Urinary Tract Infection

What is a urinary tract infection?

Urinary tract infection (UTI) is an infection of your urinary system. UTI that is limited to your bladder can be painful and annoying, but serious complications can occur if the infection spreads to your kidneys.

Women have the greatest risk of developing a UTI. Research shows that half of all women will possibly develop a UTI during their lifetimes and many will experience this more than once in a lifetime.

The urinary system removes waste from your body. The waste removal process takes place as follows:

Step 1: The kidneys (a pair of bean-shaped organs in your upper posterior abdomen) filter waste from your blood.

Step 2: Tubes called ureters carry urine (waste) from your kidneys to your bladder.

Step 3: Urine is stored in the bladder until it exits the body through the urethra.

Even though all of these system components can become infected, most infections involve the lower tract - the urethra and the bladder.

Antibiotics are the typical treatment for urinary tract infections, but there are steps that you can take to reduce your chance of getting a UTI in the first place.

Signs and symptoms

Not everyone with a UTI develops recognisable signs and symptoms, but most people have at least one or more of the following symptoms:

• a persistent urge to urinate;
• a stinging or burning sensation when urinating;
• passing frequent, small amounts of urine; and
• blood in the urine or cloudy, strong-smelling urine.

Depending on which part of the urinary tract is infected, the signs and symptoms may become more specific. For example:

• Acute pyelonephritis (infection of kidneys) may occur after spreading from an infection in your bladder. Kidney infection can cause upper back and flank pain, high fever, shaking chills and nausea or vomiting.

• Cystitis (infection of the bladder) may result in pelvic pressure, lower abdomen discomfort, frequent, painful urination and strong-smelling urine.

• Urethritis (infection of the urethra) leads to burning with urination. In men, urethritis may also cause penile discharge. Please note that urethritis may be related to sexually transmitted infections and sufferers from urethritis are strongly advised to also have counselling and testing for HIV infection.

Causes

Urinary tract infections typically occur when bacteria enters the urinary tract through the urethra and begin to multiply in the bladder. The urinary system has infection-fighting properties that inhibit the growth of bacteria and is designed to keep out such microscopic intruders.

The body's main protective device against urinary tract infections is the regular complete emptying of the bladder during voiding. Even though bacteria may get into the bladder, they are usually washed out before a significant infection can develop.

The tubes (ureters), which drain urine from the kidneys to the bladder, also have a one-way valve at their lower end where they enter the bladder. Any condition that impairs the normal flow of urine, or interferes with normal emptying, will make a person more susceptible to infection.

What puts me at risk?

Up to half of all women will develop a bladder infection over a lifetime. A key reason is their anatomy. Women have a shorter urethra than men have, which cuts down on the distance bacteria must travel to reach the bladder.

Women who are sexually active tend to have more UTIs. Sexual intercourse can irritate the urethra, allowing germs to travel easily through the urethra into the bladder. Women who use diaphragms for birth control also may be at higher risk, as are women who use spermicidal agents. After menopause, UTIs may become more common because tissues of the vagina, urethra and the base of the bladder become thinner and more fragile due to loss of oestrogen.

Other risk factors include:

• anything that impedes the flow of urine, such as an enlarged prostate in men or a kidney stone;
• diabetes and other chronic conditions that may impair the immune system;
• medication that lowers immunity, such as chronic cortisone therapy or chemotherapy for cancer;
• prolonged use of tubes (catheters) in the bladder; and
• disease related to immune deficiency, e.g. HIV and AIDS and persons on corticosteroid treatment.

Treatment

If your symptoms are typical of a UTI and you are generally in good health, antibiotics are the first line of treatment. Your doctor will assess what drugs and the length of treatment should be prescribed. He or she will provide treatment according to your condition and the most probable type of bacteria that is causing the illness. Make sure your doctor is aware of any other medication you are taking or any allergies you may have. This will help your doctor to select the best treatment.

Usually, UTI symptoms clear up within a few days of treatment. But you may need to continue antibiotics for a week or more. It is very important to complete the entire course of antibiotics recommended by your doctor to ensure that the infection is completely eradicated.

If you have recurrent UTI, your doctor may recommend a longer course of antibiotic treatment or a self-treatment programme with short courses of antibiotics at the outset of your urinary symptoms. Blood tests and urine tests may need to be sent to the laboratory for testing.

For infections related to sexual activity, your doctor may even recommend taking a single dose of antibiotic after sexual intercourse.

For severe UTI (e.g. pyelonephritis - infection of the kidneys), hospitalisation and treatment with intravenous antibiotics may be necessary. When recurrences are frequent or a kidney infection becomes chronic, your doctor will likely refer you to a doctor who specialises in urinary disorders (urologist or nephrologist) for an evaluation to determine if urologic abnormalities may be causing the infections.

Self-care or prevention

UTI can be painful, but you can take steps to ease your discomfort until antibiotics clear the infection. Follow these tips:

• Drink plenty of fluids. Drink plenty of water to dilute your urine and help you to flush out bacteria.
• Avoid coffee, alcohol and soft drinks containing citrus juices or caffeine until your infection has cleared. They can irritate your bladder and tend to aggravate your frequent or urgent need to urinate.
• Use a heating pad. Sometimes a heating pad placed over the abdomen can help minimize feelings of bladder pressure or pain.
• Use an agent like Citro-Soda dissolved in water to alkalinise the urine. Please consult your doctor if the symptoms persist.
• Antibiotics expedite recovery. Upper urinary tract infections and pyelonephritis are not suitable for home treatment. Some patients with recurrent UTIs are issued with antibiotics, which they take as soon as symptoms develop.

The following steps could reduce your risk of UTI:

• Drink plenty of liquids, especially water. Cranberry juice may also have infection reducing properties.
• Urinate promptly when the need arises. Avoid holding your urine for a long time after you feel the urge to void.
• Wipe from front to back. Doing so after urinating and after a bowel movement helps to prevent bacteria in the anal region from spreading to the vagina and urethra.
• Empty your bladder as soon as possible after intercourse. It is also suggested that you drink a full glass of water to help flush bacteria.
• Avoid potentially irritating feminine products. Using deodorant sprays or other feminine products in the genital area can irritate the urethra.

When to see a doctor

Not all self-diagnosed UTIs turn out to be UTIs after all. Some sinister and other less serious conditions can masquerade as urinary tract infections.

The following patients with a suspected UTI should see a doctor urgently:

• when uncertainty about your condition exists;
• all patients with kidney transplants;
• all children;
• all cases of suspected pyelonephritis;
• all cases with blood in the urine;
• anybody known to have only one kidney;
• previous history of stones;
• previous history of surgery to the kidneys;
• anybody with a high fever;
• vomiting;
• severe pain;
• anybody with pain in the right lower abdomen who still has an appendix;
• all pregnant females; and
• no response to antibiotics after two to three days of treatment.

References

www.mayoclinic.com

www.familydoctor.org

www.health24.com

http://www.uptodate.com/home/index.html