From Dr. Theo’s Desk

Symptoms of UTI

Have you ever experienced pain or a burning sensation while passing urine? And which comes with a desire to urinate often, but not much urine comes out when you finally go to the bathroom?

In addition, your lower belly feels painful or heavy, your urine is cloudy, yellowish or smells bad, you have pain on the sides of your back under your ribs (where your kidneys are), you have fever, nausea and/or vomiting?

Well, these are symptoms of a urinary tract infection or UTI which is a common infection in women. The urinary tract is the body’s filtering system for removal of liquid waste and consists of the kidneys, bladder, ureters, and urethra. Normal urine is sterile and contains no bacteria. However, bacteria may get into the urine from the urethra and travel into the bladder.

What causes UTI?

A UTI is an infection that occurs when bacteria invade the urinary tract system and multiply. When the UTI affects the bladder it is called cystitis or a bladder infection. When it affects the urethra (the tube that empties urine from the bladder to the outside), it is called urethritis. A kidney infection on the other hand is known as pyelonephritis.

Most urinary tract infections are bladder infections. A bladder infection usually is not serious if it is treated right away. Kidney infections are much less common but often more serious than bladder infections. Women tend to get more UTIs than men. They are particularly susceptible to UTI because they have shorter urethras, so it is easier for the germs to move up to their bladders. What causes urinary tract infections? Bacteria that enter the urethra and travel up the urinary tract are the usual cause of urinary tract infections (UTIs).

Common causes of UTIs

Bacteria from the bowel

The most common cause of UTIs are bacteria from the bowel (large intestine) that live on the skin near the rectum or in the vagina, which can spread and enter the urinary tract through the urethra.

Catheters

Catheters, which are small, flexible tubes inserted into the bladder to allow urine to drain, are a common source of bacterial infection in people who are in hospitals.

Sexual intercourse

Sexual intercourse may move bacteria into the urinary tract in women, causing UTI. Although some women find that they develop UTI after having sex, UTIs are not sexually transmitted infections (STIs) but irritation from having sex can sometimes trigger a UTI as it makes it easier for bacteria from the vaginal area to get massaged into the urethra.

Other causes

You may be more likely to get an infection if you do not drink enough fluids, you have diabetes, or you are pregnant. Another cause of UTI is waiting too long to urinate. Waiting too long past the time you first feel the need to urinate can cause the bladder to stretch beyond its capacity. Over time, this can weaken the bladder muscle. When the bladder is weakened, it may not empty completely and some urine is left in the bladder. This may increase the risk of urinary tract infections or bladder infections.

Other factors that increase the risk of getting a UTI

• Surgery or other procedure involving the urinary tract

• Antibiotic use changes the vaginal flora and promotes colonisation of the genital tract with E. coli bacteria, resulting in subsequent increased risk of UTI

• Menopause. As a woman’s estrogen levels decrease with menopause, her risk of urinary tract infections increases due to the loss of protective vaginal flora.

• Kidney stones, bladder stones and structural problems in the urinary tract can contribute to UTIs by blocking the flow of urine from the bladder

• Neurological conditions such as spinal cord injury.

• Structural bladder disease including bladder tumors

• Reduced immunity as in HIV

What are the symptoms of UTI?

The symptoms of a bladder infection include:

• A strong, persistent urge to urinate often, even right after the bladder has been emptied, in the absence of vaginal discharge

• Frequent passing of only small amounts of urine

• A burning sensation or pain when urinating

• Cloudy or bloody urine, which may have a foul or strong odor

• Pressure or cramping in the lower abdomen or back

• Urinary incontinence

• Nausea and vomiting

• Fever and chills. If the infection spreads to your kidneys, symptoms may include, chills and shaking or night sweats, fatigue and a general ill feeling, high fever, pain in the side, back, or groin, mental changes or confusion, (especially in the elderly), nausea and vomiting.

The symptoms are worse in those with diabetes, kidney problems, or a weak immune system, those older than 65 years or those pregnant.

How are urinary tract infections diagnosed?

Urine tests

Urinalysis is done to look for signs of bacteria or blood in the urine. This test can diagnose an infection most of the time. Urine culture may also be done to identify the actual bacteria and determine the best antibiotic for treatment.

Blood tests

The doctor may order some blood tests such as haemogram and a blood culture to be done as well.

Pelvic and kidney scans

One may also have pelvic and kidney scans (ultrasound, CT scan) to help rule out other problems in your urinary system like renal stones.

Treatment of urinary tract infections

Your health care provider must first decide if the infection is just in the bladder or has spread to the kidneys and how severe it is. Antibiotics prescribed by your doctor will usually cure a bladder infection. It may help to drink lots of water and other fluids and to urinate often, emptying your bladder each time.

Pyelonephritis (kidney infection) is treated more aggressively than a simple bladder infection using either a longer course of oral antibiotics or intravenous antibiotics. Hospital admission may be necessary in cases of more severe infections.

 Complications of severe Urinary Tract Infections

• Pyelonephritis

• Renal abscess

• Hydronephrosis or pyonephrosis

• kidney failure

NB: Men with UTI may also have infection of the prostate or prostate enlargement.

Ways to prevent Urinary Tract Infections

1. Drink plenty of water daily as it helps flush your urinary tract. Drink at least six to eight glasses of water every day. If your urine is dark yellow or brown, you are not drinking enough water.

2. Don’t hold it when you need to urinate! Urinate often. Go to the bathroom whenever you feel the urge, and empty your bladder completely each time. You may be tempted to resist the urge to urinate, if you are too busy, but remember the longer urine sits in your bladder, the more likely it is to stagnate and allow bacteria to grow.

3.Always wipe from front to back after a bowel movement. This is especially important to help prevent bacteria from the anus from entering the vagina or urethra.

4. Taking showers instead of baths helps prevent bacteria from entering the urethra and causing a UTI. A bath may be relaxing but sitting in a tub of water gives bacteria an opportunity to enter your urethra.

5.Always wash your genital area both before and after sexual intercourse to help prevent transferring bacteria to the urethra or vaginal area, which can create a breeding ground for a UTI.

6. Urinate before and after sex.

7. Feminine hygiene sprays and douches, particularly scented douches, can irritate the urethra and possibly lead to a UTI. Avoiding these products will help prevent not only urinary tract infections, but also other infections and irritations that these products may cause.

If your skin is sensitive, keep powders, soaps, cream bath oils and gels, and other hygiene products away from your genital area. Scented douches and feminine hygiene sprays may smell nice, but they can also irritate the urethra.

8. Postmenopausal women may want to ask their doctors about using vaginal estrogen cream around the vagina to reduce recurrent urine infections

9. Cotton panties help to prevent moisture accumulating from sweating etc. Accumulated moisture can create a potential breeding ground for bacteria. Try wearing cotton panties instead nylon or silk. Also, avoid tight pants, instead, wear thigh high stockings rather than pantyhose. Try and avoid tampons or change them often if you do use them.