· UTIs are a serious health problem affecting millions each year.
<!-· Infections of the urinary tract are the second most common type of infection in the body.
<!-· Urinary tract infections (UTIs) account for about 8.3 million doctor visits each year.* Women are especially prone to UTIs for reasons that are not yet well understood. One woman in five develops a UTI during her lifetime. UTIs in men are not as common as in women but can be very serious when they do occur.
*Ambulatory Care Visits to Physician Offices, Hospital Outpatient Departments, and Emergency Departments: United States, 1999–2000. Vital and Health Statistics. Series 13, No. 157. Hyattsville, MD: National Center for Health Statistics, Centers for Disease Control and Prevention, U.S. Dept. of Health and Human Services; September 2004.
The urinary system is composed of the kidneys, ureters, bladder and urethra. Kidneys are a key element in the system, located towards the center of the back and below the ribs. The purpose of the kidneys is to remove excess fluids and waste from the boodstream, while also producing a hormone that aids in the creation of red blood cells. Ureters are narrow tubes that carry urine from the kidneys to the bladder, a bag-like organ that stores urine and empties it through the urethra.
On average, a typical adult releases about a quart and a half per day. This amount can vary from person to person, based on the volume of foods and fluids consumed by each individual. The amount of urine created at night, is approximately half as much as is created during the day.
What are the causes of UTI?
Typically, urine is actually sterile; free of bacteria, fungi and viruses. Urine, however, does contain different fluids, salts, and wastes. Infection may occur when small organisms, such as bacteria, remain on the opening of the urethra and multiply. The urethra is the tubular structure that delivers urine from the bladder and expels it from the body. The majority of infections are a result of one type of bacteria, Escherichia or E. coli, which can typically be found in the colon.
In most cases, the bacteria travel to the urethra where they multiply, resulting in an infection. Urethritis is an infection that is limited to the urethra. If the bacteria continue on to the bladder and multiplies, a bladder infection called cystitis will occur. If not treated quickly, the bacteria may continue on up the ureters, multiplying and infecting the kidneys. Pyelonephritis is the technical term for a kidney infection.
Who is at risk?
Some individuals are more prone to UTIs than others. Abnormalities in the urinary tract, obstructing the flow of urine, can cause frequent infections. Enlarged prostrate glands can cause the flow of urine to be very slow, increasing the risk of infection as well.
Catheters placed in the urethra and bladder, are a very common cause of infection. Individuals unable to urinate on their own often require catheters which remain in place for an extended period of time. Some individuals, especially geriatric patients or those with disorders of the nervous system, may require a catheter for the remainder of their life. Any bacteria found on the catheter can easily cause an infection in the bladder. Hospitals go to great lengths to try to keep catheters clean to decrease the possibility of infection.
Those with diabetes are at higher risk for UTIs due to the constant fluctuations in their immune systems. Immune suppressing disorders, like the AIDS virus, also increase the risk of urinary infection.
UTIs can occur in individuals of any age or sex, born with abnormalities in the urinary tract, which may or may not be surgically corrected. While UTIs are more rare in boys and younger men, they can occur. The average rate of UTIs in women increases gradually with age. Although scientists are unsure of the exact reason why women are more susceptible to UTIs, they suspect it may have something to do with the shorter length of a woman’s urethra, in comparison with a man. The urethral opening of a woman is also much closer to a source of bacteria, the anus, than a man’s. Sexual intercourse, for a woman, seems to often cause an infection (although the exact reason is unknown).
What are the symptoms of a UTI?
UTIs do not cause symptoms in all individuals; however, most people will experience some. Frequently complained about symptoms include: frequent urges to urinate, painful, burning sensation in the bladder or urethra area when emptying the bladder, or blood in the urine. Many people often experience fatigue and flu-like symptoms along with constant pain. Although many experience the constant urge to urinate, quite often very little urine will actually be released if at all. Urine expelled from the bladder during a UTI may have a strange appearance, looking cloudy, milky, or tinged with red (if there is blood present). Fevers are not typical if the UTI remains in the bladder, however, a fever will occur if the infections travels to the kidneys; causing other symptoms such as nausea, vomiting, and back pain in the area of the kidneys.
Symptoms in children are often overlooked or misdiagnosed. Children and infants often exude signs of irritatiblity, lack of appetite, unexplained fever, diarrhea or incontinence. It is likely that children will experience unexplainable fevers with a regular UTI, unlike adults. UTIs can occur in both girls and boys. Children should immediately been seen by a physician if they show any of these signs, which may indicate a possible UTI.
How is a UTI diagnosed?
Simple urine tests are done to diagnose UTIs, in search of the presence of pus or bacteria in the urine. Often, it will be necessary for you to give a “clean catch” sample of urine by cleansing the genital area prior to catching your urine midstream in a sterile container. The “clean catch” method prevents any additional bacteria present on or near your genitalia from contaminating the sample you provide, allowing your physician to more accurately diagnose you. Samples are generally sent to a lab, although some physician’s offices are equipped to handle the testing on site.
In Urinalysis, technicians in a lab examine urine for traces of white or red blood cells as well as bacteria. If bacteria is found, it will be grown in a culture after which different bacterias will be tested against it, to see which bacteria is most appropriate and effective for treating the infection. This is referred to as a “sensitivity test”.
Micro-organisms, such as Chlamydia and Mycoplasma, can only be detected within specific bacterial cultures. An infection of this nature is suspected when a patient complains of typical UTI symptons, pus is found in the urine, but bacteria will not grow in the standard culture.
If antibiotics cannot clear up the infection, regardless of what the sensitivity test results have shown, physicians may questions the integrity of the patient’s system. Often, texts will be ordered, such as intravenous pyelogram, which allows for x-ray images of the kidneys, bladder, and ureters to be taken in great detail. The opaque dye that is injected intravenously travels through these organs, after which x-rays are taken. The film developed from these x-rays will show the entire urinary tract, making any abnormality apparent.
Patients, who experience recurring infections, may also be required to undergo an ultrasound in this same area. If results are hide to find using an ultrasound, physicians may resort to using a cystoscope, a hollow tube containing several lenses and a light, which allows your physician to see the entire inner lanscape of your bladder and urethra.
How is a UTI treated?
Antibiotics are generally used to treat UTIs. Which specific antibiotic, and the length the patient must take it, are specific to the patient’s history as well as the results gathered through whatever diagnostic tests were ordered. Often times, the sensitivity test exposes the most effective antibiotic for the specific infection. Typical UTIs, uncomplicated by other issues, are usually treated with the following: trimethoprim (Trimpex), trimethoprim/sulfamethoxazole (Bactrim, Septra, Cotrim), amoxicillin (Amoxil, Trimox, Wymox), nitrofurantoin (Macrodantin, Furadantin), and ampicillin (Omnipen, Polycillin, Principen, Totacillin). Quinolones are a group of four drugs, recently approved by the FDA, for treating UTIs. These include: ofloxacin (Floxin), norfloxacin (Noroxin), ciprofloxacin (Cipro), and trovafloxin (Trovan).
Uncomplicated UTIs are often cured within a day or two of treatment. Physicians often prescribe a longer duration of medication to ensure that the infection has been completely eradicated. Single-dose treatment are not used for patients who show signs of further complications as a result of the UTI, or who have a history of complicated UTIs. Extended treatment routines are also necessary for patients diagnosed with Mycoplasma or Chlamydia. Typically these are treated tetracycline, trimethoprim/sulfamethoxazole (TMP/SMZ), or doxycycline. Follow-up urinalysis is often ordered, to ensure that the urinary tract is free of all infection. It is crucial that patients follow the exact treatment regiment prescribed by their physician, to ensure that the infection is completely gone, regardless of whether or not symptoms disappear before the medication has been completed.
Hospitalization will occur with patients who are severely ill with kidney infections. Several weeks of antibiotics are typically necessary with a kidney infection. Kidney damage or failure may occur if the infection goes untreated for an extended period of time.
Recurrent Infections in Women
Women who have experienced three UTIs are more likely to experience recurring infection. Women experiencing this problem may ask their physicians about different forms of treatment, such as:
- Low doses of an antibiotic, such as TMP/SMZ or nitrofurantoin, on a daily basis for 6 plus months.
- Single dose of antibiotics after sexual intercourse.
- Short course (1-2 days) of antibiotics at the first sign of symptoms.
Women can also routinely following these preventative measures:
- Drink plenty of water daily.
- Do not wait once you experience the urge to urinate.
- Wiping one’s genitalia from front to back, preventing the sharing of bacteria from the anus to the vagina or urethra.
- Showers instead of soaking in a tub.
- Cleansing one’s genitalia prior to engaging in sexual intercourse.
- Avoid the use of feminine sprays, scented douches, or douching all together.
- Some physicians suggest regularly drinking cranberry juice, which is a diuretic.
Infections During Pregnancy
UTIs experienced during pregnancy should be promptly treated, to avoid premature births as well as other risks. Not all antibiotics are safe during pregnancy therefore, physicians take into account many different factors, such as the drug’s effectiveness, term of the pregnancy, mother’s physical health, and potential negative side effects the drug could have on the unborn baby.
Infections stemming from an obstruction in the urinary tract or other disorders, require different methods to cure, sometimes requiring surgery. If the root of the problem is not treated, patients may be at risk for damage to the kidneys.
Infections in Men
UTIs in men are typically a result of a urinary obstruction, such as a urinary stone, catheter or swollen prostrate. Physicians must determine which organism is causing the infection, and what antibiotic is most effective in eradicating it. Lengthier therapy is typically prescribed for men than women, to prevent infection to the prostate gland.
Infections of the prostate (chronic bacterial prostatitis) are more challenging to cure, as antibiotics will not be absorbed into the tissue of the infected prostate very well. Men with prostatitis, require long-term treatment routines with a very carefully chosen antibiotic. Older men typically experience UTIs associated with acute bacterial prostatitis, causing severe complications if left untreated for too long.
Is there a vaccine to prevent recurring UTIs? Potentially, in the future, scientists may discover a vaccine that can prevent recurring UTIs. Researchers have discovered a connection between children and women who experience UTIs, involving a lack of proteins called immunoglobulins, which fight infection. Immunoglobulins are found in normal levels within the urinary tract and genitalia of children and women who do not experience recurring UTIs.
Test results show that a certain vaccine helps patients build their natural power to fight infection. The dormant bacteria found in the vaccine do not spread as in an infection; rather, they cause the body to produce antibodies which will be available later to fight live organisms of the same nature. Scientists are currently testing both intravenous and oral vaccines to see which is more effective and efficient. Women may also eventually have to option to apply the vaccine as a suppository which will be placed into the vagina for absorption.