Urinary Tract Infections

Urinary tract infections, or cystitis (infection of the lower urinary tract), is often called the honeymooners disease, and for good reason. This infection can be triggered by both the introduction of bacteria and the slight physical damage done during sexual intercourse.

The urinary system is made up of the kidneys, bladder, ureters (tubes that connects the kidney in the bladder) and urethra (tube that connects the bladder to the outside of the body). Any part of that entire system can become infected but the largest majority of infections take place in the lower part of the urinary tract, mainly the urethra and bladder.

Women are at the greatest risk for developing a lower urinary tract infection than are men, because of the physiological structure. In other words, the length of the urethra, which leads from the outside of the body to the bladder, is shorter in women than it is in men. The urethra in men is also not a straight shot into the bladder. Both of these structural differences tend to decrease the amount and number of bacteria which are able to make it into the urethra and up to the bladder.

A urinary tract infection in the bladder can be painful and uncomfortable but not serious. However, if left untreated to bacterial infection can travel up through the ureters and into the kidneys which can cause serious consequences.

Most individuals are able to determine that something is wrong. However, not everyone with a lower urinary tract infection will develop signs and symptoms that lead them to seek the advice of their primary care physician. The majority of those individuals who do not perceive difficulty are often those who have other medical issues that affect their ability to perceive pain.

In general the signs and symptoms of a lower urinary tract infection will develop rather rapidly. The individual will experience a very strong urge to urinate. This urge happens frequently throughout the day but the amount of urine is not congruent with the urgency. There will be a burning sensation during urination and there also could be blood in the urine or a strong smelling urine.

Individuals who are suffering from an upper urinary tract infection will also experience pain in her side with high fevers, nausea and vomiting. These symptoms originate from the infection in the kidneys, also called acute pyelonephritis. Individuals who have a bladder infection, or cystitis, will also experience pelvic pressure and potentially a low-grade fever and those who suffer urethritis will also experience burning with urination.

The most common type of infection in women is cystitis which is usually caused by E. coli. E. coli is a bacteria that is commonly found in the gastrointestinal tract. All women are susceptible to developing cystitis because of the short urethra and the anatomical closeness of the urethra to the rectum. The second most common type of infection is urethritis which is also commonly caused by E. coli. However, because of the proximity to the vagina other sexually transmitted diseases such as herpes, gonorrhea and chlamydia can also cause urethritis.

Research has shown that there are some individuals who are much more likely to develop a urinary tract infection or who are at higher risk. These factors include being sexually active, using certain types of birth control, those who have a higher risk of kidney stones, individuals who have an abnormality in the urinary tract, age, diabetes and prolonged use of catheters. Men who are uncircumcised, have intercourse with a woman who has a vaginal infection, engage in anal sex or who have an enlarge prostate are also at greater risk for urinary tract infections. (1)

The treatment for lower urinary tract infections is generally straightforward and very successful. When they are treated quickly there are rarely any complications. But, when left untreated, they can lead to acute or chronic kidney infections that will permanently damage the kidneys.

In a normal situation, the urine is sterile. This means that there are no bacteria, viruses or fungi growing within the fluid. The urine does, however, contain salts and waste products from the body.

Interestingly, research has shown that approximately 20% of women who have had one urinary tract infection will go on to develop a second and of those 30% will go on to develop the third. In a study funded by National Institutes of Health researchers suggested that one factor that increase the risk for women to develop more than one urinary tract infection was the ability of the bacteria to attach to cells that line the urinary tract. (2)

To determine whether or not a urinary tract infection is causing your signs and symptoms your primary care physician will test a sample of urine. The sample is sent to a laboratory in order to determine the amount of bacteria and potentially also the kind of bacteria. When the test determines the kind of bacteria this is called a culture. A standard urinalysis will also examine the urine for white blood cells and red blood cells.

If this is your first urinary tract infection a culture and sensitivity may not be done in a broad spectrum antibiotic will probably be prescribed. On a second urinary tract infection a culture and sensitivity will be ordered in order to determine the exact antibiotic to which he bacteria is sensitive. Once a woman has a third urinary tract infection which is obviously not related to the first two the physician may order tests to determine if the urinary tract system is structurally normal.

One of the tests that may be recommended is an intravenous pyleogram which gives an x-ray image of the organs involved in the urinary tract system. An ultrasound exam will also give a picture of the internal organs and a cystoscopy may be recommended in order to visualize the inside of the bladder through the urethra using a catheter.

Women can take additional steps at home in order to avoid getting a lower urinary tract infection. By drinking plenty of water every day and keeping the urine a very light yellow in color she can effectively flush out bacteria from the system. Women should not resist the urge to urinate but should go to the bathroom as soon as they feel the need. Wiping from front to back will prevent bacteria that live near the anus from entering the vagina or the urethra. Women should also avoid using feminine hygiene sprays that can irritate the urethra and set it up for bacterial infection.

(1) University of California Los Angeles: Urinary Tract Infections

(2) National Kidney and Urologic Diseases Information Clearinghouse: Urinary Tract Infections in Adults

RESOURCES

MayoClinic: UTI

University of Maryland Medical Center: Urinary Tract Infections Medications

Stanford School of Medicine: Urinary Tract Infections

Washington University: Discovery helps Mice Beat Urinary Tract Infections

University of Michigan Health systems: Urinary Tract Infections can be minimized When hospitals emphasize proper catheter use

Oregon State University: Antibiotic Resistance a Growing Concern with Urinary Tract Infections

Clinical Infectious Disease: Cranberry Juice Fails to Prevent Recurrent Urinary Tract Infections: Results from a randomized placebo-controlled trial