that you and your partner wash your hands and genitals before and after sex. Cranberry juice has also been heralded as prevention for UTIs, but research hasn't shown definitively that it works. It shouldn't replace antibiotics if you have an infection, but it couldn't hurt to try if you have recurrent episodes.

Interstitial Cystitis

Symptoms
Doctors don't know what causes this chronic inflammation of the bladder wall. You feel pain as urine starts to fill the bladder and get relief once you pee. And when your bladder is inflamed, you feel the urge to go even more often. Up to 8 million women may have IC, according to the Interstitial Cystitis Association.

Treatment
Sometimes just changing your diet can ease the symptoms. Try cutting out these five categories of foods and beverages, which can irritate the bladder:

1. Carbonated beverages
2. Caffeine (sadly, that includes chocolate)
3. Alcohol
4. Spicy foods
5. High-acid foods like citrus fruit

Common treatments include physical therapy or biofeedback to relax the pelvic muscles, medications such as pain relievers, low-dose tricyclic antidepressants and antihistamines to help relieve frequency, a drug called Elmiron that coats the bladder (as Pepto-Bismol coats the stomach), anesthetic medicines administered through catheters, and sometimes even surgery.

Incontinence and Cancer

Stress Incontinence
Symptoms
Incontinence might make you think of adult diapers, but the problem is seldom that bad. If you release a tiny spurt of pee when you cough, sneeze, or laugh, that's stress incontinence. Not the end of the world, but it can be embarrassing. What causes it? Pregnancy, childbirth, and menopause all weaken the muscles that control peeing. And obesity literally weighs down your bladder. You might also have some leakage during intercourse if your pelvic muscle tone isn't good, says Dr. Kirkali.

Treatment
Kegel exercises strengthen your pelvic-floor muscles, and cutting out certain foods can help (see foods and drinks to avoid in the interstitial cystitis section). If you're overweight, drop some pounds. Other therapies include biofeedback, which alerts you to when your bladder muscles are contracting so you begin to control them, and collagen injections to thicken the tissues that surround the urethra. In severe cases, surgery can create a "sling" to support the bladder and reduce leakage. But do your research: Complications from some mesh slings have triggered an FDA report about safety concerns.

Urge Incontinence
Symptoms
The nerves and muscles of your bladder work overtime, so the bladder contracts even when it isn't full. An overactive bladder can send you to the bathroom incessantly, whether you need to go or not.

Treatment
As with stress incontinence, biofeedback and doing Kegels can put you back in command. Or retrain your bladder by peeing on a schedule, every two hours at first, then gradually increasing the time between pees. Meds called anticholinergics relax bladder muscles, calming that constant urge to go. In certain cases surgery to expand bladder capacity reduces symptoms. Nerve stimulation is another option.

Bladder Cancer
Symptoms
Women have a lower risk (one in 86) on this one than men do (one in 26). Symptoms include blood in your urine, back or abdominal pain, and pain when you pee. Smoking is one of the biggest risk factors. Recent research suggests that not drinking enough liquids may also increase your risk.

Treatment
If bladder cancer is detected early enough, 97 percent of patients live five years or longer. Treatment usually involves surgery to remove the tumor, possibly combined with radiation and chemotherapy or immunotherapy. In advanced cases, the entire bladder may be removed; afterward, you will pee into a bag or use a catheter.

Going with the Flow

• As many as 88 percent of us admit to peeing in the shower, according to various surveys.
• To pee in the woods, spread your feet wide and squat as low as you can to avoid peeing onto your pants or shoes. Bonus points if you can lean against a tree, squat and do it. (This is when those down-low yoga poses really pay off.) It's good to be on a slight rise rather than in a hollow, so your pee path flows downhill and away.
• Tinkle, tinkle, little star. Astronauts in space pee often, since their body liquids shift upward. With only one unisex bathroom for seven astronauts on space shuttle missions, they often had to float in line.
• Flushing, Queens. Besides the fact that we can't pee standing up, one of the reasons it takes us longer in the loo than the dudes: we're cleaner. A recent study by the American Society for Microbiology found that 93 percent of women washed their hands in public restrooms, versus only 77 percent of men.
• In Plain Sight. When your doctor looks at your pee under a microscope, she checks for abnormal numbers of blood cells as well as bacteria, which can signal a urinary tract infection, or yeast, which can cause trouble in the urethra. She might also see crystals, which can form painful kidney stones.

Urinalysis Color Chart

The hue of your pee provides a spectrum of information. Many color changes are harmless, but see your doctor if they persist.

1. Clear. You may be overhydrating. There's too much water in your urine.
2. Pale yellow, like lemonade. This is the color you're going for. Congratulations: You're drinking the right amount of water!
3. Dark yellow. You may be dehydrated.
4. Bright yellow. Taking megadose vitamin supplements? Excess B can turn your urine neon yellow.
5. Chartreuse to green. Asparagus can give urine a tinge of green.
6. Pink to red. Beets, blueberries, rhubarb, and certain laxatives can redden your pee. Red may also mean traces of blood or a symptom of chronic lead or mercury poisoning.
7. Orange to orangey brown. Could be jaundice, large amounts of carotene or vitamin C in your diet, the antibiotic rifampin, or the blood thinner warfarin.
8. Blue. Meds such as cimetidine, indomethacin, and amitriptyline, certain multivitamins, or the rare familial hypercalcemia can turn pee blue.
9. Dark brown. What makes your urine turn brown? Kidney and liver disorders, antimalarial drugs, the antibiotic metronidazole, nitrofurantoin (which treats UTIs), methocarbamol, a muscle relaxant, some laxatives, and even fava beans.
10. Dark to black. Can be a sign of melanoma, copper poisoning, or excessive L-dopa, a Parkinson's drug.
11. Cloudy white. Often caused by too much phosphate, triggered by a big meal or even drinking a lot of milk. Could also indicate a urinary tract infection or kidney stones.

Understanding a Urine Test

Urinalysis is a cheap and effective way to figure out how well your body is functioning. Your pee can reveal a lot about your habits and your health. "It's a great fluid to let us investigate diseases of various systems of the body, not just the urinary tract," says Dr. Kirkali. Here's what some of those indecipherable words on your lab report might mean.

pH Normal range is 4.6 to 8.0. Acidic urine could indicate diabetes, dehydration, or diarrhea, while alkaline urine might signal a UTI.

Specific Gravity Normal range is between 1.020 and 1.028. If it's too low it could be nephritis, inflammation of the nephrons caused by a reaction to a drug, long-term use of painkillers, or an autoimmune disease. If it's too high, it could be diabetes or a fever.

Protein Levels can rise temporarily after exercise, but persistent high levels can indicate kidney damage.

Glucose Excess glucose, or sugar, in your urine might mean diabetes.

Red Blood Cells Could indicate kidney stones, bladder stones, or other urinary disorders, including cancer.

White Blood Cells High levels of leukocytes, or white blood cells, usually indicate that your body is battling an infection.

Ketones High levels of ketones, created when your body breaks down fat, can indicate diabetes, or that you're on a high-protein diet.

Bilirubin This substance is created by the breakdown of red blood cells; high levels could indicate a liver disorder.

Yeast Too much can mean a urinary tract infection.

Bacteria Also indicates a urinary tract infection.

Crystals Can mean painful kidney stones.

Odor & Out Unlike poop, pee is sterile, until it picks up bacteria passing through the urethra. When it comes out of your body, healthy urine doesn't even smell. But leave it sitting for a while and it'll stink. That's because one of the main components, urea, breaks down when exposed to air, giving off an odor of ammonia.

Negotiating the Pee Process

Seems like giving a urine sample really couldn't be simpler: just pee into a cup. But doing it right takes a little finesse. Here's the Mayo Clinic's clean-catch technique.

1. Clean yourself with the sterile wipe your doctor provides, wiping from front to back, to remove bacteria or skin cells that could contaminate the sample.
2. Urinate into the toilet a bit first, stop urinating briefly, then pee into the collection cup. You don't want the first urine you pee, because it could contain germs or other contaminants from your urethra. At least two ounces is needed for a good sample. Want a visual? Imagine two shot glasses full.
3. Finish urinating in the toilet. Make sure your name's on the cup.

You Go, Girl!

"I'm always on my feet at work and have few chances to go to the restroom. If I cough, I pee. If I sneeze, I pee. I wear a pad 24/7 because I never know when or if I'm going to have an accident!"
-- Joanie, Park Rapids, Minnesota

"My bladder trouble got really bad after the birth of my first child. My doctor says I have a form of urge incontinence. The worst part is getting the panicky feeling when you are somewhere without a public restroom, or there is one but it's really hard to get to fast, like at the mall."
-- Kayla, Weatherford, Texas

"I get a urinary tract infection about every six months. In college I couldn't have sex without getting one, even though I'd pee right afterward. It got so bad that I was taking low-dose antibiotics daily just to prevent them. Having a UTI is such a pain. Really, it hurts!"
-- Fallon, Miami, Florida

Do Your Kegels
Kegels deliver a one-two punch: a more satisfying sex life, relief from urgency, and no more leaking when you cough, laugh, or sneeze. Here's the drill: While sitting or lying down, tighten your pelvic-floor muscles by pretending you're holding back pee. Do 10 times, holding each one for 10 seconds. Repeat three times a day. And be patient: It may take three to six weeks for the effects to kick in. Meanwhile, use a panty liner for occasional leaks.