URINARY TRACT INFECTION
What is a urinary tract infection?
A urinary tract infection (UTI) is an infection that can include the kidneys, ureters, bladder or urethra. These are the structures through which urine passes before being expelled from the body.
Each part of the system can become infected. As a rule, the upper the urinary tract infection is, the more serious it is.
WHAT IS THE FREQUENCY OF UTI?
Urinary tract infection is the second leading infection of the human body , in frequency, after respiratory infections.
In United States, urinary tract infections account for more than 7 million visits to clinics and hospitals every year.
About 40% of women and 12% of men have a urinary tract infection at some point in their lives.
Urinary tract infections are much more common in adults than in children, but about 1% -2% of children will suffer from a urinary tract infection. Urinary tract infections in children are more likely to be more severe than those of adults (especially young children).
WHAT ARE THE SYMPTOMS OF UTIs?
Generally, the most common symptoms of a urinary tract infections may include:
- Pain or burning sensation during urination.
- An intense feeling of an urgent need for frequent urination.
- Change of the appearance of the urine, bloody (red) or cloudy (pus).
- Pain or pressure in the anus (males) or in the region of the pubic bone (women).
- Difficulty urinating.
Other, more generalized symptoms may also accompany a urinary tract infection such as:
- Nausea and vomiting.
- Fever and chills if the infection has spread to the kidneys or blood.
WHERE DOES A UTI COME FROM?
Urine is normally sterile. An infection occurs when bacteria enter the urine and multiply. The infection usually starts from the urethra, from where the microbes move upward into the urinary tract ( ascending infection ).
The microbe in at least 90% of simple infections is a type of bacteria called Escherichia coli, better known as E. coli . These bacteria usually live in the intestines (colon) and around the anus.
These bacteria can move from the area around the anus to the urethra orifice. The two most common causes are incorrect wiping at the toilet and sexual contact.
The infection can spread further as the bacteria move upward from the bladder through the ureters.
If they reach the kidneys, they can cause a kidney infection (pyelonephritis), which can become a serious condition if not treated promptly.
WHICH PEOPLE ARE AT HIGH RISK FOR A UTI;
High-risk patients to suffer a urinary tract infection are:
- Every woman due to the short length of the urethra and the anal-vaginal proximity, which favors the spread of germs.
- Women who are sexually active : Sexual intercourse can introduce a greater number of bacteria in the bladder. Urinating after sexual intercourse appears to reduce the chance of developing a UTI.
- Women who use a diaphragm for contraception .
- Kidney stones.
- People with medical conditions which cause incomplete emptying of the bladder (e.g., spinal cord injury and neurogenic bladder).
- People with immunosuppression (Examples of situations in which the immune system is suppressed is HIV / AIDS and diabetes, people who take immunosuppressant drugs, such as chemotherapy for cancer).
- Men with prostate diseases : prostatitis or obstruction of the urethra of an enlarged prostate can result in incomplete emptying of the bladder, thus increasing the risk of infection. This is the most common cause in older men.
- Very young infants : Bacteria can enter the urinary tract through the bloodstream from other parts of the body.
- Toddlers : Toddlers have trouble wiping and wash their hands well after a bowel movement. Poor hygiene has been associated with increased incidence of urinary tract infections.
- Hospital patients and nursing home residents.
ARE UTIs CONTAGIOUS?
No, urinary tract infections are not contagious.
WHEN MUST I VISIT MY DOCTOR?
Every adult or child who develops any of the symptoms of a urinary tract infection should be evaluated by a doctor, preferably within 24 hours . Most doctors can check urine for infection using a rapid test (stick urine).
Everyone who has symptoms of an infection of the lower urinary tract (eg burning and frequent urination) should call a professional for an appointment, preferably on the same day when symptoms occur.
Everyone who has symptoms of an infection of the upper urinary tract with the involvement of the kidneys (eg fever and back pain) should call a professional immediately . Depending on the situation, he or she will recommend either a visit to the office or to an emergency department.
HOW IS THE DIAGNOSIS OF A UTI MADE?
The diagnosis of a urinary tract infection is based on information someone gives to the doctor about his symptoms. A physical examination and laboratory tests will complete the evaluation. Very often a urine culture is required to isolate the organism responsible.
WHAT IS A RECURRENT UTI?
When we talk about patient presenting with a recurrent UTI, we mean facing three or more UTIs in the last 12 months or at least two incidents in the last six months . When faced with the same bug that had caused the previous episode, then usually there is a problem in the urogenital system (gritty, congenital abnormalities of the kidneys, chronic prostatitis, urinary fistulas, etc.), which promotes microbial growth. This means that effective treatment of the urinary tract infection can not exist without addressing this cause.
On the other hand, when the microbe is different, urinary tract infections may be due to increased susceptibility of patients to germs that cause urinary tract infections, especially in women. In such cases, reinfection usually is due to microbes located outside the urinary tract.
WHAT TESTS MAY BE NEEDED FOR THE INVESTIGATION OF RECURRENT UTIs?
You may need to undergo:
- An ultrasound can evaluate the kidneys and bladder.
- An x-ray study may show some anatomic problems that predispose children and adults to urinary tract infections.
- Intravenous pyelography (IVP) is a special series of X-ray using a contrast medium to reveal defects in the urinary tract.
- Cystoscopy : involves inserting a thin, flexible tube with a tiny camera on the end through the urethra into the bladder. This allows the detection of abnormalities within the bladder that may contribute to infections.
- A CT gives a very detailed three dimensional image of the urinary tract.
WHAT IS THE TREATMENT OF A UTI?
- Follow the treatment recommended by your doctor(using appropriate antibiotics) .
- Drink plenty of water.
- Avoid coffee, alcohol and spicy foods that irritate the bladder.
Infection of the lower urinary tract (cystitis).
- In an otherwise healthy individual, a three day treatment with antibiotics is usually sufficient. Some prefer seven-day use of antibiotics. Occasionally, a single dose of an antibiotic is used. A health professional will determine which of these options is best.
- In men, if the prostate has also been infected (prostatitis), four weeks or more with antibiotic treatment may be required.
- For children with uncomplicated cystitis10 days course of antibiotics is usually needed.
Infection of the upper urinary tract (pyelonephritis)
- Young, otherwise healthy patients with pyelonephritis symptoms can be treated as outpatients.
- If someone is very sick, dehydrated, or can not keep anything in his stomach because of vomiting should be hospitalized and given intravenous fluids and antibiotics.
- A complicated infection may require treatment for several weeks.
WHAT ARE THE PREVENTION MEASURES?
The main measures are:
- Women and girls should wipe from front to back (not back to front) after bowel movements. This helps prevent bacteria transmission from the anus to the urethra.
- Empty the bladder frequently and thoroughly, especially after intercourse.
- Drink plenty of fluids.
- Cranberry juice : it has been shown to help prevent urinary tract infections. There are indications that it reduces the risk of adhesion of bacteria to the cells of the bladder.
- New trends in the prevention of urinary tract infections are the vaccines that target the most common microorganisms.