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 Women's Health

January 2012
Urinary Tract Infection a Menace
Dr Sanjay Maitra
 

Urinary tract infection (UTI) is an infection involving the kidneys, ureters, bladder, or urethra. These are the structures that urine passes through before being eliminated from the body.

Any part of the urinary tract can become infected. As a rule, the farther up in the urinary tract the infection is located, the more serious it is. UTI’s may also be classified as Upper and Lower UTI’s

  • The upper urinary tract is composed of the kidneys and ureters. Infection in the upper urinary tract generally affects the kidneys (pyelonephritis), which can cause
    fever, chills, nausea, vomiting, and other severe symptoms.
  • The lower urinary tract consists of the bladder and the urethra. Infection in the lower urinary tract can affect the urethra (urethritis) or the bladder (cystitis).
How does the urinary tract get infected?
The urine is normally sterile. An infection occurs when bacteria get into the urine and begin to grow. The infection usually starts at the opening of the urethra (from where the urine leaves the body) and moves upward into the urinary tract. Most UTIs are caused by a type of bacteria called E. coli. These bacteria normally live in the bowel (colon) and around the anus. They can move from the area around the anus to the opening of the urethra. The
two most common causes of this are poor hygiene and sexual intercourse.

Usually, the act of emptying the bladder (urinating) flushes the bacteria out of the urethra. If there are too many bacteria, urinating may not stop their spread. The bacteria can travel up the urethra to the bladder, where they can grow and cause an infection. The infection can spread further as the bacteria move up from the bladder via the ureters. If they reach the kidney, they can cause a kidney infection (pyelonephritis), which can become
a very serious condition if not treated promptly.

Why is UTI more common in women?
  • The urethra (tube from the bladder) is shorter in women than in men, making it easier for the bacteria to reach there.
  • In women, the urethra is positioned closer to the rectum. This again, enables bacteria from the rectum to move into the urethra.
  • During sexual intercourse, bacteria can be pushed into the urethra.
  • The use of Diaphragms to prevent pregnancy can lead to UTI since the Diaphragms tend to press against the urethra. This interferes with the complete emptying of urine in the bladder. When some urine remains in the bladder, bacteria can thrive in it and cause infection.
  • After menopause, UTI 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 the hormone estrogen.
  • Males in contrast, are also less likely to develop UTIs because their urethra is longer. There is a drier environment where a man’s urethra meets the outside world, and fluid produced in the prostate can fight bacteria.
Who are at increased risk of UTI?
  • Women who are sexually active. Sexual intercourse can introduce larger numbers of bacteria into the bladder. Infection due to frequent intercourse is called “honeymoon cystitis.” Urinating after intercourse seems to decrease the likelihood of developing a urinary tract infection.
  • Women who use a diaphragm or spermicidal products for birth control.
  • People with conditions that block (obstruct) the urinary tract, such as kidney stones and enlarged prostate.
  • People with medical conditions that cause incomplete bladder emptying,for example, spinal cord injury.
  • People with suppressed immune systems. Examples are patients of AIDS, diabetes, organ transplant recipients and those on chemotherapy for cancer.
  • Extremes of age also seem to be a risk factor. Young children and old patients are more at risk as they are unable to clean the genital area, thereby increasing the chance of infection.
Diagnosis of UTI
It is based on information you give about your symptoms, medical and surgical history, medications, habits, and lifestyle. A physical examination and lab tests complete the evaluation.

The single most important initial lab test is urinalysis. A sample of your urine will be tested for signs of infection, such as the presence of white blood cells and bacteria.

Typical Symptoms

Lower UTI Upper UTI
Dysuria - pain or burning during
urination
May or may not include symptoms
of a lower UTI.
More frequent urination with small
quantity of urine
Usually symptoms develop rapidly

Nocturia - frequent urination at night

High fever (generally >1010 F) with
chills
The sensation of having to urinate
urgently
Nausea and vomiting
The sensation of not being able to
urinate easily or completely
Flank pain usually at the side or
back at waist level
Cloudy, bad-smelling, or bloody urine May precipitate kidney failure if
infection is severe
Lower abdominal pain

 

 
Mild fever (<1010 F) or malaise  

Tips to Prevent UTI
  • Drink plenty of water or other liquids. This will increase your urge to urinate and by doing so you can flush out the bacteria from your system.
  • Cranberry juice has been shown to help prevent urinary tract infections.
    There is evidence that cranberries reduce the risk of the bacteria’s adhesion to bladder cells
  • Do not retain or hold back urine. Urinate as soon as you feel you need to.
  • After urinating or bowel movement, wash or wipe from front to back and not from back to front. This will prevent bacteria in the anal region from spreading to the vagina and urethra.
  • After sexual intercourse, wash your genital area and urinate to wash away bacteria.
  • If you feel vaginal dryness during sex, use a cream or jelly for lubrication.
  • If a diaphragm is the cause of your infection, ask about other methods to prevent pregnancy.
For Relief
  • Any adult or child who develops any of the symptoms of a urinary tract infection needs to be evaluated by a medical professional, preferably within 24 hours.
  • Take the proper dose and complete the full course of antibiotic medication that your
    doctor has prescribed for you, even if you are feeling better before the medication is over.
  • Take a pain-relieving medication. Or use a hot-water bottle to ease pain.
  • Drink plenty of water. Avoid coffee and alcohol, both of which irritate the bladder.
  • Quit smoking, as it also irritates the bladder.
Dr.Sanjay Maitra is Specialist in Nephrology Apollo Health City,Hyderabad


    
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