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Urinary Tract Infection(UTI): Symptoms, Risk factors, Prevention

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    Overview

    A Urinary tract infection (UTI) is an infection in any part of the urinary system of humans. i.e. Upper UTI(include Kidney & ureter) and lower UTI (include Urinary bladder & urethra).

    The most common infections involve the lower urinary tract infection such as; the bladder and the urethra.

    The urinary tract infection can be divide into two groups i.e.

    • Upper UTI:
      • Acute pyelonephritis: related kidney
      • Ureteritis: related ureter
    • Lower UTI:
      • Cystitis: related to the urinary bladder
      • Urethra: related the urethra

    According to the study, women are at greater risk of developing urinary tract infections than men.

    Symptoms of urinary tract infection 

    Urinary tract infections don’t all-time cause signs & symptoms, but when they do they include the following:

    • Flank pain
    • High fever
    • Malaise
    • Dysuria (painful urination)
    • Increased urinary frequency
    • Pain above the pubic area most common in women
    • Urine that appears as cloudy
    • Strong smelling in urine

    Some common terms related to UTI:

    • Recurrent UTI: >3 symptomatic UTIs within 12 months and following clinical therapy.
    • Reinfection: A recurrent UTI by a different pathogen at any time.
    • Relapse: A recurrent UTI by the same species causing original episode and within 2 weeks of therapy.
    • Bacteriuria: at least 105 colony-forming units (CFUs) per 1 mL of a single organism in the urine of an uncatheterized patient or 103 CFU/mL greater than or equal to one bacterial species present in the urine of a catheterized patient.
    • Pyuria: Generally defined as a positive leukocyte esterase on urine dipstick or ≥ 10 WBCs/HPF.
    • Sterile Pyuria: Pyuria without bacteriuria

     

    1. Incomplete antimicrobial treatment of Urinary tract infection
    2. Infections caused by Mycobacterial tuberculosis and other fastidious bacteria, for example, Chlamydia trachomatis.
    3. Urolithiasis and foreign bodies
    4. CIS
    5. Interstitial cystitis
    6. Schistosomiasis

    Types of Urinary tract infection (UTI) with signs and symptoms

    Infected Part of Urinary tract Signs & symptoms
    Acute pyelonephritis (kidneys)
    • Flank pain (upper backside pain)
    • High fever
    • Nausea and vomiting 
    • Shanking and chills
    • Malaise
    • WBCs and bacteria in urine
    Cystitis (Urinary bladder)
    • Frequent and painful urination
    • Urgency
    • Blood in urine
    • Pain above the pubic region (area) most common in the case of women
    • WBCs and bacteria in urine
    Urethritis (Urethra)
    • Burning with urination
    • Discharge

    •  

    When to see a doctor

    Consult your doctor if you have signs and symptoms of a UTI.

    Definitions for asymptomatic bacteriuria based on sex and method of the urine collection, shown below;

    Sex Method of specimen collection Microbiologic criteria
    Women Clean void (midstream) urine 105 CFU/mL from 2 consecutive specimens
    Men Clean void (midstream) urine 105 CFU/mL from a single specimen
    Women and men Straight catheterization 102 CFU/mL from a single specimen

    Note: CFU=colony forming units

    Causes

    Urinary tract infections typically occur when bacteria enter the urinary tract through the urethra and begin to multiply in the urinary bladder and moves to the kidney to cause Acute pyelonephritis.

    The most common UTIs occur mainly in women and mostly affected the urethra and urinary bladder.

    Infection of the urinary bladder (Cystitis)

    This type of UTI is caused by Escherichia coli (E. coli), which is a type of gram-negative (-ve) bacteria most frequently present in the gastrointestinal (GI) tract (intestine).

    However, sometimes other bacteria are responsible that as K. pneumoniae, S. saprophyticus, Enterococcus spp., S. aureus, Candida spp. etc.

    Sexual intercourse may lead to cystitis, but they don’t have to be sexually active to develop it.

    All women are at risk of cystitis because of their anatomically, a short distance from the urethra to the anus and the urethral opening to the bladder.

    Infection of the urethra (urethritis)

    This type of urinary tract infection (UTI) can occur when gastrointestinal tract bacteria spread from the anus to the urethra. Also, because the female urethra is close to the vagina, and sexually transmitted infections, such as herpes, gonorrhea, chlamydia, and mycoplasma, and other different bacteria above mention can cause urethritis.

    Risk factors of Urinary tract infection

    Urinary tract infections are common in women, and many women experience more than one infection in their lifetimes. Risk factors particular to women for urinary tract infections, include;

    • Female anatomy: A woman has a shorter urethra than a man and a short distance from the urethra to the anus and the urethral opening to the bladder.
    •  Sexual activity: Sexually active women tend to have more chance of UTIs than do women who aren’t sexually active. However, having a new sexual partner also chance to increases risk.
    • Menopause: After menopause, a decline in circulating hormone i.e. estrogen causes a change in the urinary tract that makes women more vulnerable to infection.
    • Some types of birth control: Women who use diaphragms to control the birth may be at greater risk, as well as women who use spermicidal agents.
    • Urinary tract abnormalities: Sometimes, babies born with urinary tract abnormalities that don’t allow urine to leave the body normally or cause urine to back up in the urethra have an increased risk of UTIs.
    • Urinary tract obstruction: Kidney stones or an enlarged prostate can trap urine in the bladder that leads to an increase in the growth of bacteria and an increase in the chance of UTIs.
    • A suppressed immune system: Diabetes and other diseases that impair the immune system that leads to an increase in the chance of UTIs.
    • Catheter Use:
      • People who can’t urinate on their own & use a tube (i.e. catheter) to micturate have an increased risk of urinary tract infections. This may include people who are hospitalized, those people who have neurological problems that make it difficult to control their ability to urinate, and those who are paralyzed patients.
    • A recent urinary procedure: Urinary surgery or an examination of the urinary tract that involves medical instruments can both increase the risk of developing UTIs.

    Complications

    • Recurrent infections
    • Permanent kidney damage due to an untreated Urinary tract infection.
    • Increased risk of developing hypertension in pregnancy, premature delivery, or LBW babies
    • Urethral stricture (narrowing) in men from recurrent urethritis

    Prevention 

    • Drink plenty of liquids, especially water: drinking plenty of water that helps to urine dilution and ensures that you’ll urinate more frequently and that leads to allowing bacteria to be flushed from the urinary tract before an infection can begin.
    • Drink cranberry juice
    • Wipe from front to back: ’cause doing so after urinating and after a bowel movement helps prevent bacteria in the anal region from spreading to the vagina and urethra.
    • Empty urinary bladder soon after intercourse and also drink a full glass of water to help flush bacteria.
    • Avoid irritating feminine products:  using deodorant sprays or other feminine products, such as douches and powders, in the genital area that can irritate the urethra.
    • Change your birth control method(device) such as; Diaphragms or unlubricated or spermicide-treated condoms, which can all contribute to bacterial growth.
    • Low dose antibiotics prophylaxis
    • Postcoital prophylaxis
    • Vaginal topical estrogens for postmenopausal women.
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