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Urinary Tract Infections

Urinary Tract Infections are one of the commonest ailments that bring a patient to the doctor,often more than once.However eventhough usually a simple condition,if not treated properly,itcan give rise to significant complications and sepsis.The threat is all the more high with availability of over-the-counter medications from pharmacies without even proper evaluation.

What is UTI?

UTI refers to infection in any part of the urinary tract from urethra(the passage for urine outwards from the urinary bladder) upto the kidneys,though it most commonly involves urethra and bladder.

What causes UTI?

UTI happens when microbial organisms that have gained access into the bladder through the urethra multiplies there.Every person can have one or two episodes of UTI.But having recurrent episodes of infection is something to be worried about as there would be an underlying cause(s) always.

The risk factors for UTI are:

  • Female gender: Women are more prone to getting UTIs compared to men.What makes them higher in risk?

  1. Anatomy : Women have shorter urethra compared to men;hence it is easier for the organisms to invade the bladder from the urethra.

  2. After menopause: Th ehormonal deficiencies post-menopause can increase the susceptibility of the urinary tract to infection.

  3. Sexual activity: Though this is common to both sex,the female anatomy places them at higher risk.Having a new sexual partner also increases the risk.

  4. Women using certain contraceptive methods such as diaphragms find themselves at increased risk for acquiring a UTI.

  • Abnormalities in the Urinary Tract: Any developmental abnormalities in the urinary tract such as an obstruction to the outflow(in cases like Posterior Urethral Valves in male babies) can increase susceptibility to a urinary tract infection.

  • Benign Prostatic Enlargement in men can lead to residual urine in the bladder which might get infected.

  • Kidney stones especially if they get entrapped in the tracts can lead to UTI.

  • Uncontrolled Diabetes can weaken the immune system.

  • Any recent urinary procedures like an endoscopic examination or catheterisation( to facilitate passage of urine in retention) are of importance.

  • Patients who are on long term indwelling catheters as in bedridden situations,strokes,etc.

What are the symptoms of having an UTI?

Almost everyone would be aware of this symptoms but can be summarised as:

  • Burning sensation or painful micturition

  • Increased frequency of urination.

  • Strong desire to void as and when perceived.

  • Foul-smelling urine.

  • Lower abdominal pain(suprapubic pain)

  • Low backache.

  • Cloudy urine-often seen in catheter associated UTIs.

  • Blood in urine.

  • Fever-often high grade with chills accompanying painful urination.

Why should I be worried of frequent episodes of UTI?

Frequent episodes of UTI must be a matter of concern because of the complications as well as the consideration of a basic underlying cause unidentified.

Complications of UTI:

  • Kidney scarring and loss of function in untreated high grade UTI affecting the kidneys(Pyelonephritis)

  • Narrowing of urethra due to scarring(strictures) which are more common with gonococcal urethritis in sexually promiscuous men and women.

  • Sepsis or generalised infection in the bloodstream.

  • In pregnancy UTI is associated with risk of premature delivery as well as low birthweight babies.

What causes recurrent UTI as commonly seen in general practice?

The most common reason behind recurrent UTI is inadvertent and injudicious administration of antibiotics without proper evaluation of an episode of UTI.Ideally,in UTIs,antibiotics must be started after a Urine Culture.Sadly,even with presumptive evidence,higher antibiotics are provided at the first visit and therefore cultures are not followed up.This unethical practice often can be traced to pharmacists providing antibiotics on demand for suspected UTIs.Somehow,patients seem to trust their pharmacists more without knowing the danger they are inflicting upon themselves.

Treatment of Urinary Tract Infections

Definitive management requires definitive diagnosis first.

If your symptoms are suggestive of an UTI,your doctor would order an urine analysis together with a Urine Culture test to assess sensitivity.A Urine Routine examination clinches the diagnosis in a matter of minutes but a urine culture gives valuable information regarding the pathogen(bacteria or fungus) ,its count in the sample as well as the sensitivity pattern to commonly used antibiotics. In cases of recurrent UTI,your doctor would also order an imaging study mainly UltraSonoGram(USG) to look for tract abnormalities,or stones or residual urine.In such cases,once the current infection settles down,the urologist might also perform a cystoscopy(endoscopical procedure for visualising the bladder and urethra).

Once the diagnosis is made,the backbone of management of UTIs are antibiotics.Often the symptoms become better after a couple of doses,but always take them for the exact number of days prescribed by your physician.Often it is combined with medications to reduce pain due to bladder spasms that accompany UTI. In severe cases of recurrent or persistent UTI,sometimes,antibiotics might be administered intravenously. In complicated infections involving the kidneys,some surgical interventions might be needed to aid in recovery if the renal function levels worsen which are performed by the urologist.

How can I prevent UTIs?

  1. Stay hydrated- Drink plenty of clean water and keep yourselves hydrated.

  2. Wipe from front to back after urination- This is advisable in women as this practice would prevent the inadvertent transmission of bacteria in the perianal region to urethra.

  3. Cranberry juice- Though there is lack of conclusive evidence,cranberry juice is presumed to be prophylactic for UTI.Doctors may also prescribe cranberry extract as tablets if UTI prophylaxis is deemed necessary.

  4. Always urinate after intercourse.

  5. Avoid contact with irritant products in private parts like douches or sprays.

Feel free to ask away your doubts!

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