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. Most UTIs arise from bacteria that normally live in the colon and rectum and are present in bowel movements. These bacteria cling to the opening of the urethra, begin to multiply, & travel up to the bladder. Urine flow from the bladder usually washes bacteria out of the body. However, because women have a shorter urethra than men, bacteria can reach the bladder more easily and settle into the bladder wall. This is why women are more likely to develop UTIs than men. This risk factor is exacerbated by the greater likelihood that women introduce bacteria from fecal matter, following a bowel movement, into the urinary tract. Less often, bacteria can spread to the kidney from the bloodstream. 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

• Urgency

• Lower abdominal or pelvic pain or pressure

• Blood in the urine

• Milky, cloudy, or pink/red urine

• Fever

• Strong smelling urine

In the elderly populations, symptoms of a urinary tract infection, can be easily overlooked, causing a delay in diagnosis. Elderly people with a UTI are more likely than younger people not to be diagnosed until the complication of sepsis occurs. The elderly often do not experience or report obvious symptoms that younger people have, such as difficult urination, or frequent urination. Instead they may exhibit far more vague symptoms that are similiar to many disease or may be assumed to be due to the aging process. These symptoms include: confusion, feelings of general discomfort, disorientation, fatigue, weakness, behavior changes, falling, and/or a new, acute incontinence. In addition, because incontinence is common in the elderly, they may not be aware of the symptom of frequency. If you experience any of these symptoms, see your healthcare professional.

Types of UTIs

• Cystitis - an inflammation of the bladder and the most common UTI. Almost always, it occurs in women. The infection typically affects only the surface of the bladder and is brief & acute.

• Pyelonephritis - more commonly known as a kidney infection and usually occurs when a lower UTI spreads to the kidneys. Occasionally, bacteria will spread to the kidney from the bloodstresam. Kidney infections are more serious and less common than bladder infections. Symptoms include a fever, pain in the back or side below the ribs, nausea, or vomiting.

• Urethritis - is an inflammation of the urethra. Men commonly contract urethritis through sexual intercourse with partners infected with sexually transmitted infections. Urethritis may also result from trauma to the area or from the catheterization process.

Prevention of UTI

There are several ways to prevent bladder infections.

•Bathroom Behavior:Periodically emptying the bladder by trying to urinate every two to three hours.

•Diet: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. Increasing water intake by one or two glasses per day may help limit the length of time that you have symptoms and reduce the infections.

•Hygiene: Proper hygiene in caring for the urethral area is another way to limit the amount or type of bacteria that can be drawn into the urethra. This is especially true in people who have decreased sensation in the perineal region such as those with MS or who experience any amount of fecal incontinence. Using soap & water or commercially available cleansing wipes several times per day & frequent changing of incontinence pads as they become wet can minimize the amount of bacteria in the urethral area. Women should always wipe from the front of the vagina to the back of the anus after urination or a bowel movement and wear cotton underwear. It is also reported that wearing thong undergarments may increase one's risk of developing an infection.

•Sexual Activity: Can be the source of UTIs in women. Insuring proper lubrication to the vagina and voiding before and after intercourse are tactics to help prevent infection. Using diaphragms and spermicidal jelly and/or foam may increase the risk of infection, so it is important to evaluate what type of birth control you use. Some physicians encourage women who have a history of recurrent infections to take an prophylactic antibiotic after intercourse, as it reduces risk of recurrent UTI by about 85%. At a minimum, restrict your number of sexual partners and urinate immediately after sexual intimacy to lower the risk of recurrent UTIs.

•Vaginal Estrogen: 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.

•Catheter Use: proper cleansing and storage of catheters is important in one who intermittently catheterizes, as the catheter can be a vehicle to introduce infection if the technique is incorrect or if the catheters are not properly cleaned between each use. 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. Taking aspirin, Tylenol, or non-steroidal, anti-inflammatory medications may reduce symptoms during this episode, as they may be a result of increased body temperature.

For more information regarding UTIs please visit: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001549/