Urinary Tract Infection

Urinary tract infections, also called UTI's are the most common bacterial infection in humans. They account for more 8.6 million physician visits and over one million hospital admissions in the United States each year.

A UTI remains one of the most common indications for prescribing antibiotics to otherwise healthy women. Up to 50% of all women will experience one episode in their lifetime.
While the majority of urinary tract infections are not serious, they often cause severe symptoms such as pain, frequency, urgency, urine leakage and burning with urination. Patient's with recurrent UTI's should be evaluated by a specialist who can determine that there are no other causes for the symptoms and can help prevent recurrences.

ACUTE UTI

A UTI can occur anywhere in the urinary tract, which consists of the bladder, kidneys, ureters and urethra. 
"Acute Cystitis" or "Bladder Infection" is a UTI that is localized to the bladder. When a bladder infection tracks up to the kidney it becomes a "Kidney Infection" or "Pyelonephritis". 

CAUSES OF UTI:

Bacteria are not normally present in the urine but can enter through the urethra, migrating from the vagina which is naturally colonized with bacterial flora.
The microorganisms commonly found to be responsible for a UTI include E. coli, staphylococci, enterococci, proteus, and klebsiella.
There are certain predisposing causes that should also be taken in consideration, such as sexual activity, post menopausal vaginal changes, an enlarged prostate, neuropathic bladder, kidney stones, diabetes, IBS, catheterization and vesico-ureteric reflux.

As for the chronic or recurrent UTI, causes and risk factors include untreated or inadequately treated acute UTI, enlarged prostate, stones, stricture, stasis of urine in the bladder and several more.

SYMPTOMS OF ACUTE UTI:

One of the most prominent symptoms of an acute UTI includes frequent urge to urinate with little or no urine, the urge to urinate during the night (nocturia), pain, discomfort or burning sensation while urinating, blood or cloudy urine, odor of the urine and mild fever.
A UTI can sometimes be asymptomatic, and the patient will not have any of the typical symptoms.

SIGNS AND DIAGNOSIS:

A urinalysis commonly reveals white blood cells (WBCs) or red blood cells (RBCs) and other clues that on infection is present. A urine culture, when possible, should be performed to determine the type of bacteria in the urine and delineate the appropriate antibiotic for treatment. 

TREATMENT OF ACUTE UTI:

In order to treat an acute urinary tract infection it is recommended to first perform diagnostic tests that will determine the type of microorganism that is causing the infection. This is important because different organisms are treated with different medications. If treatment is begun without knowing the exact bacteria and it's sensitivities to antibiotics, it can cause a negative urine culture even if the infection is still present.
Sometimes more than one medication is required in order to successfully treat the infection. 


PREVENTION:

  • Water helps flush your urinary tract, so make sure you drink plenty of plain water daily.
  • Don't hold it when you need to urinate! Women are often guilty of trying to finish a task before they go to the bathroom. Holding it when you need to go can help any bacteria that may be present develop into a full-fledged urinary tract infection.
  • You've probably heard that you should wipe from front to back after a bowel movement. This is especially important to help prevent bacteria from entering the vagina or urethra.
  • Taking showers instead of baths helps prevent bacteria from entering the urethra and causing a UTI.
  • Always urinate both before and after sex to help prevent transferring bacteria to the urethra or vaginal area, which can create a breeding ground for a UTI.
  • Feminine hygiene sprays and douches, particularly scented douches, can irritate the urethra and possibly lead to a UTI. Avoiding these products will help prevent not only urinary tract infections, but also other infections and irritations that these products may cause. I have found a line of non-irritating products that are safe to use and are Non-Toxic.  

 A FEW OTHER HINTS:

  • Taking cranberry tablets is a fairly well-known and natural way to both help prevent urinary tract infections, as well as help speed the recovery process when a UTI develops. A supplement called D-mannose can be added to the cranberry tablets and increase it's antibacterial effect.
  • Another nutritional route that may help prevent UTI is regularly taking vitamin C supplements. Vitamin C increases the acidity level of urine, which in turn helps decrease the number of harmful bacteria that may be present in your urinary tract system.
  • Always wear underthings made with cotton. Cotton fabric lets moisture escape while other fabrics can trap moisture, creating a potential breeding ground for bacteria.
  • If you are one of a large number of women who suffers from frequent, recurrent urinary tract infections,  changing sexual positions may reduce friction on your urethra and reduce your risk of recurrent UTI.

Women who suffer from extremely frequent urinary tract infections may be prescribed an antibiotic to take immediately before or after sex to help prevent the likelihood of a urinary tract infection from reoccurring or even take a low dose daily if the UTI's are extremely difficult to keep under control.

UTI OR SOMETHING ELSE?

The classic signs of a UTI usually means just that, a UTI. But burning with urination, lower abdominal pain, low back pain and vaginal complaints can mean something different is going on. In our office, the distressing symptoms of a UTI is an "emergency" and we will get you in to be seen immediately.

I always prefer to see my patients when they feel actively infected so I may obtain a detailed history, physical and be able to examine the urine and send it for a urine culture & sensitivity. This ensures that we are diagnosing and treating the UTI properly. I call a urine sample my "crystal ball" because just by looking at it I can tell so much.
We will treat empirically as best as possible, meaning without the culture results at first so that you will start to feel better as quickly as possible. When the C & S does come back we will call you with the result (if it is positive) and make sure you are on the correct treatment plan.


WHAT IF IT IS AFTER HOURS AND YOU THINK YOU HAVE A UTI?

If you are a known patient to me and we have followed you and your urine culture pattern over time, we will be able to better know what works best for you. That is why I discourage visits to an urgent care for UTI treatment unless it is over a weekend etc and you cannot wait. When a patient comes to me having been treated repetetively elsewhere I won't have a "pattern" of cultures and past response to treatment to guide me for future therapy.