URINARY TRACT INFECTIONS
A urinary tract infection (UTI) affects any part of the urinary system such as the urethra,bladder or kidneys. The majority of these affect the urethra or bladder which is the lower urinary tract
It affects women more than men and is usually treated with a short course of antibiotics.
Symptoms
Common symptoms are-
-Urgency-urge to urinate
Frequency
Burning when urination
Pink Urine - blood in the urine
Foul/Strong-smelling urine
Back pain /pelvic pain in women
Signs and symptoms
Bladder(cystitis--pelvic pressure,pfrequency and urgency and painful urination)
Urethritis- buring with urination, discharge
Kidneys -(Acute pyelonephritis)
Back pain or side (flank) pain
High fever with rigors
Nausea and vomiting
*UTIs occur when bacteria enters the urethra then multiply in the bladder.
Most common symptoms are bladder related (cystitis) and caused by an E Coli infection.
The commonest cause is Sexual intercourse in women because of the short distance from the urethra to the anus and the urethral opening to the bladder.
Urtheritis can occur when gastrintestinal bacteria spread from the anus to the urethra. Again anatomically the female urethra is close to the vagina so sexually transmitted infections, such as chlamydia,gonnorohea,herpes and mycoplasma, can cause urethritis.
Risk factors
.Sexual activity. Sexually active women have more UTIs than non sexually active women. Having a new sexual partner also increases your risk.
.Female anatomy. A woman has a shorter urethras than men so the distance that bacteria must travel to reach the bladder is shorter
. Menopause. During menopause, there is a reduction in Oestrogen which makes the vaginal wall dry and atrophic and therefore more prone to infection.
.Specific Contraceptiondiabetis. Women who use diaphragms for birth control may be at higher risk(Not as common in Ireland)
Less common causes
.Urinary tract abnormalities. Babies born with urinary tract abnormalities such as kidney reflux
.Blockages in the urinary tract- Such as Kidney stones or an enlarged prostate
.Decreased Immune system.Such as Diabetes or on immunocompromised medication can increase the risk of UTIs.
.Catheter use- patients in hospitals or nursing homes or that have neurological conditions that can them unable to pu on their own
Complications
Complications of a UTI may include:
.Recurrent infections, women who have two or more UTIs in a six-month period or four within a year.
.Permanent kidney damage can result from acute or chronic kidney infection (pyelonephritis) due to an untreated UTI.
.In pregnant women an untreated UTI could result in delivering low birth weight or premature infants.
.Urethral stricture in men from recurrent urethritis, as a result of with gonococcal urethritis.
Sepsis, a potentially life-threatening complication of an infection,those with pyelonephritis.Typically an older person.
Prevention
.Drink copious amount of water. This dilutes your urine and helps to urinate more frequently allowing the bacteria to be flushed out.
.Wipe from front to back. After a bowel movement this helps prevent bacteria in the anal region from spreading to the front where the vagina and urethra are located.
.Pass urine soon after intercourse. helps to flush out bacteria.
.Avoid feminine products. such as deodorant sprays or other feminine products, such as douches and powders.This can irritate the urethra.
.Birth control method. Diaphragms, or unlubricated or spermicide-treated condoms, can all contribute to bacterial growth.
Diagnosis
.Diagnostic tools- urine sample. A mid stream urine sample is sent to the lab for microscopy and culture This looks for for white blood cells, red blood cells and bacterial growth.
.STI screen- if you have recurrant UTI your doctor may perform an STI screen to r/o Chlamydia and Gonnorhea.A swab test is inserted vaginally for PCR testing or a urine sample collection in men.
.Radiological images of your urinary tract. If you are having frequent infections this may be caused by an abnormality in your urinary tract so you may need to have an ultrasound or a computerized tomography (CT) scan.
.Using a scope to see inside your bladder. If you have recurrent UTIs, the specialist may perform a cystoscopy, to see inside your urethra and bladder. The cystoscope is inserted in your urethra and passed through to your bladder.
Treatment
Antibiotics usually are the first line treatment for urinary tract infections.
Drugs commonly recommended for simple UTIs include:
Nitrofurantoin (Macrodantin, Macrobid)-- first line
Trimethoprim, Amoxicillin
Cephalexin (Keflex)
Ceftriaxone
Ciprofloxacin in complicated UTIs
Recurrant UTIs may need --
.Low-dose antibiotics, initially for 3-6 months ( based on culture)
.A single dose of antibiotic after sexual intercourse
.Vaginal Oestrogen therapy during the perimenopausal and menopause such a Vagifem,Imvaggis.This affected over half of women over 50 years.
It is important not to let UTIs go untreated.If you have symptoms please contact your pharmacist/GP.