Comprehensive Urology

Urinary Tract Infection

Urinary tract infections (UTI) are the most common bacterial infections in the United States. Although far less common, UTI may also be caused by yeast or viruses. Symptoms typically consist of frequency urge to urinate, discomfort with voiding, lower abdominal pressure, and occasionally visible blood in the urine. The bacteria E. coli is responsible for approximately 85% of urinary infections that occur outside the hospital setting.

In women, urinary infections can be associated with sexual activity, urinary incontinence, dehydration, or menopausal changes. Urinary infections can also be more common in women with other medical issues, such as diabetes and spinal cord injury. With simple infections, a physical exam, urine culture and antibiotic therapy are usually sufficient for treatment. When infections occur frequently, more attention is needed to help assure there are not other underlying problems.

Workup may include imaging, urine flow studies, cystoscopy, or specialized urinary cultures. Often times, preventative measures will be prescribed to help minimize the recurrence of infection such behavioral modification, as over the counter supplements, low dose preventative antibiotics, or vaginal estrogen cream.

The urinary tract is made up of the kidneys, bladder, ureters, and urethra. A bacterial infection in any part is known as a urinary tract infection (UTI). They typically begin in the lower portion of the urinary tract and tend to affect women in greater numbers than men. While many infections can require treatment with antibiotics, depending on the location and severity of the infection, there are a few steps and preventative measures that both men and women can take in order to lower the risk of developing a UTI in the first place.

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FAQ

What causes UTI?

A UTI often occurs due to bacteria that enters the urinary tract through the urethra, the duct that conveys urine from the bladder to the body’s exterior. In this instance, bacteria can infect the urinary tract, which may lead to a UTI.

Cystitis, infection of the bladder, is a common type of UTI that occurs due to Escherichia coli (E. coli) bacteria in the gastrointestinal (GI) tract. It may occur due to sexual intercourse, but women who are not sexually active can also develop cystitis.

Additionally, urethritis, inflammation of the urethra, may occur due to GI bacteria that spreads from the anus to the urethra. The female urethra is located near the vagina. As such, the urethra may be susceptible to sexually transmitted infections such as herpes, chlamydia, and gonorrhea, all of which have been linked to urethritis.

Risk Factors of Developing UTI?

There are a few ways that women can become susceptible to urinary tract infections. The immune system can typically fight off normal bacteria in the lower urinary tract, but sometimes bacteria travels from the urethra up to the bladder and leads to a UTI. The most common types of bacterial infections in the urinary tract result from E. Coli and bacteria from the gastrointestinal tract (GI).

The most common causes and risk factors for a urinary tract infection are:

  • Gender – UTIs are more common in women in part because of anatomy. The female urethra is shorter than in males, making it easier for bacteria to reach the bladder.
  • Method of birth control – Diaphragms and certain spermicidal gels can increase the risk for women
  • Sexual Activity – Being sexually active, a new partner, and having sex after longer periods of abstinence can increase the risk of developing a UTI
  • Hormone levels – A decrease in estrogen after menopause can lead to changes in the urinary tract that can increase the risk of infections

Additionally, medical conditions like urinary tract deformities and abnormalities, blockages, or procedures that involve the use of medical equipment in the urinary tract, such as diagnostic testing or a catheter, may also increase the risk of infection.

What are the symptoms?

The symptoms of a basic urinary tract infection include:

  • Overwhelming, constant urge to urinate, followed by the release of small amounts of urine
  • Burning sensation while urinating
  • Cloudy, dark colored (red or brown, which can indicate blood in the urine), and strong smelling urine
  • Pelvic pain
  • Blood in the urine
  • Fever and chills
  • Feeling tired or shaky
  • Recurring UTI

     

Symptoms may also vary depending on where the infection is located:

  • If located in the urethra (also known as urethritis, the most common form of UTI) symptoms include burning during urination, and discharge
  • When located in the bladder (cystitis) – pain and pressure in the pelvis and lower abdomen, blood in urine, frequent urge to urinate, pain and discomfort during urination
  • If left untreated, a bladder infection can travel to the kidneys (acute pyelonephritis). Symptoms include pain in the side and upper back, nausea, vomiting, fever, and chills
Risks of UTIs?

Although primary-care doctors are able to treat most urinary tract infections with antibiotics over the course of one week, frequent recurrences of UTI may be a sign of a more serious issues that may need further investigation by a specialist. It is important to get to the root of the problem because while UTI’s that are limited to the bladder are bothersome, they can normally disappear within 24-48 hours after treatment with antibiotics begin. However, if the condition is not responding to treatment and occurs more than twice in 6 months, it is considered a recurrent UTI.

Behavioral changes, preventative medications, or long-term and low-dose antibiotics may need to be prescribed. Unchecked urinary infections may lead to kidney infection and kidney damage. Kidney infection (pyelonephritis) is potentially life threatening and may lead to sepsis, which occurs when bacteria from the infected kidney enters the bloodstream. Sepsis is an alarming condition that can cause low blood pressure, shock, and even death. Symptoms of pyelonephritis typically include:

  • Pain and tenderness in the upper back and sides
  • Chills
  • Fever
  • Nausea
  • Vomiting
Types of UTIs

A UTI may impact the following parts of the urinary tract:

  • Kidneys: May cause a high fever, nausea, vomiting, and upper back and side pain.
  • Bladder: May cause pelvic pressure, discomfort in the lower abdomen, frequent and painful urination, and blood in the urine.
  • Urethra: May cause discharge and burning during urination
How can you prevent a UTI?

While most women are likely to suffer from a UTI at some point in time, there are practical steps anyone can take to help minimize the risk and maintain a healthy urinary tract. Following a few simple common sense guidelines on a daily basis can go a long way towards maintaining overall wellness and health.

Stay hydrated – Getting enough water every day is vital to proper kidney function and helps to dilute the urine and flush out excess bacteria.
Skip the caffeine – Certain drinks, like caffeine, alcohol, and citrus beverages can aggravate an already sensitive bladder, making the frequent urge to urinate even worse. Limiting consumption is recommended to recover from a UTI.
Heating pad – For pain and discomfort in the pelvis and abdomen, a warm (not hot) heating pad can help to alleviate the pressure.
Alternate birth control methods – If diaphragm or spermicide use is causing an infection, speak to a urologist about effective birth control alternatives.
Hygiene – Wiping front to back after bowel movements help to keep GI bacteria from entering the urethra in women.
Urinate after sex – Drinking a glass of water and emptying the bladder after sex helps to flush out bacteria that can lead to a UTI.
Avoid abrasive and irritating feminine hygiene products – The use of certain feminine hygiene products like sprays, powders, and douches can sometimes irritate the urethra.

In order to prevent complications and to clear all traces of infection once a UTI develops, women should seek medical attention for any symptoms that persist and do not clear up after a few days.

How do you treat UTIs?

Treatment options for a urinary tract infection vary according to the severity, location in the urinary tract, and the individual patient. While some women may respond to mild or alternative treatments, antibiotics are often necessary to prevent a recurrence, or to keep the infection from traveling to the kidneys.

The only sure way to cure a urinary tract infection (UTI) is with antibiotics, which are best prescribed based on a urine culture which demonstrates the specific bacteria causing infection as well as which antibiotic will be most effective for treatment.  That being said, many low-grade infections do clear spontaneously with increased hydration. Prior studies have shown that between 57 and 80% of normal, healthy women may clear the infection on their own, however the time to clearing the infection is longer than if treated with antibiotics.

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