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Urinary Tract Infection (UTI)

Urinary Tract Infections

 

Urinary tract infections (UTI) occur when bacteria enter the urinary tract and multiply. These infections typically develop in the lower urinary tract (urethra and bladder) before progressing to the upper urinary tract (ureters and kidneys) if they remain untreated. Bladder infections (cystitis) are the most common form of urinary tract infections. Women are four times more likely than men to develop a UTI. UTI’s can be uncomplicated/simple (common bacteria, normal anatomy) or complicated/complex (abnormal anatomy, recurrent UTI, highly resistant bacteria etc).

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E. coli is the most common bacterial cause of UTIs. Other bacteria and microorganisms can also cause UTIs. Men and women infected with some sexually transmitted diseases can transmit microorganisms to their partner during sexual intercourse, causing a UTI.

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Symptoms

 

Symptoms of Lower Urinary Tract Infections May Include:

 

  • ​Frequent urination 

  • Painful urination

  • Sudden urge to urinate

  • Difficulty emptying

  • Blood in the urine

  • Cloudy urine

  • Inability to urinate

  • Pelvic discomfort

  • Back pain

  • General sense of not feeling well.

 

Symptoms of Upper Urinary Tract Infections May Include:

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  • Chills

  • High fever

  • Nausea/Vomiting

  • Pain below the ribs

 

Symptoms of UTIs occur differently in individuals depending on their age and the form of infection. Elderly patients may exhibit change in mental status or behavior, increased incontinence or changed voiding patterns.

 

 

Diagnosis

 

A simple UTI can be diagnosed with symptoms and a positive dipstick. A dipstick + for leukocyte esterase is fairly reliable. Dipstick + for nitrite is <50% sensitive because many bacteria do not produce it. Most clinicians use cultures with a cut off of >100,000 colony forming units (CFU) as a standard for infection diagnosis. The diagnosis of UTI is being reevaluated, please see my page on recurrent UTI for discussion.

 

 

Treatment

 

Simple UTI’s can be treated with a short course of antibiotics. First line treatment for simple UTI’s include antibiotics like nitrofurantoin, TMP-SMX, or Fosfomycin. Symptomatic recurrent UTI’s can be treated with a short course of antibiotic, usually no more than 7 days.

 

To help with symptoms you can stay hydrated with water, avoid bladder irritants (caffeine, soda, acidic foods, spicy foods etc), and apply a heating pad to your lower abdomen.

 

 

Risk Factors

 

  • Incomplete bladder emptying

  • Sexual activity

  • Congenital or acquired urinary tract abnormalities

  • Suppressed immune systems (diabetes, steroid use etc.)

  • Increased adherence: genetic factors can make it easier for bacteria to attach to the lining of the urinary tract and some bacteria are more adept at sticking to the lining

  • Bladder outlet obstructions, including, kidney stones or BPH

  • Urinary catheterization

  • Use of spermicide

  • Menopause

  • Neurologic disease that affects the bladder (stroke, MS, spinal cord injury, Parkinson’s disease etc.)

 

 

 

Prevention

 

  • Change soiled diapers promptly

  • Drink lots of water

  • Urinate after sexual intercourse

  • Vaginal estrogen if you are post menopause

  • Natural treatments including proanthocyanidins (PAC) may help prevent recurrent UTI

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