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.
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% to 2% of children do suffer from them. Urinary Tract Infections in children are more likely to be serious than those in adults (especially in younger children).
Infection limited to the 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
- Being sexually active
- Using certain types of birth control (women who use diaphragms or spermicidal agents)
- Completing menopause (lack of estrogen causes changes in the urinary tract making 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)
- Suppressed immune system (diabetes and other diseases that impair the immune system i.e. the body’s defence against germs)
- Use of a urinary catheter (people who can’t urinate on their own and use a tube or catheter to urinate including 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 enters the urinary tract through the urethra and begins to multiply in the bladder. Although the urinary system is designed to keep out such microscopic invaders, these defences 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 signs and symptoms of UTI is important to recognize them and staying alert. 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-coloured (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. For example, infection involving kidneys (Acute Pyelonephritis) can cause upper back and side (flank) pain, high fever, shaking and chills, nausea, and vomiting. Infections involving bladder (Cystitis) can cause pelvic pressure, lower abdomen discomfort, frequent, painful urination, blood in the urine. Infections of the urethra (Urethritis) can cause burning with urination.
Diagnosis
When the above sign and symptoms are noticed, make an appointment with the Doctor immediately. The Doctor will take a detailed history with an 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 a urine sample to grow bacteria in an artificial medium. This test tells which bacteria are causing the infection and which medications will be most effective. Imaging studies are a useful adjunct to clinical and laboratory examination. If an abnormality in the 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 the 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
Urinary tract infections are commonly treated with antibiotics. Usually, symptoms clear up within a few days of treatment. But an antibiotics course may be needed to continue for a week or more. The entire course of antibiotics prescribed by the 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 in 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 the 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.
Dr. Prashanth Kulkarni | Consultant Kidney Transplant – Adult, Robotic Surgery, Urology |  Mazumdar Shaw Medical Center, Bommasandra, Bangalore