Learn about UTIs, their symptoms, causes, and prevention. Get valuable insights on UTI treatment and how to maintain urinary health at Meri Sehat.

Urinary Tract Infections (UTI)

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Ismail Munir

Overview

An infection affecting any section of the urinary tract is referred to as a urinary tract infection. 
&nbsp;

One of the most prevalent infections in primary care is an uncomplicated lower urinary tract infection (UTI). In particular, it is also the most frequent bacterial infection in children under 2 years old in both outpatient and inpatient settings.

Young women who are sexually active, elderly people, and patients who need urethral catheterization tend to have UTIs more frequently.

Nearly 40% of women experience a UTI at some point in their lives. Reportedly, 1 in 3 women experience their first UTI episode by the time they are 24 years old. In Singapore particularly, 4% of young women are affected by UTI; this number increases to 7% by the time they reach 50<a href="#accordion">[1]</a>.

There are 3 types of urinary tract infections depending on the part of the urinary system that is infected: 
&nbsp;

<ul>
	<li>Urethritis: This refers to an infection of the urethra, the hollow tube that drains urine from the bladder to the outside of the body.</li>
	<li>Cystitis: This refers to an infection in the bladder. Usually, this infection has spread from the urethra.</li>
	<li>Pyelonephritis: This refers to kidney infection, which is more serious than lower UTIs. 
	&nbsp;</li>
</ul>

Signs and Symptoms

The symptoms depend on where the infection is<a href="#accordion">[3][5]</a>: 
&nbsp;

<h5>Bladder&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</h5>

<ul>
	<li>Pain or burning sensation while urinating</li>
	<li>Strong urge to urinate often but usually passing only a small amount of urine</li>
	<li>Pain in the lower belly</li>
	<li>Pelvic pressure</li>
	<li>Blood in urine</li>
	<li>Strong-smelling urine 
	&nbsp;</li>
</ul>

<h5>Kidney</h5>

<ul>
	<li>Back or side pain</li>
	<li>High fever and chills</li>
	<li>Nausea and vomiting 
	&nbsp;</li>
</ul>

<h5>Urethra</h5>

<ul>
	<li>Burning sensation while urinating</li>
	<li>Discharge 
	&nbsp;</li>
</ul>

Note: Some people show no symptoms at all, a condition known as asymptomatic bacteriuria. 
&nbsp;

Causes

The most common cause of UTIs is when bacteria enter the urinary system via the urethra and start to spread in the bladder. The urinary system is made to keep the bacteria out. Sometimes, however, these defenses fail. In that case, a serious infection develops in the urinary tract. 
&nbsp;

Other causes include:

<ul>
	<li>Escherichia Coli (E. coli) which is commonly present in the gastrointestinal tract can cause infection of the bladder.</li>
	<li>Sexually Transmitted Infections, such as <a href="https://merisehat.pk/disease/genital-herpes">herpes</a>, <a href="https://merisehat.pk/disease/gonorrhea">gonorrhea</a>, <a href="https://merisehat.pk/disease/chlamydia">chlamydia</a>, and mycoplasma, can also result in an infection of the urethra in both men and women.</li>
	<li>Catheters are a source of infection for people who are in long-term care facilities or hospitals.</li>
	<li>Bacteria traveling through the lymph or blood system can cause bladder or kidney infection. 
	&nbsp;</li>
</ul>

Women&#39;s anatomy predisposes them to a higher vulnerability to bladder infections due to the proximity of their urethra to the anus and the close proximity of the urethral opening to the bladder. Consequently, bacteria can readily migrate from the anus to the bladder<a href="#accordion">[5]</a>. This is why the recommended method for cleaning is front to back wiping. 
&nbsp;

There is no screening test for UTI. 
&nbsp;

Diagnosis

A detailed history is crucial to the diagnosis of UTI. The doctor will begin by asking the patient questions about their symptoms and their medical history. They may also order the following tests to identify a urinary tract infection:

<ul>
	<li>Urinalysis: This test looks for bacteria, white blood cells, and red blood cells in the urine. An elevated number of WBCs and RBCs in the urine indicate an infection. 
	&nbsp;</li>
</ul>

<ul>
	<li>Urine Culture: A urine culture is used to determine the type of bacteria present in the urine. This is an important test because it helps determine the appropriate treatment. 
	In case the infection does not respond to therapy or keeps recurring, the doctor may order additional tests to assess the condition of the patient&rsquo;s urinary system: 
	&nbsp;</li>
	<li>Cystoscopy: This test utilizes a special tool called a cystoscope, a long thin tube with a lens, to look inside the urethra and bladder. 
	&nbsp;</li>
	<li>Imaging Scans: An ultrasound, X-ray, CT scan, or MRI may be used to highlight structures in the urinary tract. 
	&nbsp;</li>
</ul>

Treatment

Urinary tract infections are normally treated with antibiotics. Doctors prescribe drugs that have the most efficacy against the particular bacteria infecting the individual patient. 
&nbsp;

Some commonly used antibiotics include:

<ul>
	<li>Nitrofurantoin</li>
	<li>Sulfonamides</li>
	<li>Amoxicillin</li>
	<li>Cephalosporins</li>
	<li>Doxycycline</li>
	<li>Quinolones</li>
	<li>Fosfomycin 
	&nbsp;</li>
</ul>

NOTE: It&#39;s crucial that you take the medication according to your doctor&#39;s instructions. Don&#39;t stop taking the antibiotic because you feel better and your symptoms disappear. The infection can come back if the full course of antibiotics is not taken to thoroughly treat it. 
&nbsp;

Treating Recurring UTI: In case the patient often has UTIs, doctors recommend low-dose antibiotics to prevent the infection from recurring. This approach also ensures that the body does not develop antibiotic resistance and, hence, becomes susceptible to other types of infections. 
&nbsp;

UTIs can lead to major health issues if they are not treated immediately or effectively<a href="#accordion">[3]</a>: 
&nbsp;

<ul>
	<li>Repeated infections, i.e., two or more instances of infection within 6 months. Repeated infections are especially common in women.</li>
	<li>Permanent kidney damage from a kidney infection due to an untreated UTI.</li>
	<li>Delivering a premature or low birth weight infant when UTI occurs during pregnancy.</li>
	<li>A narrowed urethra in men due to recurring urethral infections.</li>
	<li>Sepsis, which is potentially fatal especially if the infection travels up the urinary tract to the kidneys. 
	&nbsp;</li>
</ul>

<ul>
	<li>Female Anatomy: UTIs are uncommon in adult males who are under the age of 50; however, adult women are 30 times more likely than men to get the infection1. This is because the urethra in women is shorter than in men.&nbsp; As a result, there&#39;s less distance for bacteria to travel to reach the bladder. 
	&nbsp;</li>
	<li>Sexual Activity: Being sexually active and having multiple partners increase the risk of UTIs. 
	&nbsp;</li>
	<li>Certain Types Of Birth Control: The risk of UTIs is greater when using diaphragms or spermicidal agents for reproductive control. 
	&nbsp;</li>
	<li>Menopause: A decrease in the amount of circulating estrogen after menopause leads to changes in the urinary system, which can increase the risk of UTIs. 
	&nbsp;</li>
	<li>Urinary Tract Problems: Infants who are born with urinary tract issues may have difficulty urinating. Backflow of urine into the urethra can result in UTIs. 
	&nbsp;</li>
	<li>Blockages In The Urinary Tract: Kidney stones or an enlarged prostate can block the outflow of urine from the bladder. 
	&nbsp;</li>
	<li>A Suppressed Immune System: Diabetes and other diseases can impair the immune system, which is the body&#39;s defense against germs. Naturally, this increases the risk of UTIs. 
	&nbsp;</li>
	<li>Catheter Use: A catheter is used to help people who can&#39;t urinate on their own, such as those who are hospitalized or paralyzed or those who have other neurological conditions that make it difficult to control urination. 
	&nbsp;</li>
	<li>Recent Urinary Procedure: Both surgery and a urinary tract checkup that involve medical equipment can increase the risk of getting a UTI. 
	&nbsp;</li>
</ul>

Lifestyle modifications can usually help prevent urinary tract infections. These tips include<a href="#accordion">[3]</a>: 
&nbsp;

<ul>
	<li>Practicing Good Hygiene</li>
</ul>

UTIs can frequently be prevented by practicing good personal hygiene. For women, this is especially crucial because E. coli bacteria can travel from the rectum back into their bodies more easily. To avoid this, it is important to always wipe after a bowel movement from front to back.

To prevent infections, women should also maintain good cleanliness during their menstrual cycle, like frequently changing pads and tampons. 
&nbsp;

<ul>
	<li>Drinking Plenty Of Fluids</li>
</ul>

Increasing the daily fluid intake can help the urinary system get rid of excess bacteria. It is advised to consume 6-8 glasses of water per day. 
&nbsp;

<ul>
	<li>Changing Urination Habits</li>
</ul>

Urination is very important in removing microorganisms from the body. Frequent urination can help reduce the risk of infection, especially if there is a history of recurring UTIs. Drinking plenty of fluids will help, but avoid foods and drinks that can irritate the bladder, such as alcohol, citrus juices, coffee, and spicy foods.

Additionally, urinate right before and after sex. This helps remove any microorganisms that may have transferred during sexual activity. 
&nbsp;

<ul>
	<li>Changing Birth Control Methods</li>
</ul>

Some women have an increased risk of developing a UTI if they use a diaphragm for birth control. Spermicide, too, is a risk factor for recurring UTIs.

NOTE: Talk to your healthcare provider about other options for birth control. 
&nbsp;

<ul>
	<li>Using A Water-Based Lubricant</li>
</ul>

A water-based lubricant is recommended for vaginal dryness and during intercourse. 
&nbsp;

<ul>
	<li>Changing Your Clothing</li>
</ul>

Switch to cotton underwear as that prevents extra moisture from getting trapped around the urethra. 
&nbsp;

Researchers at the University of Surrey in England recently created new artificial intelligence (AI) technology that can recognize urinary tract infections.

They used non-negative matrix factorization along with cutting-edge machine learning algorithms to create a platform that could identify the early signs of UTIs. 
&nbsp;

The study involved <a href="https://merisehat.pk/disease/dementia">dementia </a>patients for whom UTIs are one of the most common reasons for hospitalization. The new technology significantly reduced the prevalence of UTIs in this cohort, which decreased hospitalization and the financial burden of the disease, and enhanced quality of life<a href="#accordion">[4]</a>. 
&nbsp;

Key Points

<ul>
	<li>An infection affecting any section of the urinary tract is referred to as a urinary tract infection.</li>
	<li>It is the most frequent bacterial infection in children under 2 years old in both outpatient and inpatient settings.</li>
	<li>1 in 3 women experience their first UTI episode by the time they are 24 years old.</li>
	<li>Complications of a UTI include repeated infections and permanent kidney damage.</li>
	<li>&nbsp;A UTI is typically avoidable by making lifestyle adjustments. These include drinking plenty of water, changing birth control methods, and using a water-based lubricant. 
	&nbsp;</li>
</ul>