Explaining Urinary Tract Infections

A urinary tract infection or UTI begins somewhere in the urinary system. Normal urine is sterile and contains fluids, salts and waste products. It is free from bacteria, viruses and fungi. An infection occurs when microorganisms, usually bacteria from the digestive tract, cling to the opening of the urethra, the hollow tube that carries urine from the body. Most infections come from the E. coli bacteria which live in the colon.

A UTI of the bladder (bladder infection) is probably the most common UTI. It's painful and annoying and it can lead to serious consequences if the infection spreads to the kidneys. Females are most prone to developing a UTI after the age of one year. More than half of all women will develop a urinary tract infection in their life. From birth to one year, males have more occurrences because of a higher rate of birth defects in the urinary tracts of male infants. After 50, males, again, have more UTI's due to the increase in prostate disorders.

The urinary tract includes the kidneys, ureters, bladder and urethra. These all play an important role in removing waste from the body. The kidneys filter waste from the blood. The ureters carry the urine from the kidneys to the bladder. The bladder stores the urine until it exits through the urethra. All these areas can become infected, but most infections occur in the lower tract which is the urethra and the bladder.

Sometimes, you will hear the terms cystitis, urethritis, and pyelonephritis. Cystitis is an inflammation of the bladder. Urethritis is when the inflammation is in the urethra. If the infection spreads to the kidney it is called pyelonephritis.

Most bladder infections in women are called 'ascending' infections because the bacteria travels upward through the urethra to the bladder. Risk factors for UTI's in women include:

Sexual intercourse. The risk of infection increases if the woman has multiple partners.

Use of a diaphragm for contraception

An abnormally short urethra

Diabetes or chronic dehydration

The absence of a specific enzyme (fucosyltransferase) in vaginal secretions. The lack of this enzyme makes it easier for the vagina to harbor bacteria that cause UTIs.

Inadequate personal hygiene. Bacteria from fecal matter or vaginal discharges can enter the female urethra because its opening is very close to the vagina and anus.

History of previous UTIs. About 80% of women with cystitis develop recurrences within two years.

The early symptoms of a UTI in women are:

Frequent urination

A painful, burning feeling during urination

Fever

Urine appears cloudy or reddish in color (blood may be present in the urine)

Feeling pain even when not urinating

Fatigue

Pain in the back or side, below the ribs

Nausea and/or vomiting

Despite an intense urge to urinate, only a small amount of urine is passed

Women may feel an uncomfortable pressure above the pubic bone

Shaking chills

If a women experiences fever, pain in the lower back or flanks, nausea and vomiting and shaking chills, this indicates that the infection has spread to the upper urinary tract, the kidney (pyelonephritis).

Most UTI's in adult males are from complications of kidney or prostate infections. They are usually associated with a tumor or kidney stones that block the flow of urine. Male UTI's are often persistent and are caused by drug-resistant organisms.

Risk factors for UTI's in males include:

Lack of circumcision. The foreskin can harbor bacteria that cause UTIs.

Urinary catheterization. The longer the period of catheterization, the higher the risk of UTIs.

The symptoms of male urinary tract infections are the same as women.

Sometimes, both women and men have large quantities of blood in the urine. This is called hemorrhagic cystitis and is caused by an acute bacterial infection of the bladder. UTI's are the leading cause of death and health care expenditures in people of all ages.

To diagnosis a urinary tract infection the following diagnostic tests and procedures may be used:

Urinalysis-the laboratory will examine the urine for various cells and chemicals like red blood cells, white blood cells, infection or excessive protein.

Intravenous pyelogram (IVP) - This is a series of x-rays of the kidney, ureters, and bladder by injection of a dye into a vein. This is used to detect tumors, abnormalities, kidney stones or obstructions and to access the renal blood flow.

Cystoscopy-this is an examination with a flexible scope and viewing device which is inserted through the urethra to examine the bladder and urinary tract.

Renal ultrasound-This is a non-invasive test where a transducer bounces sound waves off the kidney, transmitting a picture of the organ on a video screen.

Treatment for a urinary tract infection may include:

Antibiotics and/or other medications

A heating pad to relieve pain

Health measures to include drinking plenty of water, avoiding coffee, alcohol and spicy foods, and quitting smoking

To decrease the likelihood of developing another UTI, the doctor may suggest the following:

Drinking at least 8 glasses of water every day

Drink cranberry juice. Take vitamin C supplements

Wipe from front to back to prevent bacteria around the anus from entering the urethra

Take showers instead of baths

Cleanse the genital area before/after sex

Avoid using feminine hygiene sprays and scented douches

Change feminine pads often

Wear cotton underwear

Avoid wearing tight fitting clothing and pantyhose

Pregnant women are at an increased risk to develop a UTI. In Pregnancy, hormones cause changes in the urinary tract which predispose women to infection. Also, as the uterus grows, it presses on the bladder and it can prevent the bladder from completely emptying. The urine that remains in the bladder becomes stagnant and is a source for infection. If left untreated, the infection may lead to kidney infections.

A common source of infection is catheters or tubes placed in the bladder. Bacteria on the catheter can infect the bladder. When a person cannot urinate or is unconscious or critically ill, a catheter may be needed. Some people may need a catheter for life. Special care to keep the catheter sterile is manditory and a catheter should be removed as soon as possible to help prevent a urinary tract infection.

People with diabetes have a higher risk of developing UTI's. This is due to changes in the immune system. Any illness that suppresses the immune system raises the risk of a UTI.

Women who have had three UTI's are likely to keep having them. Four out of five such women get other UTI 's within 18 months. Many women have them even more frequently. A women who has three or more UTI's a year should ask her doctor about taking low doses of antibiotics daily for six months or longer. If taken at night, the drug remains in the bladder longer and may be more effective.