Overview
The urinary tract includes the kidneys, bladder, ureters and urethra.
Urinary tract infections (UTIs) are far more common in women than men. Urinary
tract infections have different names depending on which part of the urinary
tract is infected.
- infection of the bladder is cystitis
- infection of the urethra is urethritis
- infection of the kidney is pyelonephritis
Among newborns, UTIs are more common in boys, but by one year of age, they
are ten times more likely to occur in girls. The rate of infection is 50 times
higher for sexually active women - between 16 and 35 years old - than for men.
As many as 40% of North American women have had at least one UTI. Among elderly
people, the gender difference in infection rates diminishes.
Causes
Women are more likely to get UTIs than men. That's because women have
a shorter urethra - the tube that carries urine out of the bladder - and it's
closer to the rectum. This allows bacteria easier access to a woman's urinary
tract. After urinating, wiping from the back to the front pushes bacteria from
the rectal area towards the urethra, which can lead to a UTI. Sexual intercourse
increases the risk for UTI because bacteria are spread upward into the bladder.Using
diaphragms and spermicides can also increase the risk for UTIs because the normal
bacteria around the urethra may be changed, making infection more likely. Pregnancy
also makes some women more susceptible to UTIs.
In addition to bladder infections, men may get infections of the prostate
(prostatitis). In fact, bacteria from the prostate can lead to recurrent
urinary tract infections in men. For infants and children, UTIs can be associated
with particularly narrow urinary tracts, or with a condition where the urine
is pushed back up into the kidneys.
In elderly people, UTIs are often due to problems with bladder emptying
or bowel incontinence. The urine that's left behind contains bacteria that
can easily spread to the bladder. Conditions that prevent complete emptying
of the bladder include urinary tract blockages, kidney stones, neurologic diseases
(such as stroke or spinal cord injury), and having an inserted catheter, as
in the case of hospitalized patients.
On very rare occasions, UTIs can be caused by bacteria that have spread from
infections elsewhere in the body.
Symptoms
Common UTI symptoms may include:
- pain or burning during urination
- frequent desire to urinate, often urgently and immediately
- unusual discharge from the urethra
- urine that looks cloudy or smells foul
- pressure in the lower pelvis
- fever, with or without chills
- bedwetting in a person who has normally been dry at night
- nausea and vomiting
Bladder infections (cystitis) often result in urine that's dark and
cloudy. In addition to the above symptoms, bacterial prostatitis (infection
of a man's prostate gland) can also cause fever, chills, low back pain, and
discomfort or pain around the anus or perineal region. In some cases, a kidney
infection (pyelonephritis) can follow a bladder infection by a couple
of days, causing abdominal pain, flank pain, nausea, vomiting, fever, and chills.
In infants or children, UTIs can cause symptoms such as vomiting or fever and
prevent normal weight gain.
Elderly people don't necessarily have symptoms that are common to UTIs. Instead,
they often have gastrointestinal symptoms including changes in eating habits,
or mental signs like confusion. People with catheters or neurologic disorders
might only complain of side pains and a fever.
Sometimes, there are large amounts of bacteria in the urine but no obvious
symptoms of UTIs. This is known as asymptomatic bacteriuria and it's
common in elderly people. Pregnant women and kidney transplant patients may
also develop this type of infection.
Symptomatic abacteriuria is the opposite: people have UTI symptoms,
but bacteria levels in the urine are low. Even with very little bacteria present,
a UTI can still be diagnosed.
Treatment
Elderly people with asymptomatic bacteriuria usually don't require treatment.
For most UTIs, three days to a week of antibiotics are the best treatment.
Your doctor will help decide how long treatment should last. To prevent
the infection from returning, it's important to take all of your medication
until the end of the prescribed period. Pain relievers can help ease the burning
that occurs when you urinate.
Very serious infections - such as a severe kidney infection - may require an
intravenous drip of antibiotics. Aside from standard antibiotic treatment, children
with UTIs may be checked for urinary tract abnormalities.
Treatment for prostatitis often lasts for 6 to 12 weeks. If the infection returns
after that, long-term antibiotic therapy may be an option.
In women, recurring UTIs are usually caused by new bacterial infections.
If you get three or more UTIs within one year, your doctor may recommend preventative
medication to be taken daily or after sexual intercourse. During pregnancy,
women are routinely screened for bacteria in their urine. Prompt treatment of
UTIs is important. Up to a third of untreated cases lead to kidney infections,
which can cause premature labour and low birth-weight babies.
Some strategies for preventing UTIs are:
- urinating immediately after intercourse to clear out any bacteria that may
have entered
- giving up the diaphragm and choosing other birth control measures
- good toilet habits: women should wipe from front to back, to prevent bacteria
spread from the anus
- drinking plenty of fluids to flush bacteria out from the bladder
- not holding in urine for long periods, as this gives bacteria more opportunity
to multiply in the bladder
- taking showers rather than tub baths
- washing the skin around the vagina and anus daily
- not using deodorant sprays or feminine products such as douches in the genital
area that could irritate the urethra
While waiting for the effects of the antibiotics to take place, drink plenty
of fluids to ease your discomfort, but avoid anything that can irritate the
bladder, such as coffee, alcohol, soft drinks with caffeine, citrus juices,
and spicy foods, until the infection has cleared.
Other tips:
Your doctor will consider the symptoms and do a urinalysis. You'll
be asked to give a sample of your urine which will be sent to the lab to check
for a bacterial infection. You shouldn't collect the first bit of urine that
comes out: it already contains bacteria that are normally found on your skin.
Wait until mid-stream to start collecting the sample.
Prostatitis is identified by examining the rectum to see if the prostate
gland is swollen and painful. Samples of urine and of discharge from the
urethra are sent to the lab to check for infection.
Recurring UTIs might have an underlying cause, and your urinary tract will
need to be checked. Ultrasound or intravenous pyelogram are tests that
provide a visual image of the urinary tract, revealing any structural abnormalities.
© MediResource Inc. Terms and conditions of use: The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.