Urinary Tract Infection (UTI)(2)

(Continued from last week)

What causes Urinary Tract Infection?
NORMAL urine is sterile. It contains fluids, salts,
and waste products, but it is free of infection agents such as bacteria, viruses, and fungi. An infection occurs when micro-organisms, usually bacteria from the digestive tract, cling to the opening of the urethra and begin to multiply. Most infections arise from one type of bacteria, Escherichia coli (E. coli), which normally live in the colon. In most cases, bacteria first begin to grow in the urethra. An infection limited to the urethra is called urethritis. From there bacteria often move on to the bladder, causing a bladder infection (cystitis). If the infection is not treated promptly, bacteria may then go up the ureters to infect the kidneys (pyelonephritis). Sexually transmitted micro-organisms may cause UTI but the organisms are limited to the urethra and the reproductive tract.

Who is at risk of developing UTI?
Women have more urinary infections than men. One factor may be that a woman’s urethra is short, allowing bacteria quick access to the bladder. Also, a woman’s urethral opening is near sources of bacteria from the anus and vagina. For many women, sexual intercourse seems to trigger an infection, although the reasons for this linkage are unclear. Women who use a diaphragm (as birth control) are more likely to develop a UTI than women who use other forms of birth control. When a UTI does occur in pregnancy, it is more likely to travel to the kidneys.

A common source of infection is catheters placed in the bladder in the hospital. A person who cannot void, is unconscious, or is critically ill, often needs a catheter that stays in place for a long time. People with diabetes have a higher risk of a UTI because of changes in the immune system.

Finally, UTIs may occur in infants who are born with abnormalities of the urinary tract that sometimes need to be corrected with surgery.

What are the symptoms of UTIs?
Not everyone with a UTI has symptoms, but most people get at least some. These may include a frequent urge to urinate and a painful, burning feeling in the area of the bladder or urethra during urination. Often, women feel an uncomfortable pressure above the pubic bone, and some men experience fullness in the rectum. It is common for a person with a urinary infection to complain that, despite the urge to urinate, only a small amount of urine is passed. The urine itself may look milky or cloudy, even reddish if blood is present. A fever may mean that the infection has reached the kidneys. Other symptoms of a kidney infection include pain in the back or side below the ribs, nausea, and vomiting.

In children, symptoms of a urinary infection may be overlooked or attributed to another disorder. A UTI should be considered when a child or infant seems irritable, is not eating normally, has an unexplained fever that does not go away, has incontinence or loose bowels, or is not thriving. The child should be seen by a doctor, especially if there is a change in the child’s urinary pattern.

How is UTI diagnosed?
To find out whether you have a UTI, your doctor will test a sample of your urine for pus and bacteria. Then the bacteria are grown in a culture and tested against different antibiotics to see which drug best destroys the bacteria. This last step is called a sensitivity test.

When an infection does not clear up with treatment and is traced to the same strain of bacteria, the doctor will order a test that makes images of the urinary tract. Other investigations may be requested as appropriate by the doctor.

What are the treatment options for UTI?
UTIs are treated with anti-bacterial drugs. The choice of drug and length of treatment depends on the patient’s history and the urine tests that identify the offending bacteria. An uncomplicated UTI can be cured within a week of treatment. Kidney infections generally require several weeks of antibiotic treatment. Severely ill patients with kidney infections as may be hospitalised until they can take fluids and needed drugs on their own.

Curing complicated UTI that stems from a urinary obstruction or nervous system disorder depends on finding and correcting the underlying problem, sometimes with surgery. If the root cause goes untreated, these groups of patients are at risk of kidney damage.

Prostate infections (prostatitis) are harder to cure because antibiotics are unable to penetrate infected prostate tissue effectively. For this reason, men with prostatitis often need long-term treatment with a carefully selected antibiotic.

A pregnant woman who develops a UTI should be treated promptly to avoid premature delivery of her baby and other risks such as high blood pressure.

Some antibiotics are not safe to take during pregnancy. In selecting the best treatments, doctors consider various factors such as the drug’s effectiveness, the stage of pregnancy, the mother’s health, and potential effects on the foetus.

Most doctors suggest that drinking plenty of water helps cleanse the urinary tract of bacteria. It is best to avoid smoking, coffee, alcohol, and spicy foods. Some additional steps that a woman can take to avoid an infection are:

•Drink plenty of water everyday. Some doctors suggest taking Vitamin C supplements which inhibit the growth of some bacteria by acidifying the urine;
•Urinate when you feel the need; don’t resist the urge to urinate;
•Wipe from front to back to prevent bacteria around the anus from entering the vagina or urethra;
•Take showers instead of tub baths;
•Cleanse the genital area before sexual intercourse.