Urinary Tract Infection

OVERVIEW

Urinary Tract Infections are common infections, affect men and women of all ages, and vary dramatically in their presentation and sequelae.

Urinary Tract Infections are a common cause of morbidity and can lead to significant mortality.

WHAT IS AN UTI?

A UTI is an infection involving any part of the Urinary Tract such as the Urethra, Urinary Bladder and the Kidneys.

UTI is an inflammatory response of the urothelium (lining of the urinary tract) to bacterial invasion.

INCIDENCE AND EPIDEMIOLOGY

Women are most at risk for a UTI. Nearly half of all women (50%) will experience a UTI during their lifetime.

WHY?

Women have a short urethra which makes it easier for the bacteria to enter the bladder and cause infections. Also the urethra is in close proximity to the anal canal, which is the source of these organisms.

What causes the UTI`s?

The most common causative organisms of UTI`s are bacteria from the bowel such as E.coli, proteus, pseudomonas etc.

Once the bacteria enter the urethra, they travel upwards causing infection in the bladder and sometimes other parts of the urinary tract.

Sexual intercourse is commonly associated with UTI`s in women. During intercourse, the bacteria in the vaginal area are sometimes transferred into the urethra by the motion of the penis.

Using spermicides or a diaphragm also can cause more frequent UTI`S , due to increased binding of the organisms to the lining of the urethra.

Menopause also increases the risk of getting a UTI. During menopause, the level of estrogen decreases which causes changes in the periurethral tissues that can lead to a UTI.

In men, urethritis is usually the result of bacteria acquired during sexual contact.

SYMPTOMS AND SIGNS OF A UTI

1. A strong persistent urge to urinate.
2. A burning sensation during or after urination.
3. Passing frequent, small amounts of urine.
4. Blood in the urine (Hematuria) / Cloudy Urine / Foul smelling urine.
5. Pain in the lower abdomen and the pelvis.
6. Penile discharge in men.
7. Pain in the flank region/ back, fever , nausea and vomiting, fatigue  (Infection of the kidneys)

HOW ARE UTI`S DIAGNOSED?

The Urologist will take a proper history and examine the patient and order some basic investigations like Urine Analysis and Urine Culture and sensitivity. UTI`S in males require more detailed investigations like the Ultrasound of the Abdomen to elucidate the cause of UTI.

TREATMENT

Based on the severity of the symptoms, the urologist may prescribe antibiotics empirically based on the common sensitivity patterns. The antibiotic may be changed based on the Urine C/S report , which usually takes around 48 hours time. You may also be prescribed a medicine that will relax the bladder while the antibiotic starts to work.

Patients must make sure they take the complete course of treatment as directed and to return back if the symptoms are not relieved.

Patients are also advised to drink plenty of oral fluids, which help in flushing out the bacteria from the urinary tract. Patients are also asked to avoid coffee, alcohol, and soft drinks containing caffeine until the infection is cleared because these can irritate the bladder and cause worsening of symptoms.

Kidney Infections (Pyelonephritis) usually require hospitalization and more intensive management.

PREVENTION OF UTI`S

1. Drink plenty of oral fluids to flush out the bacteria
2. Do NOT hold the urine for long periods of time. Urinate when you feel
3. Wipe from front to back after a bowel movement.
4. Urinate before and after sexual contact emptying the bladder completely each time.
5. Avoid using spermicides/ diaphragms , in case of recurrent UTI`s
6. Avoid use of feminine “hygeiene” products like douches and sprays, which could upset the delicate bacterial balance of the genital region.