Urinary Tract Infection

What Is a Urinary Tract Infection?

A urinary tract infection (UTI) occurs when one or more parts of the urinary system (kidneys, ureters, bladder, or urethra) become infected with a pathogen (most frequently, bacteria). UTIs most commonly occur in females; about 50% of all females get a UTI during their lifetime. Many UTIs are not serious but if infection reaches the kidneys, serious illness, and even death, can occur.

UTI Symptoms: Bladder Infection 

Bladder infections are the most common type of UTI. Some individuals may have few or no symptoms; however, the usual symptoms include dysuria (pain or burning during urination), low abdominal pain, and/or urine that is cloudy or smells bad or unusual.

UTI Symptoms: Kidney Infection

Some bladder infections do not resolve and get worse with the pathogens moving up (retrograde) the ureters to the kidneys. Symptoms may include those listed for bladder infections on the pervious slide, but often include other symptoms such as pain in the lower back (flank pain on one or both sides), fever, chills, and nausea and/or vomiting.

When to Visit Your Doctor :

Although a bladder infection is not a medical emergency, the following individuals have a higher risk for UTI complications such as infection spread to the kidneys or elsewhere in the body:
Pregnant women
People who have diabetes
Individuals with kidney problems
Elderly individuals

UTI or Something Else?

UTI symptoms described in previous slides may also be symptoms of other fairly common types of infections, sexually transmitted diseases (STDs).These diseases include gonorrhea (and sometimes syphilis along with gonorrhea), chlamydia, and trichomoniasis. Lab tests are readily available to diagnose and differentiate a UTI from an STD. Discharge of pus or fluid from the penis or vagina is a symptom often present in STDs but not usually present in UTIs.

Honeymoon Cystitis

Honeymoon cystitis is the term for a UTI that often occurs after sexual activity. A few women get a UTI frequently after sexual activity (honeymoon or not). Sexual activity can push infecting bacteria into the urethra resulting in an infection. Women with a diaphragm placed for birth control are at a higher risk for UTIs.

Stealth UTI

UTIs without symptoms are not unusual; urine tests can show that bacteria are present in the urine and the condition is termed asymptomatic bacteriuria. Usually this condition is not treated, but in some patients it is better to treat them with antibiotics (for example, pregnant women, some children, and kidney transplant patients).

UTI Complications

There are two major complications of UTIs. The first is infection spread to one or both kidneys. If the infection continues, kidney function can be damaged and result in kidney failure or complete loss of kidney function. The second complication is that the infecting organisms occasionally enter the bloodstream and may infect other organs or, rarely, cause sepsis and death.

How Do UTIs Begin?

The vast majority of UTIs start when pathogens (usually bacteria like E. coli ) reach the urethra and then travel up (retrograde) the urethra to the bladder. Urine is usually sterile until it reaches the distal urethra. Women have short urethras compared to men and most clinicians think the shorter urethra is the major reason women have more UTIs than men.

What Increases Your Risk?

Risk factors for UTIs were presented previously, but besides being a woman who is sexually active or someone who is elderly or

immunocompromised, there are other risk factors:

• Not drinking enough fluids (slows the wash of pathogens out of the body)


• Taking frequent baths (soaking in fluid that may promote retrograde infections)


• Waiting to urinate (promotes retrograde bacterial movement)


• Kidney stones (causes slowing or partial blockage of urine flow)

Urinary Tract Infections in Men

Adult men have infrequent UTIs; if they get a UTI there usually is an underlying cause (for example, having an enlarged prostate or kidney stone or being an elderly person with a catheter).

 

Diagnosing UTIs

Urinalysis is usually the first diagnostic test done after a patient presents their medical history and has a physical exam. The test provides information about the presence of bacteria, white and red blood cells, and chemical abnormalities. It can indicate that other studies such as urine culture and bacterial drug sensitivity tests should be done. Simple tests like the urine dipstick test or even home tests of urine can be done but they are not 100% accurate. It is best to have your doctor evaluate your symptoms and test results.

Treating UTIs

Although severe kidney infections are often treated in the hospital with IV antibiotics, most UTIs (and many mild-to-moderate kidney infections) are treated with oral antibiotics. However, many clinicians are sending urine samples to identify the infecting organisms and determine their antimicrobial resistance. It is not unusual for a doctor to call a patient and switch antibiotics because of antibiotic resistance. In addition, the doctor will usually recommend that the patient take in plenty of fluids (water) and encourage frequent urination to flush bacteria out of the urinary tract.

Treating Recurrent UTIs

Recurrent UTIs are not unusual; you should ask your primary care physician (PCP) for a referral to a urologist if you have three or more UTIs per year to see if there may be an underlying urinary tract problem that may be the cause. Your PCP may also suggest taking long-term (months) low-dose antibiotics, recommend taking an oral antibiotic after sex, or taking an oral antibiotic as needed when UTI symptoms appear.

UTIs and Diabetes

People who have diabetes are at higher risk for UTIs because the high sugar (glucose) levels in the blood can result in high sugar levels in the urine and result in a good growth environment for bacteria. People who have diabetes often have an immune system that does not respond as well to infections. Diabetes can damage nerves that result in incomplete bladder emptying thus encouraging bacterial survival and retrograde infections.

UTIs and Pregnancy

Pregnancy increases the risk of UTIs; hormonal changes may alter normal urinary tract function and the expanding uterus may put pressure on both the bladder and ureters. The effect is to slow urine output and cause pregnant women to “hold or delay urination.” This results in favorable growth conditions for bacteria. UTIs may play a role in preterm labor so your doctor(s) should be informed if you suspect you have a UTI when pregnant.

UTIs and Menopause

During menopause, estrogen levels drop. Because estrogen provides some level of protection against UTIs, its reduction during menopause may make some women more susceptible to UTIs.

 

UTIs and Hospital Stays

During a hospital stay, many patients cannot get up to go to the bathroom and require a catheter (a tube put through the urethra into the bladder to allow urine to flow). Bacteria can enter the bladder through and around the catheter in some individuals. This problem is more frequent in people who have long hospital stays or are in long-term care facilities such as nursing homes.

UTIs in the Elderly

UTIs in the elderly are common in both men and women. Although they may have symptoms commonly associated with UTIs, often UTI symptoms in elderly individuals are different. They may show only symptoms of agitation, delirium, confusion and/or behavioral changes. The elderly are at higher risk of developing complications such as kidney infections or sepsis from UTIs.

UTIs in Infants

Changing a wet and/or soiled diaper is a good way to help prevent UTIs in children. In addition, wiping from front to back in both males and females also reduces the chances of developing UTIs. Like the elderly, infants and young children may develop classic UTI symptoms but are unable to communicate them to anyone. However, signs of UTI in children may include fever, odd-smelling urine, decreased food intake, vomiting, abdominal discomfort, and fussy behavior. Early treatment of UTIs in children helps prevent kidney damage.

UTIs in Children

About 1% of boys and 3% of girls have UTIs before puberty. Some of these children have structural problems in their urinary tracts that allow retrograde flow to easily occur thus giving bacteria an easy route to the kidneys. A pediatric urologist is usually consulted for evaluation and treatment. Other children may delay urination and some may not relax their muscles enough to completely empty their bladder. These children may be helped by increased fluid intake and encouraging more bathroom trips.

UTI or Potty Training Problem?

Potty training can be difficult for the child (and the adults). However, accidents are part of this training, so adults should expect them to happen and the child should be taught that accidents can happen and to not be upset if they do. Some children rebel (scream and cry) when potty training. Reassurance is useful, but not all children can be potty trained at one particular age. Some children may not be at the developmental stage for training while others are. Children often imitate other children's behavior. Seeing a closely-aged sibling or day-care friend use the potty and be praised for it has worked well for many children. A child’s rejection of potty training is not usually considered a sign of a UTI.

UTI Prevention

Prevention methods for UTIs have been presented in several preceding slides; here is a short summary of common and easy ways to prevent UTIs:

• Drink a lot of water daily


• Don't "put off" going to the restroom (don't delay urination)


• Wipe from front to back


• Don't use feminine hygiene sprays


• Take showers instead of baths

The Cranberry Connection

Some studies suggest cranberry juice may help prevent UTIs because there is some evidence cranberry juice interferes with E.coli attaching to the bladder wall. Cranberry tablets or capsules may also accomplish this. However, there is no good evidence that indicates cranberries, in any form, can cure a UTI. People with a history of kidney stones should check with their doctor(s) before trying cranberry preparations as a preventive measure against UTIs.

Remedies for Bladder Infections :

• Women are more likely to get a urinary tract infection, and the best remedies are a combination of medical treatment and lifestyle changes.


• Some helpful lifestyle modifications for bladder infections include drinking more water, urinating frequently, wearing loose clothing, and drinking cranberry juice.


• Antibiotics and pain relievers are medical treatments for urinary tract infections.


• If you feel burning or stabbing pain when you urinate, you might have a bladder infection. Bacteria growing in the bladder or urethra cause bladder infections. The urethra is the tube that takes urine out of your body.


• Anyone can get a bladder infection, but they’re more common in women than men or children. Bladder infections are also called urinary tract infections (UTIs). The best remedies for bladder infections include a combination of medical treatment and lifestyle adjustments.

Drink More Water
Increase the amount of water you drink when you’ve got a painful UTI. Fluids perform two jobs: they empty bacteria out of your bladder, and dilute your urine.

Urine is made of waste products and acids from your body. Concentrated, dark urine is more acidic and is sometimes more painful to pass when you have a bladder infection. Diluted urine is lighter in color and usually doesn’t burn as much.

Avoid caffeinated drinks like coffee, tea or soda. Caffeine can irritate your bladder even more when you have an infection.

Frequent Urination
Bacteria can grow in your bladder for a variety of reasons. “Holding it,” or not going to the bathroom when you need to, can increase the risk of bacteria growth. One of the best remedies and preventive tools for bladder infections is to urinate frequently.

It’s especially important to urinate after having sex. Sexual activity can push bacteria deeper into the urethra of both men and women. Urinating soon after sex flushes bacteria away from your urinary tract, so it can’t settle and cause an infection.
Antibiotics
In some cases, a minor UTI resolves itself. You might feel symptoms for a day or two, but with increased hydration and urination, it should pass. Other infections are more serious and require medical treatment.

Your doctor will probably prescribe antibiotics for a bladder infection. The length of treatment might vary, depending on the specific drug you’re taking.

It’s important to take your medication for the full course even if you feel better before it’s done. You’ll need the full dose to make sure the harmful bacteria are out of your system.

Pain Relievers
Severe bladder infections can cause pain in the pelvic region even when you’re not urinating. Antibiotics will help you feel better, but it may take a day or two before the drugs kick in.

Ask your doctor if it’s safe to take over-the-counter (OTC) pain relievers in the meantime (it is for most people). OTC acetaminophen or ibuprofen can take the edge off the pain as you wait for the antibiotics to start working.

Apply Heat
If anti-inflammatory meds don't work for you, try a heating pad instead. Place the pad on a towel to avoid burning yourself, and center the heat over your bladder.

Or, try a warm, moist compress. Low heat across your abdominal region can soothe the dull ache that is sometimes a symptom of a UTI.

Appropriate Dress
Bladder infection remedies can include how you dress. Think casual, relaxed, and flowy. Clothing that lets your skin breathe can help keep the bacteria in your urinary tract at bay.

Moisture is a breeding ground for bacteria, in the bladder and elsewhere. Cotton underwear and loose pants or skirts promote air circulation and reduce the chances of bacteria growth. Tight jeans and other snug-fitting pants can trap moisture in your most delicate areas.

Cranberry: Yes or No?
Cranberry has been a natural and alternative treatment for bladder infections for generations. But does it really work? The answer isn’t clear-cut, which often leads to more questions and confusion.

According to research published in JAMA Internal Medicine, cranberry juice and tablets have shown some promise as a remedy for UTI in women who get recurring infections. Because the studies are of a very specific population, the findings don’t offer evidence of efficacy for a larger population.

The bottom line: talk to your doctor about using cranberry juice as a treatment for your bladder infection. Drinking it probably won’t hurt, but it might not help as much as you would like.