Dr. Victor Emanuel MD

OVERVIEW

A UTI is an infection that starts in your urinary system.  UTI’s can be painful and annoying, and become a serious health problem if the infection spreads to your kidneys.

Women are most at risk for a UTI.  In fact, 20% of women will likely develop one during their lifetime, and many will experience more than one.

The urinary system is composed of the kidneys, ureter, bladder and urethra, all of which play a role in removing waste from the body.  The kidneys, a pair of bean-shaped organs in your upper abdomen toward the back, filter waste from your blood.  The ureters are the tubes which carry urine from the kidneys to your bladder, where it is stored until it exits the body through the urethra.  All of these components can become infected, but most infections involve the lower tract – the urethra and the bladder.

UTI’s are typically treated with antibiotics.  But you can take steps to reduce your chance of getting a UTI in the first place.

SIGNS AND SYMPTOMS

Everyone with a UTI doesn’t necessarily develop recognizable signs and symptoms, but most people have some.  They include:

•    A burning sensation when urinating
•    A strong, persistent urge to urinate (to pee)
•    Passing frequent small amounts of urine. (Large amounts may be a sign of diabetes)
•    Blood in the urine (hematuria), or cloudy, strong-smelling urine.  Pink urine may be a sign of the slight bleeding we’re talking about.

Each type of UTI may result in more specific signs and symptoms, depending on which part of your urinary tract is infected.

Acute pyelonephritis.  Infection can spread from your bladder to your kidneys.  Of course, your ureters will also be involved, hence the “pyelo” portion of the term.  The “nephritis” comes from the kidney involvement.  Kidney infection can cause high fever, shaking chills, nausea or vomiting, and flank pain.

Cystitis.  Infection or inflammation of the bladder may result in pressure in the pelvis (housing your reproductive organs) and lower abdomen, and strong-smelling urine.

Urethritis.  Inflammation or infection of the urethra leads to burning with urination and sometimes pus in your urine.  In men, a discharge from the penis can result from urethritis.

WHAT CAUSES A UTI?

Typically UTI’s occur when bacteria enter the urinary tract through the urethra and begin to multiply in the bladder.

Bacteria in the urine don’t always signify an infection.  Some people, especially older adults, may have bacteria in the bladder that cause no harm or symptoms.  This is known as asymptomatic bacteuria.

Cystitis may occur in women after sexual intercourse. But even girls and women who are not sexually active are susceptible to lower UTI’s because the anus is so close to the female urethra.

Most cases are caused by E.coli (Escherichia coli), a species of bacteria commonly found in the gastro-intestinal tract, (the colon).

In urethritis, the same organisms that infect the kidney and bladder can infect the urethra.  In addition, because of the female urethra’s proximity to the vagina, sexually transmitted infections (STI’s) such as herpes simplex virus and chlamydia, also are possible causes of urethritis.  Some organisms that infect the urethra can easily spread to the vagina and cause an STI.

In men, urethritis often is the result of bacteria acquired through sexual contact.  The majority of these infections are caused by gonorrhea and chlamydia.

RISK FACTORS

Some people seem to be more likely than others to develop UTI’s.  Remember, one in five women will get at least one over a lifetime.  One key reason is because they have a shorter urethra than men have; bacteria have a shorter distance to travel to reach the bladder.

Sexually active women tend to have more UTI’s.  Intercourse can irritate the urethra, allowing germs to more easily travel through the urethra into the bladder.  Women who use diaphragms for birth control may also be at high risk.  After menopause, UTI’s may become more common because vaginal, urethral and base-of-the-bladder tissues become thinner and more fragile due to loss of estrogen.

Other risk factors include:
•    Anything that impedes or obstructs the flow of urine, such as an enlarged prostate or a kidney stone.
•    Diabetes and other illnesses that impair the immune system.
•    Medications that lower immunity
•    Prolonged use of tubes (catheters) in the bladder

DIAGNOSIS

If you have symptoms of a UTI, see your doctor.  If he suspects you have a UTI, an analysis and culture of a sample of your urine will be done.  Although no simple test can differentiate between an upper and lower UTI, fever and flank pain indicate that the infection is likely to be in your kidneys.

ANY COMPLICATIONS?

UTI’s rarely lead to any further problem when treated promptly and properly.  But left untreated, a UTI can become more serious than a set of uncomfortable symptoms.

Untreated UTI’s can lead to acute or chronic pyolonephritis, which could cause permanent kidney damage.  Young children and older adults are at the greatest risk for kidney damage due to UTI’s because their symptoms are often overlooked or mistaken for other conditions.  Pregnant women with UTI’s may have an increased risk of delivering low birth weight or premature babies.

TREATMENT

Antibiotics are the first line of treatment.  Which one depends on the bacteria found in your urine tests, and on your health condition.

Usually, UTI symptoms clear up within a few days of treatment.  But sometimes antibiotics may be needed for a week or more.  Whether given for three or seven days, always take the full course to ensure the infection is completely eradicated!

If you have recurrent UTI’s, you may receive short courses of antibiotics or a longer course of antibiotic treatment, as part of a self-treatment program.  For a woman with infections related to sexual activity, a single dose of antibiotic post-sex may be recommended.

For severe UTI’s, hospitalization and treatment with intravenous antibiotics may be necessary.

CAN I PREVENT THIS?

You can take steps to reduce your risk of UTI.  Women in particular may benefit from the following.

•    Drink plenty of fluids, especially water.  Cranberry juice seems to have infection-fighting properties.
•    Urinate frequently.  When you feel the urge to go, go.  Don’t retain your urine for long periods.
•    Wipe from front to back after urinating or passing stool, so as not to contaminate your vagina and urethra with bacteria from the anal region.
•    Empty your bladder as soon as possible after intercourse. Drink a full glass of water to help flush bacteria.
•    Avoid potentially irritating feminine products.  Douching and powders can irritate the urethra and really are not necessary to use.

Be not afraid if you feel you have symptoms of a UTI. See doctor early.  Treatment is usually successful, and if you follow advice, you can minimize your chances of getting one in the first place.

See you next week.