# Urinary Tract Infection

Urinary tract infection (UTI) is second to respiratory infection as the most common type of infection in the body. It is a bacterial infection involving the kidneys, ureters, bladder, or urethra. These are the structures that urine passes through before being eliminated from the body.

The upper urinary tract is composed of the kidneys and ureters and the lower urinary tract consists of the bladder and the urethra.

## Types

The infection affects the lower urinary tract (urethra or bladder), it may be called Urethritis, or Cystitis if it only affects the bladder. If it migrates to and affects the upper urinary tract (ureters or kidneys) it is called Ureteritis and if it affects just the kidneys, it is called Pyelonephritis.

Urinary tract infections are much more common in adults than in children, but about 1%-2% of children do get urinary tract infections. Urinary tract infections in children (besides bedwetting) are more likely to be serious than those in adults and should not be ignored (especially in younger children).

These infections are more common in girls and women than in boys and men younger than 50 years of age. The lifetime risk of a woman having a UTI is over 50%. They are especially prone due to anatomical reasons; a woman’s urethra is shorter than a man’s and is situated closer to the anus, making it quicker for bacteria to enter the bladder. About 40% of women and 12% of men have a urinary tract infection at some time in their life. When the kidneys are involved, UTIs can be life-threatening.

## Causes of UTIs

More than 90% of UTI cases are a type of bacteria called Escherichia coli, (E. coli). These bacteria normally live in the bowel and around the anus. E. coli bacteria are fairly sedate in their natural environment of the bowel. However, the bacteria will thrive when introduced to urine’s acidic state.

Urinary tract infections normally occur when E.coli bacteria get into the urine and begin to grow. The infection usually starts at the opening of the urethra where the urine leaves the body and moves upward into the urinary tract to the bladder. If the infection is not treated at this point, it will continue on and quickly infect the kidneys.

E. coli bacteria can move quite easily from the area around the anus and the perineum to the opening of the urethra. The two most common causes of this are improper wiping and sexual intercourse. Women are more prone to UTIs because they have shorter urethras, which provide the bacteria a quicker pathway to the bladder.

The normal process of urination flushes the bacteria out through the urethra. However, if the infection has already taken hold and there are too many bacteria, urinating may not stop their spread.

The danger here is the infection spread further. If it reaches the kidneys, it can cause a kidney infection (pyelonephritis), which can become a very serious and even life-threatening condition if not treated immediately.

### Risk Factors for UTIs

Anything that reduces bladder emptying or irritates the urinary tract can cause UTIs.

Obstructions: Blockages that make it difficult to empty the bladder can cause a UTI. Obstructions can be caused by an enlarged prostate, kidney stones, and certain forms of cancer.

Sexual Activity: Pressure on the urinary tract during sex can move bacteria from the colon into the bladder. Most women have bacteria in their urine after intercourse. However, the body usually can get rid of these pathogens within 24 hours. Bowel bacteria may have properties that allow them to stick to the bladder.

Bathroom Hygiene: Wiping from back to front after going to the bathroom can lead to a UTI. This motion drags bacteria from the rectal area towards the urethra.

Spermicides: Spermicides can increase UTI risk. They may cause skin irritation in some women. This increases the risk of bacteria entering the bladder.

Condoms: Latex condoms can cause increased friction during intercourse. They may also irritate the skin. This may increase the risk of UTIs in some individuals. However, condoms are important for reducing the spread of sexually transmitted infections.

Diaphragms: Diaphragms may put pressure on the urethra. This can decrease bladder emptying. Some studies have seen a higher UTI risk in women who use diaphragms.

Diabetes: Changes to the immune system make a person with diabetes more vulnerable to infection. Also, a higher sugar level in the urine makes it easier for bacteria to grow.

Loss of Estrogen: After menopause, a loss of estrogen changes the normal bacteria in the vagina. This can increase the risk of UTIs.

Prolonged Use of Bladder Catheters: Catheters are used when someone cannot urinate normally. These thin, flexible tubes are inserted into the bladder. They allow urine to drain into a container. Long-term catheter use can increase the risk of UTIs. They may make it easier for bacteria to get into the bladder.

Weakened immune system: Medical conditions that impair the immune system, such as diabetes and HIV, increase the risk of kidney infection. Certain medications, such as drugs taken to prevent rejection of transplanted organs, have a similar effect.

## Symptoms

Urinary tract infections do not always cause signs and symptoms, but when they do they may include:

• A strong, persistent urge to urinate.
• A burning sensation when urinating.
• Passing frequent, small amounts of urine
• Urine that appears cloudy.
• Urine that appears red, bright pink, or cola-colored is a sign of blood in the urine.
• Strong smelling urine.
• Pelvic pain, in women.
• Rectal pain, in men.
• UTIs may be overlooked or mistaken for other conditions in older adults.

### Tests and Diagnosis

Tests and procedures used to diagnose urinary tract infections include:

• Analyzing a urine sample: A urinary tract infection is a diagnosis by detection of white blood cells, red blood cells, or bacteria in a patient’s urine.
• Growing urinary tract bacteria in a lab: Lab analysis of the urine is sometimes followed by urine culture, a test that uses a urine sample to grow bacteria in a lab. This test tells which bacteria are causing infection and is helpful for a selection of the most effective medications.
• Creating images of your urinary tract: An ultrasound, a computerized tomography (CT) scan, intravenous pyelogram (IVP), use of X-rays with contrast dye to create images. These images are helpful to know abnormality in the urinary tract which causes frequent infections.
• Using a scope to see inside the bladder: The cystoscopy uses a long, thin tube with a lens (cystoscope) to see inside the urethra and bladder.

## Treatments and Drugs

Antibiotics are generally used for the treatment of urinary tract infections. Specific antibiotics and the duration of treatment depend on health conditions and the type of bacterium found in urine.

Simple infection:

Drugs commonly recommended for simple UTIs include:

• Sulfamethoxazole-trimethoprim
• Amoxicillin
• Nitrofurantoin
• Ampicillin
• Ciprofloxacin
• Levofloxacin

Usually, symptoms clear up within a few days of treatment. But may need to continue antibiotics for a week or more. To ensure that the infection is completely eradicated.

An uncomplicated UTI that occurs when the patient is otherwise healthy, may require a shorter course of treatment, such as taking an antibiotic for one to three days. And depends on particular symptoms and medical history.

Pain medication (analgesic) may be recommended, that numbs the bladder and urethra to relieve burning while urinating. One common side effect of urinary tract analgesics is discolored urine changes into orange or red.

Frequent infections:

If a person experiences frequent UTIs, often requires certain treatment recommendations, such as:

A longer course of antibiotic treatment or a program with short courses of antibiotics at the start of urinary symptoms.

A single dose of antibiotic after sexual intercourse if infections are related to sexual activity.

Vaginal estrogen therapy if postmenopausal, to minimize the chance of recurrent UTIs.

Severe infection:

A severe UTI may need treatment with intravenous antibiotics in a hospital.

## Prevention

Not all UTIs can be prevented, but there are some simple steps that can be taken to reduce the risk of developing and help prevent UTIs.

• Drinking water after having sex.
• Cleaning vaginal and rectal areas daily.
• Taking showers instead of baths
• Drink lots of fluids (six to eight glasses of water) to flush the urinary system.
• Urinate as soon as, feel the need rather than hold on.
• For women and girls, wipe the bottom from front to back to prevent bacteria from around the anus from entering the urethra.
• Urinate shortly after sex to flush away bacteria that might have entered the urethra during sex.
• Wear cotton underwear and loose-fitting clothes so that air can keep the area dry. Avoid tight-fitting clothes and nylon underwear, which trap moisture and can help bacteria grow.
• Using a diaphragm or spermicide for birth control can lead to UTIs (in women) by increasing bacteria growth. Unlubricated condoms or spermicidal condoms increase irritation, which may help bacteria to grow.
• Take vitamin C or cranberry juice, because these are said to be urinary antiseptics.
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