Urinary Tract Infections (UTI)

The Urinary System

The urinary tract is made up of the following organs:

• bladder
• kidneys
• two ureters
• urethra

The Kidneys

The kidneys:

• are located below the ribs near the middle of the back
• consist of a complex filtration system made up of individual nephrons working together to remove waste products from the blood which are eliminated from the body in the form of urine
• maintain a stable balance of salts and other substances in the blood
• produce a hormone, Erythropoietin, which triggers the production of red blood cells in the bone marrow

The Ureters

The ureters:

• are tube-like structures
• transport urine from the kidneys to the bladder where the urine is stored

The Bladder

The bladder:

• is elastic
• expands as it fills with urine

There are two sphincter muscles which tighten around the urethra to prevent urine from leaking out:

• The internal sphincter is not controlled consciously
• The external sphincter is under voluntary control

When the bladder reaches a certain capacity the brain sends impulses to:

• the internal sphincter to relax
• a muscle called the detrusor to contract and expel the urine out the urethra

Urinary tract infections (UTIs)

Conditions that cause symptoms of urinary tract infections include:

• Cystitis (infection of the bladder)
• Irritable bladder
• Urethritis (infection of the urethra)
• Vaginitis

Urinary tract infections (UTIs) are caused by bacteria that invade the urinary system and multiply resulting in an infection. About 8-10 million people become infected each year.

Women get Urinary tract infections (UTIs) more often than men, although men and children can get them.

Bacteria from the rectal area sometimes enters the urinary tract through the urethra to the bladder and causes an infection.  About 80-90% of urinary tract infections are caused by Escherichia coli (E. coli), the bacteria normally found in the rectum. 

Symptoms

Symptoms of Urinary Tract Infection (UTIs) include:

• Abdominal pain
• Blood in the urine
• Cloudy urine
• Lower back pain
• Painful urination, often with a burning sensation
• Urgent and constant need to urinate

If pain is the predominant symptom interstitial cystitis may be considered

See your doctor or health professional if the symptoms persist for more than 24 hours and get immediate medical treatment if more severe symptoms occur such as:

• Chills
• Fever
• Nausea
• Severe pain in the mid-back
• Vomiting

Transmission

Women get the infection more often because it is much easier for bacteria to enter the urethra and work its way up into the bladder as it is so close to the vagina and the anus. 

Urinary tract infections include:

Urethritis

• infection of the urethra

Cystitis

• infection of the bladder

Pyelonephritis

• the kidneys become infected when bacteria ascends up the ureters 

Contributing Factors

Some factors that may result in urinary tract infections are:

Sexual Intercourse: 

• can transfer bacteria from the anal-vaginal area to the urethra and the bladder
• may irritate tissues

Birth Control Methods:

• Ill-fitting diaphragms may place pressure on the bladder
• The chemicals in spermicides may irritate vaginal tissues

Physical Structural Problems:

Some women may have an actual physical problem which predisposes them to urinary tract infections (UTIs).  A physical examination and medical history will determine if there is any problem.

Risk Factors

In Children:

• Babies born with abnormalities of the urinary tract, such as posterior urethral valves or vesicoureteral reflux, which may require surgery
• Small girls have a shorter urethra than boys so get infected easier
• Soiled diapers on young children can cause an infection if left on too long
• Uncircumcised boys more than circumcised boys because bacteria survives in warm, moist areas under the foreskin

In Adults

• Low water intake will cause less urination, which flushes out the system
• People with diabetes have a higher risk of infection because of changes in the immune system
• Sexually active teenagers and adult women because of friction occurring at the meatus during intercourse
• Wiping from back to front after using the toilet can expose the vaginal and meatal area to rectal bacteria, often Escherichia coli (E. coli)
• Women with specific blood types 

Other Factors

Catheters or tubes placed in the bladder:

• when urination is impossible
• when people are unconscious or critically ill
• on the elderly
• on those with nervous system disorders such as spinal cord injury where loss of bladder control may require catheters permanently

Infections can be caused by the bacteria:

• Citrobacter
• Enterobacter
• Escherichia coli (E. coli)
• Klebsiella
• Proteus
• Pseudomonas
• Serratia
• Staphylococcus aureus
• Streptococcus fecalis

Diagnosis

Your doctor or health professional will check your symptoms and test your urine, which is essential as other conditions have similar symptoms, including:

• Bladder cancer
• Chlamydia
• Gonorrhea
• Irritable bladder
• Vaginal infection

Treatment

If there are bacteria in your urine several different antibiotics may be prescribed to treat uncomplicated infections.

The regimen is usually:

• antibiotics for 1-3 days for first infection
• antibiotics for 7-10 days

For recurrent infections a urinary analgesic, such as Phenazopyridine, may be prescribed for the pain

Help Factors

• Hot water bottles or heating pads to ease cramps and soothe the pain

 If left untreated infections can result in:

• kidney damage
• death

Prevention

Help Factors

Drink

• a cup of water with a half a teaspoon of baking soda 1-2 times a day
• cranberry juice as it helps reduce the amount of bacteria in your urine
• large amounts of water to help flush the bacteria out of the system

Avoid

• acid foods
• alcohol
• caffeine
• chocolate
• citrus fruits
• spices
• tomatoes

Other Factors

• Drink water before and after sex so that you will urinate a good volume with a steady stream afterward
• Regular testing of urine during pregnancy
• Urinating after sexual intercourse
• Wiping from the vagina to the anus after urinating to avoid spreading bacteria
• Wear cotton underwear as it is less irritating and provides more ventilation than nylon

Risk Factors

• Tight clothing and pantyhose may irritate tissues, trap heat and promote bacterial growth

Prognosis

Complications

Recurrent Cystitis

Some women suffer from recurrent urinary tract infections:

• 20% of women who have had one urinary tract infection (UTI) will have one recurrence
• 30% of those women will have more than one recurrence

The recurrent infection usually stems from a different strain or type of bacteria from the original urinary tract infection (UTI)

During Pregnancy

If a pregnant woman develops a urinary tract infection (UTI) it often travels to the kidney causing pyelonephritis, due to hormonal changes and fluctuations and increased pressure on the bladder

In Babies

• If left untreated the infection can harm the fetus
• Newborn babies may get a systemic infection called Sepsis

After Menopause

Infection can occur when vaginal tissues start to break down due to a decrease in estrogen levels