FYI on UTIs

    Dr. Vivien Tucker, Family Medicine, Deaconess Clinic Darmstadt

    In my career I’ve treated thousands of urinary tract infections. They’re very common, can be quite painful, and can cause serious complications if untreated.

    What is a UTI?

    A urinary tract infection, or UTI, is an infection of the urinary tract. The infection can occur at different points in the urinary tract, including:
    • Bladder. An infection in the bladder is also called cystitis or a bladder infection.
    • Kidneys. An infection of one or both kidneys is called pyelonephritis or a kidney infection.
    • Ureters. The tubes that take urine from each kidney to the bladder are rarely the only site of infection.
    • Urethra. An infection of the tube that empties urine from the bladder to the outside is called urethritis.
     
    Who gets UTIs?

    Among all UTIs, bladder infections are most common. These infections also most often occur in women. 

    Most UTIs are caused by bacteria that enter the urethra and then the bladder. The infection most commonly develops in the bladder, but can spread to the kidneys. Most of the time, your body can get rid of these bacteria. However, certain conditions increase the risk of having UTIs.

    Women tend to get them more often because their urethra is shorter and closer to the anus than in men. Because of this, women are more likely to get an infection after sexual activity or when using a diaphragm for birth control.

    The following also increase your chances of developing a UTI:
    • Diabetes
    • Advanced age and conditions that affect personal care habits (such as Alzheimer disease and delirium)
    • Menopause
    • Problems emptying the bladder completely
    • Having a urinary catheter
    • Bowel incontinence
    • Enlarged prostate, narrowed urethra, or anything that blocks the flow of urine
    • Kidney stones
    • Staying still (immobile) for a long period of time (for example, while you are recovering from a hip fracture)
    • Pregnancy
    • Surgery or other procedure involving the urinary tract

    People of all ages can develop UTIs—even babies in diapers (typically baby girls). That’s why it’s important to know the symptoms so that early treatment can begin.

    UTI Symptoms & Complications

    The symptoms of a bladder infection include:
    • Cloudy or bloody urine, which may have a foul or strong odor
    • Low fever in some people
    • Pain or burning with urination (this is an understatement—it can feel like knives and fire!)
    • Pressure or cramping in the lower abdomen or back
    • Strong need to urinate often, even right after the bladder has been emptied
    • Mental changes or confusion--in older people, these symptoms are often the only signs of a UTI

    If the infection spreads to your kidneys, symptoms may include:
    • Chills and shaking or night sweats
    • Fatigue and general ill feeling
    • Fever above 101°F (38.3°C)
    • Pain in the side, back, or groin
    • Nausea and vomiting
    • Severe abdominal pain

    There are major complications that can result from a UTI, including:
    • Life-threatening blood infection called sepsis. The risk is greater among the young, very old adults, and those whose bodies cannot fight infections (for example, due to HIV or cancer chemotherapy).
    • Kidney damage or scarring.
    • Kidney infection, called pyelonephritis.

    Also, women who are pregnant can go into pre-term labor if a UTI isn’t treated—in fact, it’s the most common cause of pre-term labor.

    UTIs are serious and should be treated as such.

    When to see a doctor

    If you are symptomatic of a UTI, you should see your doctor ASAP.  If it’s after hours, call the on-call physician or go to Urgent Care. A bladder infection can “climb” further into the urinary tract, like the kidneys, and/or become a systemic infection like sepsis.   

    When you see your doctor with a suspected UTI, you will need to provide a urine sample for the following tests:
    • Urinalysis. This test is done to look for white blood cells, red blood cells, bacteria, and to test chemicals such as nitrites in the urine. This test can diagnose an infection most of the time.
    • Clean-catch urine culture. This test may be done to identify the bacteria and determine the best antibiotic for treatment.

    Blood tests such as complete blood count (CBC) and a blood culture may be done as well.

    How UTIs are treated

    Your health care provider must first decide if the infection is just in the bladder, or if it has spread to the kidneys, and how severe of an infection may be present.

    Mild bladder and kidney infections
    • Most of the time you will need to take an antibiotic. Finish all of the antibiotics, even if you feel better. If you do not finish the whole dose of medicine, the infection may return and be harder to treat later.
    • If you are pregnant, have diabetes, or have a mild kidney infection, you will most often take antibiotics for 7 to 14 days.
    • Always drink plenty of water when you have a bladder or kidney infection.
    • Tell your provider if you might be pregnant before taking these drugs.

    Recurrent bladder infections
     
    Some women have repeated bladder infections. Your provider may suggest that you:
    • Take a single dose of an antibiotic after sexual contact to prevent an infection.
    • Always urinate shortly after sexual contact to help flush out the urethra.

    Severe kidney infections
     
    You may need to go into the hospital if you are very sick and cannot take medicines by mouth or drink enough fluids. You may also be admitted to the hospital if you:
    • Are an older adult
    • Have kidney stones or changes in the anatomy of your urinary tract
    • Have recently had urinary tract surgery
    • Have cancer, diabetes, multiple sclerosis, spinal cord injury, or other medical problems
    • Are pregnant and have a fever or are otherwise ill.
     
    At the hospital, you will receive fluids and antibiotics through an IV.

    Specialized Treatment for Chronic/Recurrent UTIs

    Some people have UTIs that do not go away with treatment or keep coming back. These are called chronic UTIs. If you have a chronic UTI, you may need stronger antibiotics or will need to take medicine for a longer time.

    For most of my patients, I’m able to effectively treat and manage urinary tract infections.  But some may need surgery or other specialized treatment if the infection is caused by a problem with the structure of the urinary tract.  This can be common in older women who have had children. 

    Here at Deaconess, if a patient needs a referral for specialized care, I have options to share with you.  My colleagues at Deaconess Clinic Urology can help treat complex problems that may be contributing to recurrent or chronic UTIs. 

    Also, the Pelvic Health & Wellness Center at The Women’s Hospital specializes in the assessment and treatment of pelvic health issues, including urinary problems.

    Preventing UTIs

    Finally, there are several things that can be done to help prevent UTIs.
    • Women should shower rather than take baths. Bubble baths are especially problematic as they relax and irritate the urethra.
    • Stay well hydrated, as keeping fluids moving through the urinary tract can help reduce the opportunity for bacteria to multiply.
    • Drinking cranberry juice or taking cranberry supplements can help make the walls of the bladder “slippery,” preventing bacteria.
    • Avoid soft drinks and caffeine as they are bladder irritants.
    • Women should always wipe front to back after using the restroom, to prevent bacteria from going “the wrong way” and up the urethra.
    • Urinate shortly after intercourse to help flush out bacteria that may’ve entered the urethra.
    Ultimately, do what you can to prevent UTIs, and when you believe you have symptoms of one, see a health care provider right away.  
    Posted: May 11, 2017 by Kate Reibel

    Tags: bladder, infection, infection control, tract, urinary, UTI

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