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Urinary tract infection (UTI) is the infection of any part of the urinary system which may include kidneys, ureters, urinary bladder or urethra. Amongst these, the infection of the urinary bladder, the structure where the urine gets collected before releasing out is the commonest type of UTI. This is especially common in females where it is said to develop in about 50% women at least once in their lifetime.
The infection of the kidneys, called pyelonephritis is rare but is a much more serious problem.
The UTI is usually caused by bacteria that typically enters through the urethra and starts multiplying in the urinary bladder. The commonest bacteria to cause UTI is E.coli which is found in the gut, which gets its access due to close proximity of the anus to the urethra, especially in women.
UTI is not mere presence of bacteria or microorganism in the urine. Many a times bacteria can be seen in urine in a person with no symptoms which doesn’t indicate urinary tract infection. When the person develop symptoms or inflammation of urinary tract along with the presence of microrganism in the urine, it is said to be urinary tract infection.
Urinary tract infection (UTI) is one of the most common bacterial infections in females, seen developing in about 50% of women at least once in a lifetime. It is less common in males developing in about 8% men. Amongst females about 27% women are found to develop recurrent UTI within 6 months.
The UTI is caused by micro-organisms that usually enters from urethra and ascends upwards into bladder and sometimes to kidneys. Rarely, the UTI develops from infection in the blood which is more often seen in immunocompromised people. The microorganisms that causes UTI are as follows:
Bacteria: comprises most of the cases of UTI. The E.coli is the commonest bacteria to cause UTI accounting for 85% cases. Other bacterias that causes UTI are Proteus, Klebsiella, Enterococcus faecalis etc.
Fungus: is a less common cause, accounting for about 7% of cases. In recent decades, it has shown increase in number of cases with risk factors given below. The commonest fungus to cause UTI is Candida albicans accounting for 50% to 70% cases. Other fungi to cause UTI can be Cryptococcus neoformans, Aspergillus species and others.
Virus: UTI is rarely caused by a virus. If it is seen, it is more often seen in immunocompromised people such as organ transplant recipients. It is usually caused by BK virus,cytomegalovirus or adenovirus.
The above described micro-organisms usually comes from the region adjacent to your urethra such as anus or perineum. From here they get direct access to the urethra which is many a times aided by certain activities like sex or some medical procedures such as catheterization. These microorganisms once inside your urinary system if not countered by your body’s defense response, could multiply to cause infection.
Following are the risk factors that can predispose you to develop an UTI:
It is estimated that women are 30 times more prone to develop UTI than men.
• Female anatomy: much more common in females due to short urethra and its close proximity to the vagina and anus.
• Sexual activity: more common in young sexually active females due to higher level of sexual activity.
• Specific birth control methods: more common with use of diaphragm or spermicide agents.
• Menopause: More often seen after menopause due to lower vaginal estrogen levels which makes it easier for the bacteria to grow.
• Urinary tract abnormalities: some people are born with abnormalities of the urinary tract which leads to abnormal passage of urine out of the body or causes back flow of urine on attempt of urination. These conditions can be hypo/epispadiasis, posterior urethral valve and others.
• Factors promoting microbe ascent: bladder catheterization, urinary surgery or procedure such as cystoscopy, incontinence of urine, incontinence of stools/soiling of underpants. Bladder catheterization is commonly done in patients who are hospitalized and can’t move, before people with neurological problems that make it difficult to control their ability to urinate and people who are paralyzed.
• Factors promoting urine stasis: Decreased or obstructed flow of urine can be caused by stones, enlarged prostate, stricture of urethra, neurogenic bladder or inadequate intake of fluids. All these factors results into stasis of urine in bladder which further promote bacterial growth.
• Underlying conditions: such as diabetes and other immuno-supressed states HIV, chemotherapy etc, and pregnancy increases the risk of UTI.
Risk factors such as prolonged hospital stay, catheterization, immuno-compromised status, excessive use of antibiotics, prophylaxis and urinary tract surgeries
The UTI is typically classified into two types on the basis of symptoms and prognosis
1. Lower UTI (cystitis) involving bladder and urethra
2. Upper UTI (pyelonephritis) involving kidneys
The lower UTI is much more common than upper UTI. The upper UTI usually occurs when the lower urinary tract infection ascends upwards to involve the kidneys. Most of the time the infection remains restricted to the lower urinary tract. Less often it ascend upwards or spreads from blood to the kidneys.
The characteristic signs and symptoms of lower UTI or cystitis are:
• Urgency: Strong lingering urge to pass urine, even when the bladder is empty.
• Frequency: passing urine frequently in small quantities
• Nocturia: increased urination in the night
• Burning: tinging or burning sensation felt on passing urine
• Feeling of incomplete emptying of the bladder
• Urine incontinence
• Abnormal appearance of urine: urine may appear cloudy due to pus cells. It may sometime contains blood which makes it look red, pink, or cola-colored.
• Foul-smelling urine
• Pelvic pressure or pain
• Non-specific symptoms: diarrhea, lethargy, irritability, confusion, and rarely fever.
The characteristic signs and symptoms of upper UTI or Pyelonephritis are:
In addition to the symptoms of cystitis discussed above, pyelonephritis may present with:
• Fever with chills
• Flank pain: pain in abdomen or back on one or both the sides
• Nausea and vomiting
The urinary tract infection may lead to the following conditions:
• Recurrent UTI: where a woman develops more than 1 episode of UTI within six-months period or more than 3 episodes within a year.
• Stricture in the urethra: urethra in men may develop narrowing due to recurrent urethritis leading to obstruction in the passage of urine.
• Kidney damage: due to untreated acute or chronic kidney infection (pyelonephritis).
• Premature birth: UTI in pregnant women may increase the risk of delivering premature babies.
• Sepsis: UTI, especially in susceptible individuals may lead to sepsis. Sepsis is a life-threatening condition where the body shows overwhelming response to the infection which in turn damages multiple organs of the body.
1. Urine analysis (midstream sample): the test can reveal abnormal pus cells, RBC’s or bacteria in the urine which in presence of symptoms suggest a diagnosis of UTI. Quite often the bacterias present near the urethra can contaminate the urine sample giving a false positive result of UTI. This is avoided by using a special antiseptic pad to clean the genitals and by taking a mid stream sample of urine.
The doctor would treat the UTI mainly by using antibiotics. There are a number of antibiotics available for the treatment of UTI.
There are several day to day habits that can help you prevent from developing urinary tract infection. These are as follows:
• Drink plenty of water and fluids: it is advisable to drink at least 2 liters of water per day which helps to dilute the urine and flush out microbes. This is not applicable for a person with urinary incontinence, or a person with heart or kidney failure. These people should consult their doctors. Some of the studies show drinking cranberry juice helps in preventing UTI, however few other studies discard this notion.
• After intercourse: you should urinate immediately after intercourse and drink plenty of water. This helps to flush out microorganisms with the urine.
• Wipe genitals from front to back: wiping from front to back after urinating or passing stools prevents microbes present in the anal region to spread to the urethra.
• Maintain genital hygiene and keep it dry: it is advisable to wear cotton underwear and loose fitting clothes to keep the area dry.
• Avoid using products in the genital area: application of products such as deodorant, powdersand douches in the genital area can irritate the urethra making it susceptible to infection.
• Avoid certain birth control methods: avoid using diaphragms, non lubricated condoms or spermicidal agents.
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