“It was a normal day at work, but I was tired, feeling feverish and felt like I had to pass urine the whole day. But when I went to the bathroom, not much came out. When I did pass urine, it burned and smelled bad — and looked cloudy too. These problems lasted a few days. So I called my doctor, and I was told to get an appointment as I might be having an Urinary Tract Infection (UTI)”

Many people experience this situation and ultimately get diagnosed to have a urinary tract infection (UTI). It is an infection involving the kidneys, ureters, bladder, or urethra. These are the structures that urine passes through before being eliminated from the body.

Epidemiology

Urinary tract infections are the 2nd most common infection in the body second only to respiratory infection. These infections are much more common in girls and women than in boys and men younger than 50 years of age. Women have a lifetime risk of over 50% of developing a urinary tract infection. The reason for this is not well understood, but anatomic differences between the genders (a shorter urethra in women and situated closer to the anus, making it quicker for bacteria to enter the bladder.) might be partially responsible.

Urinary tract infections are much more common in adults than in children, but about 1%-2% of children do get urinary tract infections. Urinary tract infections in children are more likely to be serious than those in adults (especially in younger children).

Infection limited to urinary bladder can be painful and annoying. However, serious consequences can occur if a UTI spreads to the kidneys. Most UTIs are not serious, but some can lead to serious problems, particularly with upper urinary tract (kidney and ureter) infections. Recurrent or long-lasting kidney infections (chronic) can cause permanent damage, and some sudden kidney infections (acute) can be life threatening, particularly if septicemia (bacteria entering the bloodstream) occurs.

With more and more awareness about health and increasingly accessible good medical care, it becomes very important to have a basic knowledge about UTI and talk about it more frequently, especially among women.

Etiology

Bacteria cause the majority of urinary tract infections and most common among them is E. Coli bacterium.

Risk factors

Knowledge about the risk factors which predispose an individual to UTI is important. Female gender (UTIs are common in women, shorter urethra than men which cuts down on the distance that bacteria must travel to reach a woman’s bladder), being sexually active (sexually active women tend to have more UTIs than do women who are not), using certain types of birth control (women who use diaphragms  or spermicidal agents), completing menopause (UTIs may become more common because the lack of estrogen causes changes in the urinary tract that make it more vulnerable to infection), urinary tract abnormalities (these defects don’t allow urine to leave the body normally or cause urine to back up in the urinary system), blockages in the urinary tract (kidney stones or an enlarged prostate can trap urine in the bladder and increase the risk of UTI), suppressed immune system (diabetes and other diseases that impair the immune system i.e. the body’s defense against germs, can increase the risk of UTIs) and use of a urinary catheter (people who can’t urinate on their own and use a tube or catheter to urinate have an increased risk of UTIs. This may include people who are hospitalized, people with neurological problems that make it difficult to control their ability to urinate and people who are paralyzed)

Pathology

Urinary tract infections typically occur when bacteria enter the urinary tract through the urethra and begin to multiply in the bladder. Although the urinary system is designed to keep out such microscopic invaders, these defenses sometimes fail. When that happens, bacteria may take hold and grow into a full-blown infection in the urinary tract.

Signs and symptoms

Understanding the presentation of UTI signs and symptoms is important to recognize them and staying alert. Common symptoms include a strong, frequent urge to urinate and a painful and burning sensation while urinating. Urinary tract infections don’t always cause signs and symptoms, but when they do they may include:

  • A strong, persistent urge to urinate but not much comes out when you do.
  • A burning sensation while urinating.
  • Passing frequent, small amounts of urine.
  • Urine appears cloudy.
  • Urine appears red, bright pink or cola-colored — a sign of blood in the urine.
  • Strong-smelling urine.
  • Pelvic pain, in women.
  • Rectal pain, in men.
  • Feeling tired or shaky or having a fever.

Each type of UTI may result in more-specific signs and symptoms, depending on which part of the urinary tract is infected e.g. infection involving kidneys (Acute Pyelonephritis) can cause upper back and side (flank) pain, high fever, shaking and chills, nausea, vomiting. Infections involving Bladder (cystitis) can cause pelvic pressure, lower abdomen discomfort, frequent, painful urination, blood in urine and infections of the urethra (urethritis) can cause burning with urination.

 

 

 

Diagnosis

When above sign and symptoms are noticed, take an appointment with the Doctor immediately. The Doctor will take a detailed history with assessment of symptoms and will examine urine and blood samples along with imaging, to confirm the presence of UTI.

Analyzing a urine sample is done to look for white blood cells (pus cells), red blood cells or bacteria. To avoid potential contamination of the sample, first wipe the genital area with an antiseptic pad and collect the urine midstream. Growing urinary tract bacteria in a lab i.e. urine culture is a test that uses urine sample to grow bacteria in artificial medium. This test tells which bacteria are causing the infection and which medications will be most effective. Imaging studies are useful adjunct to clinical and laboratory examination. If an abnormality in urinary tract is suspected or there are frequent infections, an ultrasound or a computerized tomography (CT) scan is of great help. In certain situations, contrast dye might be used along with X-Ray or CT to highlight structures in urinary tract. Using a scope to see inside the bladder (Cystoscopy) is not always needed. If there are recurrent UTIs and no abnormality is found in routine tests, then in these very few cases cystoscopy might be useful.

Treatment

So, how to get rid of these infections? Don’t panic!!!

Urinary tract infections are commonly treated with antibiotics. Usually, symptoms clear up within a few days of treatment. But antibiotics course may be needed to continue for a week or more. Entire course of antibiotics prescribed by doctor should be taken to ensure that the infection is completely gone. Recurrent infections (three or more UTIs) can cause permanent kidney damage.

An uncomplicated UTI is one that occurs in an otherwise healthy person with a normal clear urinary tract. These can usually be cured with 2-3 days of treatment. Most young women with urinary tract infections have uncomplicated urinary tract infections. A complicated UTI is one that occurs in a person who is weakened by another condition. Complicated UTIs tend to require longer periods of antibiotics, usually between 7-14 days. Men with urinary tract infections should be presumed to have complicated urinary tract infections until it can be proven otherwise.

In severe cases, seriously ill patients with urinary tract infections may need to be hospitalized.

People who have frequent UTIs may have special recommendations as in: Longer course of antibiotic treatment (take a single, daily dose of an antibiotic for at least 6 months) or a program with short courses of antibiotics at the very start of urinary symptoms, home urine tests, in which patient dips a test stick into a urine sample, to check for infection. A single dose of antibiotic can be taken after sexual intercourse if infections are related to sexual activity. Vaginal estrogen therapy is helpful postmenopausal women, to minimize chances of recurrent UTIs.

It is of utmost importance that the full course of treatment should be completed for UTIs, in order to ensure that the infection is fully clear. Remember, UTI symptoms can disappear before the infection has completely gone which is a false sign that UTI is cured. With each UTI, the risk that a woman or man will have another UTI increases especially if proper treatment is not taken.

 

 

Prevention

  • Drink plenty of liquids (especially water). Drinking water helps dilute urine and ensures that patient urinates more frequently — allowing bacteria to be flushed from the urinary tract before an infection can begin.
  • Wipe genitalia from front to back. Doing so after urinating and after a bowel movement helps prevent bacteria in the anal region from spreading to the vagina and urethra.
  • Avoid potentially irritating feminine products. Using deodorant sprays or other feminine products, such as douches and powders, in the genital area can irritate the urethra.
  • Cranberry juice: There’s some indication, though it hasn’t been proved, that cranberry juice may have infection-fighting properties and drinking it daily may help prevent urinary tract infections.

So, don’t ignore the signs and symptoms of UTI. Prompt diagnosis, adequate treatment and precautions to prevent recurrence is the key.

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