A ('''UTI''') is an
Infection of the
Urinary Tract . An infection anywhere from the
Kidney s to the
Ureter s to the
Bladder to the
Urethra qualifies as a urinary tract infection.
- or a burning sensation throughout the urethra with Micturition ( Dysuria ).
-
- Hematuria (bloody urine)
- cloudy and foul-smelling urine
- High temperature lasting for more than 3 days should be a trigger to get the urine culture done to ascertain whether the fever is due to UTI or not. UTI is very harmful especially in infants since it can cause permanent renal damage.
- Nausea and vomitting, accompanied by high fever may indicate a more complicated UTI in which the kidney is infected
- Some urinary tract infections are asymptomatic
A patient with
Dysuria (painful voiding) and urinary frequency generally has a spot mid-stream urine sample sent for
Urinalysis , specifically the presence of
Nitrite s,
Leukocyte s or
Leukocyte Esterase . If there is a high bacterial load without the presence of leukocytes, it is most likely due to contamination.
Pyelonephritis is ruled out by checking for
Costovertebral Angle Tenderness (CVAT). The diagnosis of UTI is confirmed by a urine
Culture .
If the urine culture is negative:
In severe infection, characterised by
Fever ,
Rigor s or flank pain,
Urea and
Creatinine measurements may be performed to assess whether
Renal Function has been affected.
Common organisms that cause UTIs include: ''
Escherichia Coli '' and ''
Staphylococcus Saprophyticus ''. Less common organisms include ''
Proteus Mirabilis '', ''
Klebsiella Pneumoniae '', and ''
Enterococcus '' spp.
A
Mnemonic that can be used to remember the bacteria that cause UTIs is (''Staph saprophyticus'', ''E. coli'', ''Enterococcus'', ''Klebsiella'', ''Proteus'', ''
Pseudomonas '').
The following are a list of things that can be done to avoid a urinary tract infection. As many people, especially women, experience recurrent infections some commonly recommended preventative measures are:
- Having adequate fluid intake, especially water.
- Not resisting the urge to urinate.
- Taking showers, not baths, or urinating soon after taking a bath.
- Practicing good hygiene, including wiping from the front to the back to avoid contamination of the urinary tract by faecal pathogens.
- Cleaning genital areas prior to and after Sexual Intercourse .
- For sexually active women, and to a lesser extent men, urinating within 15 minutes of sexual intercourse to allow the flow of urine to expel the bacteria before specialized extensions anchor the bacteria to the walls of the urethra.
- It has been advocated that Cranberry juice can decrease the Incidence of UTI. A specific type of Tannin found only in cranberries and blueberries prevents the Adherence of certain Pathogens (eg. E. coli) to the Epithelium of the urinary bladder.
UTIs are most common in sexually active women, and increase in
Diabetics and people with
Sickle-cell Disease or anatomical malformations of the urinary tract.
The use of
Urinary Catheter s in both men and women who are elderly, people experiencing nervous system disorders and people who are convalescing or unconscious for long periods of time may result in an increased risk of urinary tract infection for a variety of reasons. Scrupulous aseptic technique may decrease this risk.
Women are more prone to UTIs than males because in females, the
Urethra is much shorter and closer to the
Anus than in males. The article on
Vulvovaginal Health has some health tips for preventing UTIs.
A common cause of UTI is an increase in sexual activity, such as vigorous sexual intercourse with a new partner. The term "honeymoon cystitis", although somewhat demeaning, has been applied to this phenomenon
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Most uncomplicated UTIs can be treated with oral
Antibiotic s such as
Trimethoprim ,
Cephalosporin s,
Macrodantin , or a
Fluoroquinolone (e.g.
Ciprofloxacin ,
Levofloxacin ). (Whilst
Co-trimoxazole was previously used (and continues to be used in the U.S.), the additional benefits of the
Sulphonamide gave little additional benefit compared to the trimethoprim component alone, but was responsible for its both high incidence of mild allergic reactions and rare but serious complications).
If the patient has symptoms consistent with
Pyelonephritis ,
Intravenous antibiotics may be indicated.
Patients with recurrent UTIs may need further investigation. This may include
Ultrasound scans of the kidneys and bladder or
Intravenous Urography (X-rays of the urological system following intravenous injection of iodinated contrast material).
Often long courses of low dose antibiotics are taken at night to help prevent otherwise unexplained cases of recurring cystitis.
Acupuncture has been shown to be effective in both treating urinary tract infections, (sometimes along with chinese herbs with antibiotic compounds) as well as preventing new infections in chronic cases
1 ''(cf acupuncture group, x2 incidents in the sham group, x3 in the control group)''
2
3 ''(highlights need for considering different TCM diagnostic categories in acupuncture research)''
. A study published in October 2002 in the American Journal of Public Health showed that urinary tract infection occurrence was reduced by 50% for 6 months
4
. Acupuncture appears to reduce the total amount of residual urine in the bladder.
If there is no response to treatments,
Interstitial Cystitis may be a possibility.
