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- Urinary Tract Infection.
Urinary Tract Infection
Urinary tract infection is also known as UTI or bladder infection. It is an infection of the urinary bladder or urethra.
This is strictly not a kidney disease but a disease of the urinary tract. It may however, lead to infection of the kidneys
(pyelonephritis) and cause permanent kidney damage, if left untreated.
Signs and Symptoms:
Symptoms includes:
- Painful urination (burning sensation).
- Hot and foul smelling urine.
- Blood in urine, milky/cloudy urine.
- Fever (sometimes with chills).
- Painful lower abdomen.
- Increased frequency of wanting to pass urine.
- Urgency to pass urine.
- Nausea and/or vomiting.
- Back pain (pyelonephritis).
Additional symptoms that may be associated with this disease:
- Painful sexual intercourse.
- Penile pain.
- Flank pain.
- Fatigue.
- Fever.
- Chills.
- Vomiting.
- Mental changes or confusion*.
*Often in the elderly person, mental changes or confusion are the only signs of a possible urinary tract infection.
Causes:
Cystitis is caused by bacteria which enter the urethra and bladder and cause inflammation. Over 90% of cases of cystitis
are caused by E. coli, a bacterium normally found in the intestine. Cystitis occurs in 2 out of 100 people, and more
commonly in females, because the urethra is shorter and closer to the anus. Older adults are at higher risk of developing
cystitis. The incidence in the elderly can be as high as 33 out of 100 people.
Normally, the urethra and bladder have no bacteria. Bacteria that manage to enter the bladder are usually removed during urination.
But if bacteria remain in the bladder, they grow easily and quickly and result in infection.
Risks for cystitis include obstruction of the bladder or urethra with resultant stasis of urine, insertion of instruments into the
urinary tract (such as catheterization or cystoscopy), pregnancy, diabetes, and a history of analgesic nephropathy or reflux nephropathy.
Sexual intercourse can increase the risk of cystitis in women because bacteria can enter the bladder through the urethra.
The elderly population is at increased risk for developing cystitis due to incomplete emptying of the bladder associated with such
conditions as benign prostatic hyperplasia (BPH), prostatitis, and urethral strictures. Also, lack of adequate fluids, bowel incontinence,
immobility or decreased mobility, and placement in a nursing home, all place the person at increased risk for developing cystitis.
Treatment/Prevention:
Mild cases of acute cystitis may disappear spontaneously without treatment. However, because of the risk of the infection spreading to the
kidneys (complicated UTI), treatment is usually recommended. Also, due to the high mortality rate in the elderly population, prompt treatment
is recommended.
Antibiotics may be used to control the bacterial infection. The drug of choice and length of treatment depends on the patient's history and
the urine test that identify the offending bacteria. It is imperative that the patient finishes the entire course of prescribed antibiotics.
Commonly used antibiotics include:
- nitrofurantoin.
- sulfa drugs (sulfonamides).
- amoxicillin.
- cephalosporins.
- trimethoprim-sulfamethoxazole.
- doxycycline.
Chronic or recurrent UTI should be treated thoroughly because of the chance of kidney infection (pyelonephritis). Antibiotics control
the bacterial infection. They may need to be given for long periods (as long as 6 months to 2 years), or stronger antibiotics may be
needed than for single, acute episodes of cystitis. Prophylactic low-dose antibiotics at night may be recommended after acute symptoms
have subsided.
Surgery is generally not indicated in the presence of a urinary tract infection. Preventive measures may reduce symptoms and prevent
recurrence of infection. Keeping the genital area clean and remembering to wipe from front to back may reduce the chance of dragging
E. coli bacteria from the rectal area to the urethra.
Urinating immediately after sexual intercourse may help eliminate any bacteria that may have been introduced during intercourse. Delaying
urinating for long period will allow bacteria time to multiply, so frequent urination may reduce the risk of cystitis in those who are prone
to urinary tract infections.
Increasing the intake of fluids (2 to 4 litres per day) encourages frequent urination that flushes the bacteria from the bladder.
Avoid fluids that irritate the bladder, such as alcohol, citrus juices, and caffeine.
Follow-up measures may include urine cultures to ensure that bacteria are no longer present in the bladder. Appropriate hygiene and cleanliness
of the genital area may help reduce the chances of introducing bacteria through the urethra. The genitals should be cleaned and wiped from front
to back to reduce the chance of dragging E. coli bacteria from the rectal area to the urethra.
Preventive measures:
- Drink plenty of water daily.
- Drink cranberry juice (or take vitamin C supplement) to acidify urine.
- Urinate immediately when there is an urge; do not resist urge for long periods.
- Take shower instead of tub bath.
- Wipe from front to back after defaecation (to prevent bringing contamination from anus).
- Cleanse genital area after intercourse.
- Avoid scented douches.
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