URINARY TRACT INFECTIONS
WHAT IS A URINARY TRACT INFECTION?
A urinary tract infection (UTI) is an infection in any part of your urinary system — your kidneys, ureters, bladder and urethra.
A UTI can happen anywhere in your urinary tract. Your urinary tract is made up of your kidneys, ureters, bladder, and urethra. Most UTIs only involve the urethra and bladder, in the lower tract. However, UTIs can involve the ureters and kidneys, in the upper tract. Although upper tract UTIs are more rare than lower tract UTIs, they’re also usually more severe.
A UTI is one of the most common infections worldwide. Every year, an estimated 8.1 million people visit the hospital because of a UTI.
If you're a woman, your chance of getting a urinary tract infection is high. Some experts rank your lifetime risk of getting one as high as 1 in 2, with many women having repeat infections, sometimes for years. Approximately 1 in 10 men will get a UTI in their lifetime.
TYPES OF UTIs AND SYMPTOMS
Each type of UTI may result in more-specific signs and symptoms, depending on which part of your urinary tract is infected.
WHAT IS THE TREATMENT FOR UTIs?
Treatment of UTIs depends on the cause. Your doctor will be able to determine which organism is causing the infection from the test results used to confirm the diagnosis.
In most cases, the cause is bacteria. UTIs caused by bacteria are treated with antibiotics.
In some cases, viruses or fungi are the causes. Viral UTIs are treated with medications called antivirals. Fungal UTIs are treated with medications called antifungals.
The form of antibiotic used to treat a bacterial UTI usually depends on what part of the tract is involved. Lower tract UTIs can usually be treated with oral antibiotics. Upper tract UTIs require intravenous antibiotics. These antibiotics are put directly into your veins.
Sometimes, bacteria develop resistance to antibiotics. To reduce your risk of antibiotic resistance, your doctor will likely put you on the shortest treatment course possible. Treatment typically lasts no more than 1 week.
Results from your urine culture can help your doctor select an antibiotic treatment that will work best against the type of bacteria that’s causing your infection.
Treatments other than antibiotics for bacterial UTIs are being examined. At some point, UTI treatment without antibiotics may be an option for bacterial UTIs by using cell chemistry to change the interaction between the body and the bacteria.
There are no home remedies that can cure a UTI, but there are some things that you can do that can help your medication work better.
Simple home remedies like drinking more water may help your body clear the infection faster. Cranberry juice or cranberries don’t treat a UTI once it’s started. However, a chemical in cranberries may help prevent certain types of bacteria that can cause a bacterial UTI from attaching to the lining of your bladder. This may be helpful in preventing future UTIs.
While cranberries are a popular remedy, the research on their effect on UTIs is mixed. More conclusive studies are needed.
It’s important to treat a UTI — the earlier, the better. Untreated UTIs become more and more severe the further they spread. A UTI is usually easiest to treat in the lower urinary tract. An infection that spreads to the upper urinary tract is much more difficult to treat and is more likely to spread into your blood, causing sepsis. This is a life-threatening event.
If you suspect that you have a UTI, contact your doctor as soon as possible. A simple examination and urine or blood test could save you a lot of trouble in the long run.
HOW IS A UTI DIAGNOSED?
If you suspect that you have a UTI based on your symptoms, contact your doctor.
Your doctor will review your symptoms and perform a physical examination. To confirm a diagnosis of a UTI, your doctor will need to test your urine for microbes.
The urine sample that you give your doctor needs to be a “clean-catch” sample. This means the urine sample is collected at the middle of your urinary stream, rather than at the beginning. This helps to avoid collecting the bacteria or yeast from your skin, which can contaminate the sample. Your doctor will explain to you how to get a clean catch.
When testing the sample, your doctor will look for a large number of white blood cells in your urine. This can indicate an infection. Your doctor will also do a urine culture to test for bacteria or fungi. The culture can help identify the cause of the infection. It can also help your doctor choose which treatment is right for you.
If a virus is suspected, special testing may need to be performed. Viruses are rare causes of UTIs but can be seen in people who have had organ transplants or who have other conditions that weaken their immune system.
UPPER TRACT UTIs
If your doctor suspects that you have an upper tract UTI, they may also need to do a complete blood count (CBC) and blood cultures, in addition to the urine test. A blood culture can make certain that your infection hasn’t spread to your bloodstream.
Most UTIs go away after treatment. Chronic UTIs either don’t go away after treatment or keep recurring. Recurrent UTIs are common among women.
Many cases of recurrent UTIs are from reinfection with the same type of bacteria. However, some recurrent cases don’t necessarily involve the same type of bacteria. Instead, an abnormality in the structure of the urinary tract increases the likelihood of UTIs.
If you have recurrent UTIs, your doctor may also want to check for any abnormalities or obstructions in your urinary tract. Some tests for this include:
An ultrasound, in which a device called a transducer is passed over your abdomen. The transducer uses ultrasound waves to create an image of your urinary tract organs that are displayed on a monitor.
An intravenous pyelogram (IVP), which involves injecting a dye into your body that travels through your urinary tract and taking an X-ray of your abdomen. The dye highlights your urinary tract on the X-ray image.
A cystoscopy, which uses a small camera that’s inserted through your urethra and up into your bladder to see inside your bladder. During a cystoscopy, your doctor may remove a small piece of bladder tissue and test it to rule out bladder inflammation or cancer as a cause of your symptoms.
A computerized tomography (CT) scan to get more detailed images of your urinary system.
CAUSES AND RISK FACTORS
Anything that reduces your bladder emptying or irritates the urinary tract can lead to UTIs.
There are also many factors that can put you at an increased risk of getting a UTI. These factors include:
age — older adults are more likely to get UTIs
reduced mobility after surgery or prolonged bed rest
a previous UTI
Bacteria, called Escherichia coli (E. coli), that live in the digestive system and spread to the urinary tract, and staph saphrophyticus, cause most urinary tract infections.
urinary tract obstructions or blockages, such as an
enlarged prostate, kidney stones, and certain forms of cancer
prolonged use of urinary catheters, which may make it easier for bacteria to get into your bladder
diabetes, especially if poorly controlled, which may make it more likely for you to get a UTI
abnormally developed urinary structures from birth
a weakened immune system
ADDITIONAL RISK FACTORS FOR MEN
Most UTI risk factors for men are the same as those for women. However, having an enlarged prostate is one risk factor for a UTI that’s unique to men.
ADDITIONAL RISK FACTORS FOR WOMEN
There are additional risk factors for women. Some factors that were once believed to be a cause of UTIs in women have since been shown to not be as important, such as poor bathroom hygiene. Recent studies have failed to show that wiping from back to front after going to the bathroom leads to UTIs in women like previously believed.
In some cases, certain lifestyle changes may help lessen the risk of some of these factors.
The length and location of the urethra in women increases the likelihood of UTIs. The urethra in women is very close to both the vagina and the anus. Bacteria that may naturally occur around both the vagina and anus can lead to infection in the urethra and the rest of the urinary tract.
A woman’s urethra is also shorter than a man’s, and the bacteria have a shorter distance to travel to enter the bladder.
Pressure on the female urinary tract during sexual intercourse can move bacteria from around the anus into the bladder. Most women have bacteria in their urine after intercourse. However, the body can usually get rid of these bacteria within 24 hours. Bowel bacteria may have properties that allow them to stick to the bladder.
Spermicides may increase UTI risk. They can cause skin irritation in some women. This increases the risk of bacteria entering the bladder.
Condom use during sex
Non-lubricated latex condoms may increase friction and irritate the skin of women during sexual intercourse. This may increase the risk of a UTI.
Diaphragms may put pressure on a woman’s urethra. This can decrease bladder emptying.
Decrease in estrogen levels
After menopause, a decrease in your estrogen level changes the normal bacteria in your vagina. This can increase the risk of a UTI.
HOW TO PREVENT UTIs
You can take these steps to reduce your risk of urinary tract infections:
Drink six to eight glasses of water daily -Drinking water helps dilute your urine and ensures that you'll urinate more frequently — allowing bacteria to be flushed from your urinary tract before an infection can begin.
Drink cranberry juice. Although studies are not conclusive that cranberry juice prevents UTIs, it is likely not harmful.
Wipe 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.
Empty your bladder soon after intercourse. Also, drink a full glass of water to help flush bacteria.
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.
Change your birth control method. Diaphragms, or unlubricated or spermicide-treated condoms, can all contribute to bacterial growth.
PREGNANCY AND UTIs
Women who are pregnant and have symptoms of a UTI should see their doctor right away. UTIs during pregnancy can cause high blood pressure and premature delivery. UTIs during pregnancy are also more likely to spread to the kidneys.