< BACK URINARY TRACT INFECTIONS A urinary tract infection (UTI) is an infection involving the kidneys, ureters, bladder, or urethra. These are the structures that urine passes through before being eliminated from the body. The kidneys are a pair of small organs that lie on either side of the spine at about waist level. They have several important functions in the body, including removing wastes and excess water from the blood and eliminating them as urine. The ureters drain urine from the kidneys into the bladder. The bladder is a small saclike organ that collects and stores urine. The bladder contracts to expel the urine. The urethra is a small tube connecting the bladder with the outside of the body. Any part of this system can become infected. As a rule, the higher up the infection, the more serious it is. The upper urinary tract is composed of the kidneys and ureters. Infection in the upper urinary tract generally affects the kidneys (pyelonephritis). The lower urinary tract consists of the bladder and the urethra. Infection in the lower urinary tract can affect the urethra (urethritis) or the bladder (cystitis). In the United States, urinary tract infections account for more than 7 million visits to medical offices and hospitals each year. Urinary tract infection is much more common in adults than in children, but about 1-2% of children do get urinary tract infections. Urinary tract infections in children are more likely to be serious than those in adults. Urinary tract infection is second only to respiratory infection as the most common type of infection. These infections are much more common in girls and women than in boys and men younger than 50 years. About 40% of women and 12% of men have a urinary tract infection at some time in their life. CAUSES OF URINARY TRACT INFECTIONS The urine is normally sterile. An infection occurs when bacteria get into the urine and begin to grow. The infection usually starts at the opening of the urethra where the urine leaves the body and moves upward into the urinary tract. The culprit in at least 90% of uncomplicated infections is Escherichia coli (E coli.) These bacteria normally live in the bowel (colon) and around the anus. These bacteria can move from the area around the anus to the opening of the urethra. The two most common causes of this are poor hygiene and sexual intercourse. Usually, the act of emptying the bladder (urinating) flushes the bacteria out of the urethra. If there are too many bacteria, this won't stop them. The bacteria can travel up the urethra to the bladder, where they can grow and cause an infection. The infection can spread further as the bacteria move up from the bladder via the ureters. If they reach the kidney, they can cause a kidney infection (pyelonephritis), which can become a very serious condition if not treated promptly. The following people are at increased risk of urinary tract infection: People with conditions that block (obstruct) the urinary tract, such as kidney stones People with medical conditions that cause incomplete bladder emptying (for example, an enlarged prostate or spinal cord injury or cystocele, also known as a "dropped bladder") People with suppressed immune systems Women who are sexually active: Sexual intercourse can introduce larger numbers of bacteria into the bladder. Urinating after intercourse seems to decrease the likelihood of developing a urinary tract infection. Uncircumcised males: This risk is still relatively low, but it is higher than in circumcised males. Males are also less likely to develop UTIs because their urethra is longer. The following special groups may be at increased risk of urinary tract infection: Children of all ages: Urinary tract infection in children can be (but is not always) a sign of an abnormality in the urinary tract. Hospitalized patients or nursing home residents: Many of these individuals are catheterized for long periods and are thus vulnerable to infection of the urinary tract. SYMPTOMS OF UTIs Lower urinary tract infection (cystitis) Dysuria - Pain or burning during urination Frequency - More frequent urination (or waking up at night to urinate) Urgency - The sensation of not being able to hold urine Hesitancy - The sensation of not being able to urinate easily or completely (or feeling that you have to urinate but only a few drops of urine come out) Cloudy, bad smelling, or bloody urine Lower abdominal pain Mild fever (less than 101°F), chills, and malaise Upper urinary tract infection (pyelonephritis): Symptoms develop rapidly and may or may not include the symptoms for a lower urinary tract infection. Fever (higher than 101°F) Shaking chills Nausea Vomiting Flank pain - Pain in your back or side, usually on only one side at about waist level In infants, children, and elderly people, the classic symptoms of a urinary tract infection may not be present. Other symptoms may indicate a urinary tract infection. Infants - Vomiting, diarrhea, fever, poor feeding, not thriving Children - Irritability, eating poorly, unexplained fever that doesn't go away, loss of bowel control, loose bowels, change in urination pattern Elderly people - Fever or hypothermia, poor appetite, lethargy, change in mental status WHEN TO SEEK MEDICAL CARE Any adult or child who develops any of the symptoms of a urinary tract infection needs evaluation by a medical professional, preferably within 24 hours. Most medical offices can test urine for infection by using a quick urine "dipstick" test or, preferably, by examining your urine with a microscope. If you have symptoms of a lower urinary tract infection, call your urologist for an appointment, preferably on the very day that symptoms are recognized. If you have symptoms of an upper urinary tract infection involving the kidneys, call your urologist immediately. Depending on the situation, he or she will recommend either a visit to the office or to a hospital emergency department. If you have symptoms of a lower urinary tract infection and any of the following applies to you, you may have a urinary tract infection that involves the kidneys. Go to a hospital emergency department right away. Vomiting and inability to keep down clear fluids or medication Not better after taking antibiotics for 2 days Pregnant Having diabetes or another disease that affects the immune system (for example, AIDS) Taking medication that suppresses the immune system DIAGNOSIS Diagnosis of a urinary tract infection is based on information you give about your symptoms, medical and surgical history, medications, habits, and lifestyle. A physical examination and lab tests complete the evaluation. Your doctor may simply perform a urine dipstick in the office. Only a few minutes are needed to obtain results. The urine can also be examined with a microscope to look for the presence of bacteria. Your doctor may also send your urine to the lab for testing. These results take a few days to come back. This tells your doctor the exact bacteria causing your infection and to which antibiotics these bacteria have resistance or sensitivity. You may be asked to give a clean-catch, midstream urine specimen. This avoids contamination of the urine with bacteria from your skin. You should be instructed in how to do this. If you cannot produce a urine specimen or are unable to follow instructions for a clean-catch specimen, your urologist will obtain a urine specimen by catheterizing you. Men will most likely require a rectal examination so that the prostate can be checked. A prostate infection (prostatitis) requires a longer course of antibiotics than a urinary tract infection. In some cases, an imaging test may be indicated to detect any underlying problem in the urinary tract that could cause an infection. Cystoscopy involves insertion of a tiny camera through the urethra into the bladder. This allows detection of abnormalities inside the bladder that might contribute to infections. A CT scan gives a very detailed 3-dimensional picture of the urinary tract. An ultrasound can evaluate kidney and bladder problems. Intravenous pyelogram (IVP) is a special series of x-rays that uses a contrast dye to highlight abnormalities in the urinary tract. A fluoroscopic study can show any physical problems that predispose children to urinary tract infections. Imaging tests are most often needed for the following groups: Children with urinary tract infections Adults with frequent or recurrent urinary tract infections TREATMENT Because the symptoms of a urinary tract infection mimic those of other conditions, you should see your urologist if you think you have a urinary tract infection. A urine test is needed to confirm that you have an infection. Self-care is not recommended. You can help reduce the discomfort by taking the following steps: Finish all antibiotic medication. Take a pain-relieving medication. Drink plenty of water. Avoid coffee, alcohol, and spicy foods, all of which irritate the bladder. Quit smoking. Smoking irritates the bladder and is known to cause bladder cancer. MEDICAL TREATMENT The usual treatment for both simple and complicated urinary tract infections is antibiotics. The type of antibiotic and duration of treatment depend on the circumstances. Lower urinary tract infection (cystitis) In an otherwise healthy young female, a 3-day course of antibiotics is often enough. Some providers prefer a 7-day course to be sure of getting rid of the infection. Adult males with a UTI require 7-14 days of antibiotics. If the prostate is also infected (prostatitis), 4 weeks of antibiotic treatment may be required. To alleviate burning pain during urination, Pyridium or Prosed can be used for 1-2 days. Upper urinary tract infection (pyelonephritis) Young, otherwise healthy females with symptoms of pyelonephritis can be treated as outpatients. They may receive IV fluids and antibiotics or an injection of antibiotics, followed by 10-14 days of oral antibiotics. If you are very ill, dehydrated, or unable to keep anything in your stomach because of vomiting, an IV will be inserted into your arm. You will be given fluids and antibiotics through the IV until you are well enough to switch to an oral antibiotic. A complicated infection may require treatment for several weeks. You may be hospitalized if you have symptoms of pyelonephritis and any of the following: Appear very ill Are pregnant Have not gotten better with outpatient antibiotic treatment Have underlying diseases that compromise the immune system (diabetes is one example) or are taking immunosuppressive medication Are unable to keep anything in your stomach because of nausea or vomiting Had previous kidney disease, especially pyelonephritis within the last 30 days Have a device such as a urinary catheter in place Have kidney stones FOLLOW-UP Follow your urologist's treatment recommendations. Finish all medications even if you are feeling better before the medication is gone. Your urologist will want to see you again to repeat the urinalysis and make sure you are getting better. Occasionally, the infection does not go away with the first treatment. If you are being treated for an infection and have any of the following, call your urologist promptly Fever or pain with urination is not gone after 2 days of antibiotic treatment. You cannot keep the medication down or it has severe side effects. You are unable to keep foods, fluids, or medication down because of nausea or vomiting. You develop signs of kidney involvement (such as flank pain, shaking chills, high fever). Your symptoms are worse rather than better after 2 days of antibiotics. PREVENTION Women and girls should wipe from front to back (not back to front) after going to the bathroom. This helps prevent bacteria from the anus entering the urethra. Empty your bladder regularly and completely, especially after sexual intercourse. Drink plenty of fluids. Cranberry juice, especially, has been shown to help prevent urinary tract infections. There is evidence that cranberries reduce the risk of the bacteria's adhesion to bladder cells. < BACK Click Here to contact your doctor's office. For Billing Questions Click Here The Urology Group 4700 Smith Road Cincinnati, Ohio 45212 Click Here For A Complete Listing Of Our Locations Copyright © 2012 - The Urology Group - All rights reserved