A urinary tract infection or UTI is an infection that takes place anywhere within the urinary tract including the kidneys, ureters, bladder and urethra. The vast majority of urinary tract infections occur within the urinary bladder.
Women have a higher risk of higher risk of developing a UTI than men owing to the short length of the female urethra and its location in the vagina, a moist environment, and its proximity near the rectum, a source of bacteria. The male penis creates a physical separation from the bacterial environment of the rectum and the longer urethral length makes it more difficult for bacteria to enter the end of the urethra at the meatus and initiate a UTI.
Typically, urinary tract infections are limited to the bladder and cause mild symptoms such as burning with urination, urgency and frequency or urination; however, under certain situations, urinary tract infections can ascend into the ureters and kidneys and result in more serious and even life-threatening conditions.
The treatment for most urinary tract infection is antibiotic therapy; however, certain conditions require and intervention in addition to antibiotics such as a catheter to relieve urinary retention, lithotripsy to break up a stone, or a prostate reduction procedure.
What are the symptoms associated with a urinary tract infection?
Although on occasion a UTI can be asymptomatic, typical symptoms of a urinary tract infection include:
Dysuria or burning with urination
Urgency or a sudden strong desire to urinate
Frequency or needing to go to the bathroom often
Cloudy urine that you cannot see through easily
Hematuria or blood in the urine
Malodorous or foul-smelling urine
Back, flank or pelvic pain
Are there different types of urinary tract infections?
The classification of UTI is related to the specific organ in the urinary tract which the infection is present.
Symptoms include side (flank) pain, fever, chills, nausea and vomiting
Symptoms include pelvic pain or pressure, frequency, urgency, possible blood in the urine
Symptoms include burning with urination and urethral discharge
What are the causes of a urinary tract infection?
A urinary tract infection takes place when bacteria enters the urinary tract via the urethra and then begins to grow in numbers within the urinary tract. Under normal circumstances, the body’s natural defense mechanisms can fight off invading microbes; however, when these mechanisms fail, bacteria can multiply in the urethra, bladder or kidneys resulting in a UTI.
Cystitis occurs when bacteria, most commonly E. Coli from the GI tract, enters the urethra and multiplies in the bladder. In women, the physical act of intercourse can allow bacteria to enter the urethra resulting in cystitis. Women are at increased risk for a UTI owing to their short urethra and its close proximity to the anus.
Urethritis in an infection in the urethra and can occur as a result of STDS such as herpes, chlamydia, gonorrhea, mycoplasma and common GI bacteria.
What are the risk factors associated with a urinary tract infection?
Urinary tract infections are more common in women than in men. Risk factors associated with UTIs in women include:
Female anatomy- Women have a shorter urethra making it easier for bacteria from the GI tract to travel into the bladder. Also, the urethral meatus on a woman is located within vagina, a moist environment that may be colonized with bacteria.
Sexual activity- During intercourse bacteria can be forced into the urethra and so sexually active women have a higher risk for UTIs.
Birth control- Birth control methods specifically diaphragms and spermicidal agents increase a woman’s risk for UTIs.
Menopause- A decrease in estrogen after menopause causes changes in the vagina and urinary tract that increase a woman’s risk for UTI.
Additional UTI risk factors:
Abnormalities of the urinary tract- Some of us are born with certain anatomical variations and abnormalities of the urinary tract that leave us more susceptible to UTIs. Examples include ureteropelvic junction obstruction and vesicoureteral reflux.
Urinary tract obstruction. - A stone that blocks a kidney from draining can cause a urinary tract infection. Enlarged prostate as men age can result in obstruction of the bladder causing UTIs as well.
Immunosuppression- Patients with immunodeficiency diseases such as HIV or people with diabetes can have an increased risk for UTIs.
A urinary catheter- People who wear a foley catheter to drain their bladder for medical conditions or in the post-operative period may develop a UTI.
Instrumentation- A recent surgery in which a camera or instrument is introduced into the urinary tract can increase the risk for developing a UTI.
What complications can develop as a result of a urinary tract infection?
Under normal circumstances, when a UTI is treated promptly and correctly , it is rare to have any complications or significant consequences.
Complications however may occur especially in patients with recurrent UTIs and these include permanent kidney damage or scarring from recurrent UTIs or pyelonephritis, an increased risk of premature delivery or low birthweight infants in pregnant women, urethral strictures or scarring as well as severe bacterial growth and entry into the blood stream called sepsis.
How can a urinary tract infection be prevented?
In general, increasing water. Intake to flush bacteria out before it gets a hold is helpful. Cranberry juice is commonly recommended to decrease risk for a UTI, but there are no studies supporting its use. Women should always wipe from front to back and empty their bladders after intercourse. Avoid irritating products such as deoderants, douches and powders. Try and use other birth control methods other than diaphragms or spermicide treated condoms.
In more complicated circumstances such as patients with stones or urinary tract abnormalities surgical interventions might be recommended to decrease the risk of urinary tract infections.
Does cranberry juice help a urinary tract infection?
There is a commonly held belief that drinking cranberry juice or taking cranberry tablets will help to treat or prevent a urinary tract infection. There is an active ingredient in cranberries called A-type proanthocyanidins that may prevent the adherence of E.coli bacteria to the bladder wall. The amount of this acitve ingredient in supplements and juice does vary significantly. Additionally, studies looking at clinical UTIs in patients taking supplements or drinking cranberry juices are mixed with some showing a benefits and others showing no benefit at all. Some definitive recommendations that are scienttifically provent to prevent UTIs are taking precaution with sexual activity. Patients with more sexual partners are at higher risk for UTIs. Using spermicides and diaphragms are additionally assoicated with an increased risk for UTIs. Good bowel habits help prevent UTIs. Patients with constipation or diarrhea tend to have more pathological bacteria in and around the vagina. Balancing "good" bacteria with the "bad" by taking probiotics with lactobacillus and using estrogen cream in post menopausal women to optimize the pH for the "good" bacteria can help prevent UTIs as well.