Urinary Tract Infection (UTI)

More than 4 million doctor office visits per year in the United States are for urinary tract infections (UTI). About 12% of men and 50% of women will have a UTI during his or her lifetime. A UTI occurs when bacteria, such as E. coli found in the lower intestine, ascend into the urethra or bladder. A recurrent UTI is classified as three or more a year.

Risk Factors for UTI

Several factors can contribute to the risk of UTI. Sexual intercourse, use of contraceptive spermicide, low levels of estrogen, catheterization, diabetes, pregnancy, and immune suppression increase susceptibility to UTI.

Naturally occurring estrogen helps prevent recurrent UTI in women. After menopause, estrogen levels drop along with the number of vaginal lactobacilli, the “good bacteria” which prevent growth of intestinal bacteria in the vagina. This makes postmenopausal women especially susceptible to UTI.

Catheters also present a risk of recurring UTI. Catheters are associated with colonization of bacteria and increased risks of clinical infection. Using the techniques described previously can help keep catheters clean and prevent recurrent UTI. While single-use of sterile catheters reduces the risks, it does not prevent UTI from occurring. It is therefore important to maintain proper care and use of catheters at all times while remaining alert to symptoms of UTI.

Common Symptoms of UTI

• Painful urination
• Frequency and urgency of urination
• Lower abdominal or pelvic pain or pressure
• Blood in the urine
• Fever

The elderly may exhibit none of these symptoms early in the course of a UTI, but instead may only exhibit confusion, feelings of general discomfort, and/or a new, acute incontinence. If you experience any of these symptoms, see your healthcare professional.

Prevention of UTI

• The use of cranberry products seems to decrease the ability of bacteria to adhere to the lining of the urethra and bladder. As cranberry juice can have a high amount of sugar, cranberry extract can be taken in capsule or pill form instead.
• Contraceptive spermicide use doubles the risk of UTI. Use another form of contraception to decrease your chance of UTI.
• Vaginal estrogen use reduces risk of recurrent UTI by repopulating the normal vaginal lactobacilli that keep bacteria from the rectum from multiplying and causing a bladder infection. Forms of vaginal estrogen are available at very low dosages that have minimal systemic absorption.
• Prophylactic antibiotic use reduces risk of recurrent UTI by about 85%. In women who have sexually associated UTI, antibiotic use after sexual activity is effective.
• A “closed system” catheter provides a reliable means of sterile IC because the introducer tip is surrounded by a urine collection bag and never exposed to bacteria typically found at the urethral opening. This greatly reduces the risk of infection.
NOTE: Vaginal estrogens and antibiotics are medications that need to be prescribed by your healthcare provider.

Treatment of UTI

Depending on the severity of infection, UTI can be treated with oral antibiotics. A three-day course of antibiotics can treat a simple UTI. However, some infections may need to be treated for several days or weeks. Length of antibiotic treatment also depends on the type of antibiotic prescribed.

Even if a few doses of medication relieve some symptoms, you should still complete the full course of medication prescribed by your doctor.

In addition to signs and symptoms of UTI, call your healthcare provider immediately if these other warning signs are present with catheterization:
• Inability to catheterize due to pain
• Fever above 100 degrees Fahrenheit
• Back pain in the area of the kidneys around your lower rib cage
• A sudden onset of urine leakage between catheterizations
• Cloudy, foul-smelling, or bloody urine (like cranberry juice)
• Sudden feeling of lethargy and/or forgetfulness