Urinary Tract Infections: things you never expect would increase your risk of infection.

The urinary tract consists of the kidneys, ureters (which connect the kidneys and the bladder), bladder, and urethra. . The bladder serves as a storage container for urine, which is then emptied by urinating through the urethra, a tube that connects the bladder to the skin. The urethra connects to the end of the penis in a male and connects to an area above the vagina in a female.


Normal urine is sterile and contains no bacteria. Usually, germs get into your system through your urethra, the tube that carries urine from your bladder to the outside of your body. The germs that usually cause these infections live in your large intestine and are found in your stool. If these germs get inside your urethra, they can travel up into your bladder and kidneys and cause an infection.
Urinary tract infections (UTIs) can occur in any part of the urinary tract.  A bladder infection is known as cystitis and a kidney infection is known as pyelonephritis. Kidney infections are much less common — but often more serious — than bladder infections. Women tend to get more bladder infections than men. This is probably because women have shorter urethras, so it is easier for the germs to move up to their bladders. Having sex can make it easier for germs to get into a woman's urethra.

A UTI is an infections are caused by microbes—organisms too small to be seen without a microscope. Bacteria are the most common cause of UTIs but can also be caused by fungi or viruses.. Normally, bacteria that enter the urinary tract are quickly removed by the body before they cause symptoms. But sometimes bacteria overcome the body’s natural defenses and cause infection. You may be more likely to get an infection if you have diabetes or you are pregnant. The chance that you will get a bladder infection is higher if you have any problem that blocks the flow of urine from your bladder. Examples include having kidney stones or an enlarged prostate gland.

UTIs are the second most common type of infection in humans. The National Kidney & Urologic Diseases Information Clearinghouse (NKUDIC) reports that UTIs account for over eight million doctor visits annually.

Risk Factors and Causes of Urinary Tract Infections

Anything that reduces bladder emptying or irritates the urinary tract can cause UTIs. Many factors can put someone at risk.

·         OBSTRUCTIONS: Blockages that make it difficult to empty the bladder can cause a UTI. Obstructions can be caused by an enlarged prostate, kidney stones, and certain forms of cancer.

·         GENDER: Women are more likely to get UTIs. This is because their urethras are shorter. UTIs in men are less common and more serious.

·         SEXUAL ACTIVITY: Pressure on the urinary tract during sex can move bacteria from the colon into the bladder. Most women have bacteria in their urine after intercourse. However, the body usually can get rid of these pathogens within 24 hours. Bowel bacteria may have properties that allow them to stick to the bladder.

·         BATHROOM HYGIENE: Wiping from back to front after going to the bathroom can lead to a UTI. This motion drags bacteria from the rectal area towards the urethra.

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

·         CONDOMS: Latex condoms can cause increased friction during intercourse. They may also irritate the skin. This may increase the risk of UTI in some individuals. However, condoms are important for reducing the spread of sexually transmitted infections.

·         DIAPHRAGMS: Diaphragms may put pressure on the urethra. This can decrease bladder emptying. Some studies have seen a higher UTI risk in women who use diaphragms.

·         DIABETES: Diabetes may make patients more susceptible to UTI.

·         LOSS OF ESTROGEN: After menopause, a loss of estrogen changes the normal bacteria in the vagina. This can increase the risk of UTI.

·         PROLONGED USE OF BLADDER CATHETERS: Catheters are used when someone cannot urinate normally. These thin, flexible tubes are inserted into the bladder. They allow urine to drain into a container. Long-term catheter use can increase the risk of UTI. They may make it easier for bacteria to get into the bladder. Treatment for a catheter-associated UTI may require removal of the device.

Symptoms of Urinary Tract Infections

Symptoms of UTI depends on the part of the urinary tract that is infected.
Lower UTIs are infections of the urethra and bladder. Their symptoms include:

• burning with urination
• increased frequency of urination with scant amounts of urine being passed
• bloody urine
• cloudy urine
• urine that looks like cola or tea
• strong odor to urine
• pelvic pain (women)
• rectal pain (men)

Upper UTIs are infections of the kidneys. These are potentially life threatening, if bacteria move from the infected kidney into the blood. This condition is called sepsis. Sepsis can cause dangerously low blood pressures, shock, and death. Symptoms of upper UTI include:

• pain and tenderness in the upper back and sides
• chills
• fever
• nausea
• vomiting

Women who are pregnant and have symptoms of UTI should see their doctor right away. UTIs during pregnancy can cause premature delivery and high blood pressure. UTIs during pregnancy are also more likely to spread to the kidneys.

Diagnosis of Urinary Tract Infection

History and physical exam may suggest you have a lower or upper UTI. Ways to diagnose a UTI are via urinalysis and/or urine culture.
Definitive diagnosis requires a “clean catch” urine specimen. This is urine collected from the middle of the urinary stream. This should be done by an expert to avoid picking up bacteria from your skin. Your doctor will look for a large number of white blood cells in your urine. This can signal an infection. Your urine will also be cultured for bacteria. This can identify the cause of infection. It can also help your doctor choose appropriate treatment.
If an upper UTI is suspected, you may also need a complete blood count (CBC) and blood cultures. These can make certain your infection hasn’t spread to the blood.
People with recurrent UTIs may need to be checked for obstructions. Some tests for this include:

• ultrasound
• intravenous pyelogram (IVP) – this injected dye allows doctors to see your entire urinary tract
• cystoscopy, which uses a small camera to examine the bladder

During a cystoscopy, your doctor may remove a small piece of bladder tissue. This is called a biopsy. A biopsy can be used to rule out bladder cancer.

Treatment of Urinary Tract Infection

A simple UTI can be treated with a short course of oral antibiotics. A three-day course of antibiotics will usually treat most uncomplicated UTIs. However, some infections may need to be treated for several weeks. Depending on the type of antibiotic used, you may take a single dose of medication a day or up to four daily doses. A few doses of medication may relieve you of the pain or urge to urinate frequently but you should still complete the full course of medication prescribed for you even if all symptoms have been relieved. Unless UTIs are fully treated, they can frequently return. You should also remember to drink plenty of liquids, especially around the time of a UTI.

If the UTI is a complicated UTI, then a longer period of antibiotics is given and usually is started intravenously in the hospital. After a short period of intravenous antibiotics, then the antibiotics are given by mouth for a period up to several weeks. Kidney infections have usually been treated as a complicated UTI.

Simple UTIs routinely improve with the three days of oral antibiotics and you do not need a urine culture to prove that it is gone. If you have a complicated UTI, however, you should have a urine culture to show that the UTI is gone. If your symptoms continue even with medication, then you may need a longer course of medications, a different drug or different delivery method (for example, if you are taking medication by mouth, then you may need it intravenously).

 

Prevention of Urinary Tract Infection

Researchers are trying to develop a vaccine to prevent recurrent UTIs.
In the meantime, there are simple steps you can take to help prevent UTIs. WomensHealth.gov recommends:

• wiping from front to back after urinating or having a bowel movement
• drinking enough water
• drinking water after having sex
• not holding urine for long periods of time
• cleaning your vaginal and rectal areas daily
• taking showers instead of baths
• wearing comfortable underwear, tight fabric traps moisture
• wearing underpants with a cotton crotch

·         Urination after sexual intercourse (decrease the risk of UTI because it can flush out any bacteria that were introduced during intercourse)

·          Sometimes a dose of antibiotics after intercourse can help prevent recurrence of UTIs.

·         Certain forms of birth control, such as spermicidal foam and diaphragms, are known to increase the risk of UTIs in women who use these as their form of contraception.

While these steps are useful, they don’t guarantee that you won’t get a UTI. Contact your medical provider whenever you have any symptoms of UTI. If you have recurrent UTIs and use spermicides or a diaphragm, your doctor may recommend alternative birth control.

Frequently asked questions:

Can UTI cause damage to the kidneys?
If the UTI is treated early, then there will probably be no lasting influence on your urinary tract. Recurrent or unrecognized UTIs could cause damage if not remedied expeditiously.

If UTIs are recurring, can I get over them?
If you are having recurrent UTIs (three or more per year), then you should see your doctor for possible further testing like a urinalysis. You may also need an ultrasound or CT scan to look for any abnormalities of the urinary tract. If you continue to have UTIs, you may benefit from a longer course of low-dose antibiotics or by taking an antibiotic after sexual intercourse. There are also methods of self-testing that your urologist may help coordinate with you to institute both diagnosis and treatment of UTIs at home.

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