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URINARY TRACT INFECTIONS

A urinary tract infection (UTI) is an infection that involves the structures that urine passes through before being eliminated from the body (i.e. the kidneys, ureters, bladder, or urethra).

The kidneys are a pair of small organs that lie on either side of the spine at about waist level. Their functions in the body are many and includes removing waste and excess water from the blood and eliminating them as urine. The aforementioned functions make them important in the regulation of blood pressure. Kidneys are also very sensitive to changes in blood sugar levels and blood pressure and electrolyte balance. Thus both diabetes and hypertension can cause damage to the kidneys.

Two narrow tubes (Ureters) drain urine from each kidney into the bladder.

The bladder is a sack-like organ that collects and stores urine. When the urine reaches a certain level in the bladder, one begins to experience the sensation to empty it, the muscle lining the bladder is then voluntarily contracted to expel the urine.

The urethra is a small tube that connects the bladder with the outside of the body.

A muscle known as the urinary sphincter which is located at the junction of the bladder and the urethra, must relax at the same time the bladder contracts to expel urine.

The fact is that any part of this system can become infected. The sad thing is that, the farther up in the urinary tract the infection is located, the more serious it is.

The upper urinary tract comprises the kidneys and ureters. Infection in the upper urinary tract generally affects the kidneys (i.e. pyelonephritis), which causes fever, chills, nausea, vomiting, and other severe symptoms.

The lower urinary tract comprises the bladder and the urethra. Infections in the lower urinary tract can affect the urethra (i.e. urethritis) or the bladder (i.e. cystitis).

Urinary tract infections are much more common in adults than in children, however urinary tract infections in children are more likely to be serious than those in adults.

Besides bedwetting, urinary tract infection is the most common urinary tract problem in children.

How the Urinary Tract Works

The role of the urinary tract is to make and store urine. Urine is one of the waste products of the human body. It is made in the kidneys and travels down the ureters into the bladder which stores it until it is emptied by urinating through the urethra which is a tube that connects the bladder to the skin. The urethra opens at the end of the penis in males and above the vaginal opening in females.

The kidneys are a pair of fist-sized organs in the back that filter liquid waste from the blood and remove it from the body in the form of urine. Kidneys also balance the levels of many chemicals in the body (e.g. sodium, potassium, calcium, phosphorous etc.) as well as checking the blood's acidity. Certain hormones that help control blood pressure, boost red blood cell production and help make strong bones are made in the kidneys.

Normal urine has no bacteria in it, and the one-way flow helps prevent infections but bacteria may still get into the urine through the urethra and travel up into the bladder.

TYPES OF URINARY TRACT INFECTIONS

Each type of UTI may result in more-specific signs and symptoms, depending on which part of the urinary tract is infected.

Kidneys (acute pyelonephritis)

  • Vomiting
  • Shaking and chills
  • Upper back and side (flank) pain
  • High fever
  • Nausea

Urethra (urethritis)

  • Discharge
  • Burning with urination

Bladder (cystitis)

  • Frequent, painful urination
  • Lower abdomen discomfort
  • Blood in urine
  • Pelvic pressure

CAUSES

Urine is normally germ free. An infection occurs when bacteria get into the urine and begin to grow. The bacterial infection usually begins at the entrance of the urethra where the urine leaves the body and moves upward into the urinary tract.

The most common culprit of uncomplicated infections is a bacteria called Escherichia coli, better known as E. coli. This bacteria normally lives in the bowel (colon) and around the anus.

  1. coli bacteria can move from the area around the anus to the opening of the urethra. The most common causes of this are improper wiping after bowel movement and sexual intercourse. Usually, the act of emptying the bladder (i.e. urinating) flushes the bacteria out of the urethra. However, urinating may not stop their spread if there are too many bacteria.

The bacteria can travel up the urethra to the bladder, where they can multiply and cause an infection.

The infection can spread further as the bacteria move up from the bladder via the ureters.

Should they reach the kidneys, they can cause pyelonephritis, which can become a very serious condition if not treated promptly.

The following people are at increased risk of urinary tract infection:

  • People with suppressed and battered immune systems: (E.g. HIV/AIDS and diabetes patients).
  • Sexually active women. Sexual intercourse can introduce large numbers of bacteria into the bladder. Urinating after intercourse may decrease the likelihood of developing a urinary tract infection.
  • Postmenopausal women: Decreased estrogen secretion and circulation makes the urinary tract more vulnerable to a UTI.
  • Men with enlarged prostate. Prostatitis or an obstruction of the urethra by an enlarged prostate can lead to incomplete bladder emptying, thus increasing the risk of infection. This is most common in older men.
  • People who suffer from conditions that block or obstruct the urinary tract, e.g. Kidney stones.
  • People with medical conditions that does not allow for the complete emptying of the bladder (for example, spinal cord injury)
  • People who take immune-suppressant medications such as chemotherapy for cancer also are at increased risk.
  • Women who use diaphragms for birth control.
  • Breastfeeding has been linked to decrease the risk for urinary tract infections in children.

The following special groups may be at increased risk of urinary tract infection:

Very young infants: - Bacteria can gain entry to the urinary tract through the bloodstream from other sites in the body.

Young children: - Young children usually experience troubles with wiping themselves and washing their hands well after a bowel movement. Poor hygiene has been linked to an increased frequency of urinary tract infections.

Children of all ages: - Urinary tract infection in children can sometimes be a sign of an abnormality in the urinary tract. An example is vesicoureteral reflux (a condition in which urine moves backward from the bladder up the ureters).

Hospitalized patients or nursing-home residents: - Many of these individuals wear catheters for long periods and are thus vulnerable to infections of the urinary tract. A thin tube (catheter) is placed in the urethra to drain urine from the bladder. This is done for people who have problems urinating or cannot reach a toilet to urinate on their own.

SYMPTOMS

The symptoms of a UTI may include:

  • Cloudy, dark, bloody, or strange-smelling pee
  • A burning feeling when urinating
  • Pain or pressure in the back or lower abdomen
  • A frequent and/or intense urge to urinate,
  • Feeling tired or shaky
  • Fever or chills (which is a sign that the infection may have reached the kidneys)

RISK FACTORS

Urinary tract infections are common in women, and many women experience more than one infection during their lifetimes. Risk factors specific to women for UTIs include:

Sexual activity: - Sexually active women would have more UTIs than do women who are not sexually active. Additionally, having a new sexual partner also increases the risk.

Certain types of birth control: - Women who use diaphragms for birth control as well as women who use spermicidal agents may be at higher risk.

Menopause: - After menopause, there is a decline in circulating estrogen. This causes changes in the urinary tract that make one more vulnerable to infection.

ADDITIONAL UTI RISK FACTORS FOR WOMEN

There are additional risk factors for women. Some factors that were once believed to be a cause of UTIs in women have since been shown to not be as important;

In some of these cases, certain lifestyle changes may help lessen the risk of these factors.

Poor bathroom hygiene: -

Recent studies have failed to confirm that wiping from back to front after going to the bathroom leads to UTIs in women, however since it is yet to be confirmed, it remains a risk factor.

Shorter urethra: -

The length and location of the urethra in women adds up to the likelihood of UTIs. In women, the urethra is very close to both the vagina and the anus and so bacteria that may naturally occur around both the vagina and anus can lead to infection in the urethra and the rest of the urinary tract and then in women, the bacteria have a shorter distance to travel to enter the bladder.

Sexual intercourse: -

Pressure on the female urinary tract during sexual intercourse can facilitate the movement of bacteria from around the anus into the bladder. Most women will have bacteria in their urine after intercourse. However, the body can usually get rid of these bacteria within 24 hours.

Spermicides: -

Spermicides may increase the risk of UTI. They can even cause skin irritation in some women. This increases the risk of bacteria entering the bladder.

Condom use during sex: -

Latex condoms if not-lubricated, may increase friction and irritate the skin of women during sexual intercourse. This may add up the risk of a UTI. However, condoms are still important for reducing the spread of sexually transmitted infections.

Diaphragms: -

These may put a lot of pressure on a woman's urethra which can decrease bladder emptying.

Decrease in estrogen levels: -

After menopause, a decrease in estrogen level changes the normal bacteria in the vagina. This can increase the risk of a UTI.

Other risk factors for UTIs include:

Abnormalities in the urinary tract. Babies that are born with urinary tract abnormalities that hampers urine to leave the body normally or cause urine to back up in the urethra have an increased risk of UTIs.

Blockages in the urinary tract: -

An enlarged prostate or kidney stones can trap urine in the bladder and increase the risk of UTIs. Diabetes and other diseases that impair the body's defense against germs (immune system) can increase the risk of UTIs.

Catheter use: -

People who cannot urinate on their own and use a tube (catheter) to urinate have an increased risk of UTIs. This may include people with neurological problems that make it difficult to control their ability to urinate and people who are paralyzed. A urinary surgery that involves medical instruments can also increase the risk of developing a urinary tract infection.

Additional UTI risk factors for men: -

Having an enlarged prostate is one risk factor for a UTI that's unique to men. Apart from that, most UTI risk factors for men are the same as those for women.

POSSIBLE COMPLICATIONS

Lower urinary tract infections hardly lead to complications if treated promptly and properly. Left untreated however, a urinary tract infection can have serious consequences.

Complications of UTI may include:

  • Stricture (Urethral narrowing) in men from recurrent urethritis, as seen with gonococcal urethritis.
  • Potentially life-threatening, this is a complication of an infection, especially if the infection works its way up the urinary tract into the kidneys.
  • Recurrent infections especially in women who experience two or more UTIs in a six-month period or more within a year.
  • Permanent kidney damage which could be from an acute or chronic kidney infection (pyelonephritis) due to an untreated UTI.
  • Higher risk in pregnant women of delivering low birth weight or premature infants.

DIAGNOSIS

Diagnosis of UTI will usually be made after asking about symptoms and testing a urine sample to assess the presence of white blood cells, red blood cells, and bacteria.

For the urine test, it will be required that the patient washes their genital area before providing a urine sample mid-flow. This helps to eliminate bacteria from around the genital area getting caught in the sample. This method of collecting urine is called 'clean catch'.

In cases of recurrent UTIs, a doctor may request further diagnostic tests to determine if anatomical issues or functional issues are to blame.

Such tests may include:

Diagnostic imaging: This involves an assessment of the urinary tract using ultrasound, CT and MRI scanning, radiation tracking, or X-rays.

Urodynamic: This is a procedure that determines how well the urinary tract is storing and releasing urine.

Cystoscopy: A diagnostic exam that allows the doctor to see inside the bladder and urethra with a camera lens, which is inserted through the urethra through a long thin tube.

In men

UTIs in men are quite rare. For men under the age of 50 years the incidence is between 5 and 8 men out of 10,000.

For men, a UTI, it will infect the same organs and areas as in a woman. Except that for men, the prostate is also at risk of infection.

Men with circumcised penis are less likely to get a UTI than men who have not undergone circumcision. Treatment methods would be similar to those used to treat UTIs in women.

TREATMENT AND HOME REMEDIES

The usual treatment for both simple and complicated urinary tract infections is antibiotics. The type of antibiotic and duration of treatment will depend on the circumstances. Examples of common antibiotics used in treatment include, amoxicillin, sulfamethoxazole/trimethoprim (Bactrim), ciprofloxacin, Nitrofurantoin (Macro bid), and many others.

  • (cystitis, or bladder infection)

In an otherwise healthy person, a three-day course of antibiotics is usually enough. Some doctors prefer a seven-day course of antibiotics. Occasionally, a single dose of an antibiotic is used

In adult males, if the prostate is also infected (prostatitis), four weeks or more of antibiotic treatment may be required.

For adult females who have the potential for early involvement of the kidneys, urinary tract abnormalities, or diabetes, a five- to seven-day course of antibiotics is usually recommended.

For children who suffer from uncomplicated cystitis, a 10-day course of antibiotics is recommended.

Phenazopyridine (Pyridium) or a similar drug can be employed to alleviate burning pain during urination. This can be used in addition to antibiotics for one to two days.

Upper urinary tract infection (pyelonephritis)

Young, patients without serious underlying conditions but with symptoms of pyelonephritis can be treated as outpatients. IV fluids and antibiotics or an injection of antibiotics in the emergency department can be recommended, followed by 10-14 days of oral antibiotics.

With very ill, dehydrated patients, or those who are unable to keep anything in their stomach because of vomiting, an IV will be inserted into the arm. They are likely to be admitted to hospital and given fluids and antibiotics through the IV until they are well enough to switch to oral antibiotics. A complicated or acute infection may require treatment for several weeks.

A person may be admitted to hospital if they have symptoms of pyelonephritis and;

  • Has kidney stones
  • Has a device such as a urinary catheter
  • Appear very ill
  • Is pregnant
  • Has not gotten better with outpatient antibiotic treatment
  • Has underlying diseases that compromise the immune system (e.g. diabetes)
  • Is unable to keep anything in the stomach because of nausea or vomiting
  • Has previous kidney disease, especially pyelonephritis, within the last 30 days

People with symptoms like vaginal or penile discharge, for example should be treated with appropriate antibiotics because urethritis in men and women can be caused by the same bacteria as sexually transmitted diseases (STDs).

HOME REMEDIES

There are a variety of self-care measures (home remedies) and other treatments available for urinary tract infections.

Using a hot-water bottle can ease pain.

Drink plenty of water.

Avoiding coffee, alcohol, and spicy foods, these irritate the bladder.

Because the symptoms of a urinary tract infection mimic those of other conditions, people should see their health care professionals if a urinary tract infection is suspected. A urine test will be needed to confirm an infection. Avoid self-care

PREVENTION

Everyone can take the following steps to help prevent UTIs:

  • Drink six to eight glasses of water daily.
  • Don't hold urine for long periods of time.
  • Talk to a doctor about managing any urinary incontinence or difficulties fully emptying the bladder.

UTIs happen much more frequently in women than in men. Results show that for every eight women who have UTIs, only one man does.

Certain steps may help prevent UTIs in women.

Using topical or vaginal estrogen prescribed by a doctor for peri-menopausal or postmenopausal women, could make a difference in preventing UTIs. If the doctor believes that intercourse is a factor of the recurrent UTIs, preventive antibiotics after intercourse, or long-term, may be recommended.

Daily cranberry supplements or vaginal probiotics, may also help in the prevention of UTIs.

Be sure to discuss with a doctor what the right prevention plan is most suitable.

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