Urinary Tract Infection

One the most common infections - especially among women - is an infection of the urinary tract. About 40% of women develop a urinary tract infection (UTI) at some point in their life. The condition is uncommon in boys and young men. Serious consequences can occur if a urinary tract infection affects the kidneys. Infections of the urinary tract are usually treated with antibiotics.

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What is UTI?

Urinary tract infection (UTI) is an infection that affects any part of the urinary system, which comprises the kidneys, ureters, bladder and urethra. Bladder infection, or cystitis, is the most common type of UTI. If the infection affects the kidney, it is called pyelonephritis, which is more serious.

Women are especially prone to UTI, owing to the shortness of the female urethra, which is closer to the anus than men’s. In addition, women are at particular risk of recurrent UTIs after menopause because of decreased levels of oestrogen, which reduces the number of lactobacilli, the “friendly” bacteria that inhabit the vagina of fertile women and prevent other bacteria from invading the urethra. Also, after menopause, the mucous lining of the urinary tract becomes thinner, reducing its ability to resist bacteria invasion. In Singapore, about four percent of young adult females are affected. The incidence rises with age to seven percent at 50 years. During the first six months of life, UTIs are more common in boys because more males are born with structural abnormalities of the urinary tract. Thereafter, UTIs are more common in females.

Urine is normally sterile. Infection occurs when microorganisms (usually bacteria from the gut) attach themselves to the urethra and begin to multiply. The infection may remain in the lower urinary tract (urethra and bladder) or it may move higher to the kidneys. UTI may also be transmitted sexually.

UTI Causes and Risk Factors 

Cystitis is caused by bacteria which enter the urethra and bladder and cause inflammation. Over 90 percent of cases of cystitis are caused by E. coli, a bacterium normally found in the intestine. Cystitis occurs in two percent of people, mostly women.

Normally, the urethra and bladder have no bacteria. Bacteria that manage to enter the bladder are usually excreted during urination. But if they remain in the bladder, they grow easily and quickly and result in infection.

Other risk factors for cystitis include:
Obstruction of the bladder or urethra, which results in trapped urine
Insertion of instruments into the urinary tract (such as catheterisation or cystoscopy)
Pregnancy
The presence of an underlying medical condition such as diabetes, analgesic nephropathy or reflux nephropathy
Sexual intercourse, which can increase the risk of cystitis in women because bacteria can enter the bladder through the urethra
Age — older people are at increased risk of developing cystitis due to incomplete emptying of the bladder associated with such conditions as benign prostatic hyperplasia (BPH), prostatitis, and urethral strictures
Lack of adequate fluids
Bowel incontinence
Urinary stasis (trapping of the urine) brought about by immobility or prolonged bed rest

UTI Symptoms

The following are UTI infection symptoms in men and women :
Painful urination (burning sensation)
Hot and foul-smelling urine
Blood in urine; milky/cloudy urine
Fever (sometimes with chills)
Painful lower abdomen
Increased frequency of wanting to pass urine
Nausea and/or vomiting
Back pain (pyelonephritis or kidney infection)

Additional symptoms that may be associated with this disease:
Painful sexual intercourse
Penile pain
Flank pain
Fatigue
Vomiting
Mental changes or confusion (often the only sign of a possible urinary tract infection for elderly person)

UTI Complications 

If cystitis is not successfully treated, the infection may move upwards causing kidney damage. Bacteria may also enter the bloodstream and this can cause a serious blood infection called septicaemia.

UTI Screening and Diagnosis 

The first test to diagnose UTI is a urine sample analysis, which looks for the presence of nitrites and white blood cells. However, a urine culture to identify the bacteria is needed to confirm the diagnosis.

Urinary tract infections in certain groups, such as young children and adult men, may require special methods of investigation.

UTI Treatment

Mild cases of acute cystitis may disappear spontaneously without treatment. However, because of the risk of the infection spreading to the kidneys (complicated UTI), treatment is usually recommended. Also, prompt treatment is recommended for the elderly due to the high mortality rate in this group.

Antibiotics may be used to control the bacterial infection. The choice of drug and length of treatment is determined by  the patient's history and the urine tests that identify the offending bacteria. It is imperative that the patient finishes the entire course of prescribed antibiotics. Commonly-used antibiotics include:
Nitrofurantoin
Sulfa drugs (sulfonamides)
Amoxicillin
Cephalosporins
Trimethoprim-sulfamethoxazole
Doxycycline

For infection that has spread to the kidneys, stronger antibiotics given intravenously may be needed.

Chronic or recurrent UTI should be treated thoroughly because of the chance of kidney infection. Once the acute symptoms have subsided, low-dose antibiotics to be taken at night may be recommended. In chronic UTI, antibiotics may need to be given for as long as six months to two years.

Follow-up measures may include urine cultures to ensure that bacteria are no longer present in the bladder. Appropriate hygiene and cleanliness of the genital area may help reduce the chances of introducing bacteria through the urethra.

UTI Prevention

Preventive measures include:
Drinking plenty of water daily
Drinking cranberry juice (or taking vitamin C supplements) to acidify the urine
Urinating immediately when there is an urge
Wiping from front to back after defecation to prevent contamination from the anus
Cleansing the genital area after intercourse
Avoiding fluids that irritate the bladder, such as alcohol, citrus juices and caffeine
Avoiding scented douches

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