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Urinary Tract Infection

Keep A Tab On Your Urinary Tract Infection!

 

Urinary Tract Infection - What it is!

The residence of bacteria in significant numbers within the urinary tract leads to urinary tract infections (UTIs).Statistics reveals that UTIs are more common in women, claiming 1 in 5 adult women aged 20-65, who experience a UTI at least once a year. Nearly 50% of women will experience UTIs at least once in their life time.

Cystitis (bladder infection) is majorly responsiblefor these infections. Involvement of the upper urinary tract (pyelonephritis) is less common when compared to that of cystitis but can be accompanying more serious complications.

Urinary Tract Infections – Symptoms

The symptoms commonly associated with UTIs are when you feel a burning feeling while you urinate. There is a frequent or intense urge to urinate, even though little comes out when you do. You experience pain or pressure in your back or lower abdomen, and smell cloudy, dark, bloody, or strange-smelling urine.

Signs and Symptoms

The onset of UTI can be associated with one or more of the following symptoms:

  1. Pain on passing urine (dysuria)
  2. Urinary urgency
  3. Urinary frequency
  4. Sensation of bladder fullness or lower abdominal discomfort
  5. Fever
  6. Blood in the urine (hematuria)
  7. Flank pain and tenderness over the lower back area next to the spine (may suggest involvement of the upper urinary tract)

Urinary Tract Infections - How to prevent?

​Approximately 25 percent of women with severe cystitis develop recurrent UTIs. Most recurrent infections are caused from bacteria present in the faecal or periurethral reservoirs. Some strategies can be adopted to mitigate the impending risk of recurrent infections.

1. Lifestyle changes

  • Sexually active women should attempt to void immediately after intercourse to reduce the risk of coitus-related introduction of bacteria into the bladder.

 

  • Wiping from front to back after going to the toilet to avoid faecal contamination of the urinary tract (especially during an episode of diarrhoea).

 

  • Daily consumption of cranberry juice or cranberry tablets.

 

  • Avoid use of diaphgrams and spermicide by considering other forms of contraception.

 

  • Avoid use of deodorants and bubble baths.

 

  • Drinking plenty of water.

2. Prophylactic antibiotics

A once-daily dose of an appropriate antibiotic may be indicated in patients with a positive history of multiple episodes of UTI to abate the risk of recurrence of infection.

3. Treatment of any existing structural abnormalities

If recurrent UTI occurs against a background of structural abnormalities in the urinary tract (e.g. stones, kidney cysts), consideration should be prioritized to the treatment of these conditions to eradicate the source.

4. Treatment of any vaginal/lower genital tract infection

These infections may spread to the urinary tract. As such, they should be treated promptly, if present.

Urinary Tract Infections - Causes and Risk Factors

In maximum cases of uncomplicated cystitis, the Escherichia coli is involved. This bacterium is present in 70-95 percent in both of the upper and lower UTIs. The other common pathogens are Enterococcus faecalis, Klebsiella species, Proteus species and yeast.

What are the predisposing factors?

Adult women mark the largest group of patients suffering from UTIs. They are more vulnerable to UTIs than men because in females, the urethra is much shorter and closer to the anus.

Other predisposing factors include:

1. Menopause

The occurrence of UTIs remains higher in postmenopausal women for a few known reasons. For the one being, the presence of bladder or uterine prolapse can trigger off incomplete bladder emptying and stasis (reduced or stoppage flow) of urine, which in turn,endorses the growth of pathogens. Correspondingly, the loss of oestrogen after menopause leads to changes in the vaginal flora, especially the loss of lactobacilli, and surges your susceptibility to infection.

2. Sexual activity

UTIs are very common in women aged 18-30 years as it is associated with coitus (the so-called ‘honeymoon cystitis’). In this age group, sexual intercourse is the prime cause of 75 to 90 percent of bladder infections, with the risk of infection being linked to the frequency of sex. The use of spermicides and diaphgrams for contraceptive purposes further enhances the risk of UTIs as it causes a change in the vaginal flora and eradication of the vaginal lactobacilli.

3.Recent instrumentation of the urinary tract (e.g. catheterization, cystoscopy, urodynamic studies)

The insertion of foreign instruments into the urinary tract promotes the translocation of bacteria colonized around the peri-urethral area into the bladder and other parts of the urinary tract. This increases the risk of developing bacteriuria (presence of bacteria in the urine) in large numbers,consequently leading to a UTI.

4. Foreign bodies (e.g. catheters, urinary stones)

Urinary catheters are the most major risk factors for bacteriuria. Catheters introduce organisms into the bladder and sponsorcolonization by providing a foreign surface for bacteria to adhere to and by causing irritation of the bladder mucosa. About 80 percent of UTIs that ensue, while in hospitals or healthcare institutions, are related to urethral catheterization, and 5-10 percent are related to manipulation of the genito-urinary tract. Urinary stones likewise irritate the bladder as well as provide a nidus (a place in which bacteria have multiplied or may multiply; a focus of infection) for bacteria to adhere to, thereby increasing the risk of developing a UTI.

5. Neurological disorders, drugs or pelvic organ prolapse

These conditions may cause partial emptying of the bladder, thereby promoting stasis (stoppage) of urine which increases the risk of UTI development.

6. Medical conditions (e.g. diabetes)

Diabetes leading to glycosuria (sugar in the urine) gives room to fertile breeding ground for bacteria. A study revealed that 9.4 percent of patients with Type 2 diabetes had a UTI compared to only 5.7 percent of people without diabetes.

Urinary Tract Infections - Diagnosis

The diagnosis of a UTI can be assumed from a well-taken history and physical examination.

Specific tests to confirm a UTI comprise a urine dipstick, urine analysis and urine culture. The foremost emphasis lies with the detection of pyuria (white blood cells or pus cells in the urine) on dipstick and urine analysis. Associated findings can include microscopic hematuria (blood in the urine, which cannot be detected by the naked eye). A urine culture will help in the identification of the organism causing the infection.

No imaging studies are indicated in the routine evaluation of an uncomplicated cystitis.

Urinary Tract Infections - Treatments

Empirical antibiotics are generally prescribed for UTIs. The patient may be prescribed alternative antibiotics after the urine culture results are available. The duration of treatment of the UTI is contingentupon the antibiotic in use. Some common first-choice agents for the treatment of uncomplicated cystitis in women include nitrofurantoin, Bactrim or beta-lactams such as cephalexin.

A vast majority of patients can be treated on an outpatient basis. Nevertheless, hospital admission for management of complicated UTIs may be indicated in some patients. Complicating factors include the incidence of structural abnormalities (e.g. stones, indwelling catheters), metabolic disease (e.g. diabetes, pre-existing kidney disease) or patients who are immunosuppressed and therefore, more susceptible to grave infections (e.g. HIV, patients on chemotherapy).

Recurrent UTI

Recurrent UTI is defined as having UTI three or more times in a year. This can be owing to the same or different bacteria. In such cases, further investigations may berequired to be carried out, e.g. renal ultrasound, intravenous pyelogram, cystoscopy, urine for tuberculosis and cytology, to look for any underlying causes and complications of recurrent UTIs.

 

Patients with recurrent UTI may be administered prophylactic antibiotics for a period of six months. They will also be advised on the various preventive measures and the importance of keeping good personal hygiene.

The Bottom Line

If you are experience any of the above-stated conditions, we remain just a thought away – to help, guide and treat you, at all times and against all odds!