Disease and Condition

Urinary Tract Infections (UTI)See also: Bladder Infection

What is it?
The term urinary tract infection (UTI) is used to describe an infection that begins in the urinary system. UTIs can be painful and annoying. They can also become a serious health problem if the infection spreads to the kidneys.

Urinary tract infection (UTI) refers to a group of inflammations of the urethra, bladder, or kidneys. The urinary tract consists of the kidneys, ureters, bladder, and urethra. The kidneys filter waste materials from the blood, and these waste materials become urine. The ureters carry the urine from the kidneys to the bladder, where it is held until you go to the bathroom. The tube that carries the urine from the bladder and outside of your body is called the urethra. Urine is usually sterile, which means it doesn’t contain any bacteria or infectious organisms. However, these types of organisms sometimes get into the urinary tract and cause an infection.

Who gets it?
Urinary tract infections are more common in women than in men. In fact, 1 in 5 women will develop one during her lifetime, and many will have more than one. The male urethra is long, so it is harder for bacteria to get to the bladder. Men are more likely to get a UTI once past the age of 50. People with kidney stones, urinary tract abnormalities, weakened immune systems, spinal cord injuries, and diabetes are more likely to get UTIs, as are patients who have been catheterized to drain urine directly from the bladder.

What causes it?
Urinary tract infections can be caused by bacteria, viruses, fungi, or some types of parasites. The most common types of urinary tract infections are bladder infections, called cystitis; kidney infections, called pyelonephritis; and infections of the urethra, called urethritis. They are caused by bacteria that are normally present in your digestive system and on the skin around the rectum and vagina. This bacteria can pass through the urethra and up into the bladder. Urinary tract infections are not contagious. However, bacteria in the area of the vagina can get pushed into the urethra during sexual intercourse. Infections can also be caused by irritation to your genital area, such as using a diaphragm or spermicides as contraception, wearing tight pants, and using perfumed soaps. Children, especially girls, are more likely to get UTIs from bubble baths and other irritants. Men are more likely to get UTIs when an enlarged prostate gland presses on the bladder and prevents it from emptying completely, or because of kidney stones.

Cystitis commonly occurs in women as a result of sexual intercourse. But even sexually inactive girls and women are susceptible to lower urinary tract infections because the anus, a constant source of bacteria, is so close to the female urethra. More than 90 percent of cystitis cases are caused by Escherichia coli (E. coli) , a species of bacteria commonly found in the rectal area.

Risk Factors
Some people appear to be more likely than others to develop UTIs. Women are one such group. Up to 20 percent will develop a bladder infection over a lifetime. A key reason is their anatomy. Women have a shorter urethra than men have, which cuts down on the distance bacteria must travel to reach the bladder.

Women who are sexually active tend to have more UTIs because sexual intercourse can result in bacteria being pushed into the urethra. Studies have also shown that women who use diaphragms for birth control may be at higher risk. After menopause UTIs may become more common because tissues of the vagina, urethra and the base of the bladder become thinner and more fragile due to loss of estrogen.

Other risk factors include anything that impedes the flow of urine, such as an enlarged prostate or a kidney stone . Changes in the immune system, which can occur with conditions like diabetes , also can increase the risk of UTIs. So can the prolonged use of bladder catheters, which may be needed by the chronically ill or older adults.

New research funded by the National Institutes of Health suggests that a woman's blood type may play a role in her risk of recurrent UTIs. Bacteria may be able to attach to cells in the urinary tract more easily in those with certain blood factors. But more research is needed to determine whether an association exists and whether it could be useful in identifying people at risk of recurrent UTIs.

What are the symptoms?
Not everyone with a UTI will develop symptoms, but most people have some. They can include:

A strong persistent urge to urinate
A burning sensation when urinating
Passing frequent, small amounts of urine
Pain in the lower part of your abdomen or lower back
Blood in the urine (hematuria) or cloudy, strong-smelling urine
A man with a urinary tract infection may have a discharge from his penis. A kidney infection is more serious. Its symptoms include a burning sensation when you urinate, abdominal and lower back pain, fever, chills, nausea, the frequent need to urinate, and cloudy or bloody urine. Some sexually transmitted diseases can cause symptoms that look like a UTI. For example, the chlamydia organism can cause urethritis. For this reason, it is important to see a doctor for diagnosis if you have any symptoms of a urinary tract infection. Symptoms will also get worse if not treated. Untreated UTIs can spread to the blood and cause a serious infection that can be fatal.

There are more specific signs and symptoms for each type of UTI. In addition to the symptoms listed above you may experience the following:

Acute pyelonephritis may cause flank pain, high fever, shaking chills and nausea or vomiting.
Cystitis may result in pressure in the lower abdomen and strong-smelling urine.
Urethritis may lead to pus in the urine. In men, urethritis may cause penile discharge.
How is it diagnosed?
If you have any symptoms of a urinary infection, contact your physician as soon as possible. To diagnose a UTI, your doctor will look at your medical history, ask about your symptoms, and perform a physical exam that includes pressing on your abdomen to check for tenderness. If a UTI is suspected, your physician will most likely ask for a urine sample to determine if bacteria are present in your urine. You will wash your genital area with a disposable wipe, then urinate into a sterile cup. Your doctor will ask you to begin urinating in the toilet, then stop and continue urinating into the cup. This is so any bacteria outside the vagina or on the end of the penis is washed away and not included in the sample. This sample will be tested for bacteria and other causes of UTIs. Although no simple test can differentiate between an upper and lower urinary tract infection, the presence of fever and flank pain may indicate that the infection involves the kidneys. If you have repeated infections, your doctor may order additional tests such as an ultrasound study of your abdomen; intravenous pyelography (IVP), which is an x-ray of the urinary tract; or a cystoscopy, which involves inserting a tube into the urethra for a close view of the urethra and bladder. If you are a man, your doctor will also perform a prostate exam to check for any tenderness or enlargement. He or she will also check for and take a sample of any discharge from the penis.

When treated promptly and properly, UTIs rarely lead to complications. But if they are left untreated, a lower urinary tract infection can become something more serious than a set of uncomfortable symptoms.

Untreated UTIs can lead to potentially life-threatening complications, such as acute or chronic pyelonephritis, which could permanently damage your kidneys. Young children and older adults are at the greatest risk of kidney damage due to UTIs because their symptoms are often overlooked or mistaken for other conditions. Women who have UTIs while pregnant may also have an increased risk of delivering low birth weight or premature infants.

What is the treatment?
Urinary tract infections are usually easy to treat, but it’s important to begin treatment right away. If you have a mild bladder infection, drinking plenty of fluids may be enough to wash away the bacteria and let your body do the rest. In most cases, your doctor will prescribe antibiotics to fight the infection. If you have a lot of pain in the abdominal area, your doctor may give you a different medication for that. Medications for UTIs usually make your urine bright orange. Follow your doctor’s instructions and take all medications until they are gone. If you do not, all the bacteria may not be killed and you may get the infection again. Make sure you drink plenty of fluids everyday. Research has shown that cranberry juice is also effective in treating urinary tract infections and even in preventing them. If you are sexually active, you should avoid sexual intercourse until your symptoms have been gone for at least two weeks.

Usually, UTI symptoms clear up within a few days of treatment. But you'll likely need to stay on antibiotics for a week or more. Indeed, it's important to take the entire course of antibiotics recommended by your doctor to ensure that the infection is completely eradicated. For an uncomplicated UTI that occurs when you're otherwise healthy, your doctor may recommend a shorter treatment with a double-strength version of a prescription drug. But this will depend on your particular symptoms and history.

If you have recurrent UTIs, your doctor may recommend longer antibiotic treatment or refer you to a urologist or nephrologist for an evaluation to see if urologic abnormalities may be causing the infections. If abnormalities of the urinary tract are not to blame, taking a single dose of antibiotic each time after sexual intercourse may be helpful.

For severe UTIs hospitalization and treatment with intravenous antibiotics may be required. When recurrences are frequent or a kidney infection becomes chronic, it's important to have a urologic evaluation because an underlying physical problem may require treatment.

Self-care tips
You can prevent urinary tract infections by making sure you always empty your bladder completely when you go to the bathroom. Women, in particular, may benefit from the following:

Drink plenty of liquids, especially water. Cranberry juice may have infection-fighting properties.
Urinate frequently, and avoid retaining your urine for a long time after you feel the urge to void.
Wipe from front to back after a bowel movement to prevent bacteria in the anal region from spreading to the vagina and urethra.
Take showers rather than bubble baths.
Wash the skin around the vagina and anus daily.
Empty your bladder as soon as possible after intercourse, and drink a full glass of water to help flush bacteria.
Avoid using deodorant sprays or feminine products such as douches in the genital area that could irritate the urethra.
Wear cotton underwear
If you are sexually active, make sure you wash your genital area and urinate after intercourse. This will help to remove any bacteria that could travel up the urethra.
Men can prevent UTIs by wearing condoms during intercourse. If you are uncircumcised, make sure you wash carefully under your foreskin each time you bathe.

UTIs can be painful, but you can take steps to ease your discomfort until antibiotics clear the infection. Sometimes a heating pad placed over the abdomen can help minimize feelings of stomach pressure or pain. It's also a good idea to avoid coffee, alcohol, soft drinks with caffeine, citrus juices and spicy foods until you have finished a course of antibiotics. These items can irritate the bladder and aggravate the frequent or urgent need to urinate.

If recurrent bladder infections are a problem, make sure your physician is aware of this. Together, you can develop a strategy to reduce recurrences and the discomfort they can bring into your life. Call your doctor if symptoms return after treatment, or do not get better after a few days of treatment.

References from Medline Plus