A urinary tract infection (UTI) is an infection in any part of the urinary system. The urinary system includes the kidneys, ureters, bladder and urethra. Most infections involve the lower urinary tract — the bladder and the urethra.
Women are at greater risk of developing a UTI than are men. If an infection is limited to the bladder, it can be painful and annoying. But serious health problems can result if a UTI spreads to the kidneys.
Health care providers often treat urinary tract infections with antibiotics. You can also take steps to lower the chance of getting a UTI in the first place.
UTIs don’t always cause symptoms. When they do, they may include:
- A strong urge to urinate that doesn’t go away
- A burning feeling when urinating
- Urinating often, and passing small amounts of urine
- Urine that looks cloudy
- Urine that appears red, bright pink or cola-colored — signs of blood in the urine
- Strong-smelling urine
- Pelvic pain, in women — especially in the center of the pelvis and around the area of the pubic bone
UTIs typically occur when bacteria enter the urinary tract through the urethra and begin to spread in the bladder. The urinary system is designed to keep out bacteria. But the defenses sometimes fail. When that happens, bacteria may take hold and grow into a full-blown infection in the urinary tract.
The most common UTIs occur mainly in women and affect the bladder and urethra.
- Infection of the bladder. This type of UTI is usually caused by Escherichia coli (E. coli). E. coli is a type of bacteria commonly found in the gastrointestinal (GI) tract. But sometimes other bacteria are the cause.Having sex also may lead to a bladder infection, but you don’t have to be sexually active to develop one. All women are at risk of bladder infections because of their anatomy. In women, the urethra is close to the anus. And the urethral opening is close to the bladder. This makes it easier for bacteria around the anus to enter the urethra and to travel to the bladder.
- Infection of the urethra. This type of UTI can happen when GI bacteria spread from the anus to the urethra. An infection of the urethra can also be caused by sexually transmitted infections. They include herpes, gonorrhea, chlamydia and mycoplasma. This can happen because women’s urethras are close to the vagina.
UTIs are common in women. Many women experience more than one UTI during their lifetimes.
Risk factors for UTIs that are specific to women include:
- Female anatomy. Women have a shorter urethra than men do. As a result, there’s less distance for bacteria to travel to reach the bladder.
- Sexual activity. Being sexually active tends to lead to more UTIs. Having a new sexual partner also increases risk.
- Certain types of birth control. Using diaphragms for birth control may increase the risk of UTIs. Using spermicidal agents also can increase risk.
- Menopause. After menopause, a decline in circulating estrogen causes changes in the urinary tract. The changes can increase the risk of UTIs.
Other risk factors for UTIs include:
- Urinary tract problems. Babies born with problems with their urinary tracts may have trouble urinating. Urine can back up in the urethra, which can cause UTIs.
- Blockages in the urinary tract. Kidney stones or an enlarged prostate can trap urine in the bladder. As a result, risk of UTIs is higher.
- A suppressed immune system. Diabetes and other diseases can impair the immune system — the body’s defense against germs. This can increase the risk of UTIs.
- Catheter use. People who can’t urinate on their own often must use a tube, called a catheter, to urinate. Using a catheter increases the risk of UTIs. Catheters may be used by people who are in the hospital. They may also be used by people who have neurological problems that make it difficult to control urination or who are paralyzed.
- A recent urinary procedure. Urinary surgery or an exam of your urinary tract that involves medical instruments can both increase the risk of developing a UTI.
When treated promptly and properly, lower urinary tract infections rarely lead to complications. But left untreated, UTIs can cause serious health problems.
Complications of a UTI may include:
- Repeated infections, which means you have two or more UTIs within six months or three or more within a year. Women are especially prone to having repeated infections.
- Permanent kidney damage from a kidney infection due to an untreated UTI.
- Delivering a low birth weight or premature infant when a UTI occurs during pregnancy.
- A narrowed urethra in men from having repeated infections of the urethra.
- Sepsis, a potentially life-threatening complication of an infection. This is a risk especially if the infection travels up the urinary tract to the kidneys.
These steps may help lower the risk of UTIs:
- Drink plenty of liquids, especially water. Drinking water helps dilute the urine. That leads to urinating more often — allowing bacteria to be flushed from the urinary tract before an infection can begin.
- Try cranberry juice. Studies that look into whether cranberry juice prevents UTIs aren’t final. However, drinking cranberry juice is likely not harmful.
- Wipe from front to back. Do this after urinating and after a bowel movement. It helps prevent the spread of bacteria from the anus to the vagina and urethra.
- Empty your bladder soon after having sex. Also drink a full glass of water to help flush bacteria.
- Avoid potentially irritating feminine products. Using them in the genital area can irritate the urethra. These products include deodorant sprays, douches and powders.
- Change your birth control method. Diaphragms, unlubricated condoms or condoms treated with spermicide can contribute to bacterial growth.
URINARY TRACT INFECTIONS
Urinary tract infection is very common in children, but in the vast majority of the cases it is mild and easily treated. Infections of the urinary tract may appear as a variety of disorders. These infections may be broadly classified as upper and lower urinary tract infections depending on the patients presenting symptoms. Lower urinary tract infections involve the urinary bladder (cystitis), urethra (urethritis) and prostate gland (prostatitis). Upper urinary tract infections may involve the kidney and renal pelvis (pyelonephritis).
Urinary tract infection is the presence of organisms in the urinary tract which is usually sterile.
Bacteria such as:
Candida (usually associated with catheterization)
Female sex: Females have a shorter urethra than males. In addition, the female urethra is in close proximity to the vagina and anal area. This can easily cause infections of the vagina and anal areas to ascend to the urethra.
Instrumentation, for example, catheterization or diagnostic procedures: In both procedures sterility can be lost leading to introduction of infection in to the urinary tract.
Failure or delay inemptying the bladder completely: Regular emptying of the bladder helps to keep the urinary tract sterile by flushing away bacteria. Holding urine promotes bacteria growth.
Anatomical abnormality of the urinary tract:These can be congenital or acquired. For example, bladder diverticulum (a pouch or sac protruding from the wall of a tube or hollow organ), cystocele or urethral stricture. These do not allow urine to leave the body normally or may cause backward flow of urine.
Vesicoureteric reflux: Reflux of urine into the ureters or kidney during micturition is abnormal and can predispose to urinary tract infection or can cause infection to ascend to the kidneys much more easily.
Chronic diseases such as diabetes mellitus: Sugar is a good media for micro-organisms. In addition, diabetes mellitus lowers an individual’s immunity making him susceptible to contracting infections.
Kidney stones: Special enzyme secreting bacteria that eliminate the ammonia level found in urine may cause urinary tract infections leading to kidney stones. The presence of stones anywhere in the urinary tract makes infection more likely, and also renders it much harder to eliminate.
Inadequate fluid intake:This makes urine concentrated, increases irritation and burning, and causes stasis of urine which promotes multiplication of bacteria in the urinary tract.
Chronic constipation: When the bowel is full of hard stool, it presses against the bladder neck, blocking the flow of urine and allowing bacteria to grow.
In normal circumstances urine produced in the kidneys flows through the urinary tract without obstruction. Urine reaches the urethra as a sterile unit. Most urinary tract infections result from gram negative organisms, such as E. coli, klebsiella, Proteus or pseudomonas that originate in the person’s own intestinal tract and ascend through the urethra to the bladder. During micturition urine may flow back to the ureters (vesicoureteral reflux) and carry bacteria from the bladder up through the ureters to the kidney pelvis. Whenever urinary stasis occurs, such as with incomplete emptying of the bladder, renal calculi or genitourinary obstructions, the bacteria have greater a opportunity to grow. Urinary stasis also promotes more alkaline urine which facilitates bacterial growth.
Frequency because of incomplete emptying of the bladder.
Urgencybecause of the presence of inflammation.
Dysuria as a result of urethritis
Cloudy or foul-smelling urine due to progression of the infection.
Suprapubic discomfort due to irritation of urine to the mucous lining of the bladder.
Haematuria as a result of inflammation of the bladder and urethra.
Bacteriuria because of the presence of infection.
Upper urinary tract infections and pyelonephritis are associated with
Fever because of the presence of infection.
Flank pain because of the spread of infection to the kidneys.
Nausea vomiting because of the presence of toxins that irritate the gastro-intestinal tract.
Urine microscopy, culture and sensitivity to isolate the causative organism and for specific antibiotics.
In advanced cases, ultra sound scans. This is very helpful in acute pyelonephritis to exclude obstruction.
Intravenous urography (IVU) to exclude the possibility of a functional or structural abnormality of the kidneys or urinary tract.
Cysto-urethroscopy to exclude problems or infections of the bladder and urethra.
Antibiotics are given according to the culture and sensitivity results. For example, Cefotaxine 50mg/kg bwt six hourly for 7-14 days to combat infection.
Ceftriaxone 50mg/kg bwt 12 hourly for 7-14 days.
Ampicillin 50mg/kg bwt six hourly and gentamycin 5mg/kg bwt for 7-14 days.
Paracetamol 100-250mg tds for 3-5 days to relieve pain, lower the fever and suppress inflammation.
Propantheline bromide 15 mg/kgbwt to decrease bladder spasms. Administer the drug one hour before meals.
Increasing fluid intake unless contra-indicated. Increased fluid intake helps to dilute the urine, lessens irritation and burning, and provides a continued flow of urine to minimize stasis and multiplication of bacteria in the urinary tract.
Sitz baths may provide comfort for the individual urethritis.
Regular intake of vitamin C to reduce bacterial growth due to ascorbic acid.
Lemon juice may be provided to increase ascorbic acidity thereby preventing growth of bacteria.
Educate the patient and community o the symptoms of urinary tract infections and the need for prompt medical attention when symptoms occur.
Educate on the need to complete treatment even if symptoms subside to ensure complete eradication of the infection.
Maintenance of fluid intake to help flush bacteria out of the urinary tract.
Educate on the need to avoid bubble bath, powders and strong soaps in the perineal area as these may cause irritation and promote growth of bacteria.
Educate on the need to wear cotton pants as nylon and synthetic materials do not allow ventilation and may facilitate bacterial growth.
Advise to avoid wearing tight fitting pants that may irritate the urethra.
For women, educate on the importance of wiping the perineal area from front to back to prevent introducing bacteria into the urethra.
Educate on the need to have a shower bath for patients with recurrent urinary tract infections.
Educate on the need to avoid urinary stasis by voiding approximately every 2-4 hours.
Educate on the need for regular intake of vitamin C or lemon juice to prevent urinary tract infections.
Complications of urinary tract infections
Permanent kidney damage due to untreated urinary tract infections.
Pyelonephritis due to severity of the infection and this can result in damage and scaring of the kidney tissues.
Urethritis which can lead to stricture and damage of the urethra.
Kidney stones: Special enzyme secreting bacteria that eliminate the ammonia level found in urine may cause urinary tract infections leading to kidney stones.
Chronic renal failure due to progress of the infection.
Urinary tract infection is one of the commonly diagnosed bacterial infections in children.When treated promptly, urinary tract infection rarely leads to complications, but if left untreated or if not treated promptly, it can lead to serious complications.