What is urine infection?

Normal urine is sterile. When bacteria get into the urine, it can affect only the bladder when the term cystitis can be applied. Infection that goes up to the kidneys are more severe and can lead to kidney damage. Bacteria usually get into urine by going up the urethra (urine passage).

How do we know it is urine infection?

Urine infection is common and can affect children and adults alike. In children, urine infection presents with fever, irritability, vomiting, shivering and poor feeding. In adults, symptom ranges from frequency of urination, lower abdominal pain, burning sensation in the urine passage, cloudy and smelling urine to blood in the urine. When the infection affects the kidneys, the patient can be very ill with loin pain, shivering and even shock.

What predispose to infection?

Urine infection more likely to occur when there is an abnormality in the urinary tract (kidney, ureter, bladder, urethra). In a normal person, the female urethra is much shorter than that of the male and consequently, in the absence of any urinary tract abnormality, women get infection more readily than men. In women, sexual intercourse predisposes to urine infection. Typically, young girls get their first cystitis when they become sexually active. Such infections are not regarded as venereal diseases and do not transmit between partners. Diabetic patients are more likely to get urine infections due to the presence of sugar in the urine. After menopause, the state of the vagina and urethra becomes less healthy and more easily prone to infection. Infections are also more likely to occur when there is stagnant urine in the bladder because of incomplete voiding during micturition caused either by an obstruction of bladder outlet (urethral narrowing associated with menopause, prostate enlargement in men) or abnormal bladder function due to disease or injury affecting the nerves involved in the normal control of the bladder. Ultimately the types of bacteria that get into the bladder originate from the faeces and maintaining lower body hygiene is an important way to prevent urine infection.

How is it diagnosed?

Urine infection can be suspected based on a typical history of an acute onset of frequent urination, burning pain, lower abdominal pain, back pain and cloudy or bloody urine. The finding of red and white blood cells in your urine when examined under the microscope is highly suggestive of an infection. However, the diagnosis can only be confirmed by obtaining a clean catch specimen of mid stream for culture to isolate the offending bacteria and identify the effective antibiotics against it. Most laboratories can give results of urine culture within 48 hours. Occasionally, the same bacteria can be identified in the blood.

What other investigations would the doctor do?

A special X-ray of the urinary tract (intravenous urogram) is indicated when there is blood in the urine. This X-ray is also done in patients with recurrent infections or in patients who have kidneys stones associated with the infection. Ultrasound scan can also give useful information about the kidneys and bladder. Occasionally, a telescope inspection of the bladder (cystoscopy) is carried out to rule out associated bladder disease, particularly bladder tumours.

Recurrent Infections

Many women suffer from frequent UTI's. Nearly 20 percent of women who have a UTI will have another, and 30 percent of those will have yet another. Of the last group, 80 percent will have recurrences. It is well known that some women are more prone to get recurrent attacks than others. Research had shown that women with certain blood types are particularly prone to UTI's because the cells lining the vagina and urethra may allow bacteria to attach more easily. Further research will show whether this association is sound and proves useful in identifying women at high risk for UTI's.

Infections in Pregnancy

Pregnant women seem no more prone to UTI's than other women. However, when a UTI does occur, it is more likely to travel to the kidneys. About 2 to 4 percent of pregnant women develop a urinary infection. Scientists think that hormonal changes and shifts in the position of the urinary tract during pregnancy make it easier for bacteria to travel up the ureters to the kidneys. For this reason, many doctors recommend periodic testing of urine.

Treatment

The mainstay of UTI treatment is the use of an appropriate antibiotic. An uncomplicated UTI can be cured with 1 or 2 days of treatment. UTI's are treated with antibacterial drugs. The choice of drug and length of treatment depends on the patient's history and the urine tests that identify the offending bacteria. The sensitivity test is especially useful in helping the doctor select the most effective drug. The drugs most often used to treat routine, uncomplicated UTI's are trimethoprim, trimethoprim/sulfamethoxazole (Bactrim), amoxicillin (Amoxil), nitrofurantoin, ampicillin and newer antibiotics such as ciprofloxacin (Ciprobay), pefloxacin (Peflacin) and oflaxacin (Tarivid).

Often, a UTI can be cured with 1 or 2 days of treatment if the infection is not complicated by an obstruction or nervous system disorder. However, most doctors prefers to ask their patients to take antibiotics for 5 to 7 days to ensure that the infection has been cured. Single-dose treatment is not recommended for some groups of patients, for example, those who have delayed treatment or have signs of a kidney infection, patients with diabetes or structural abnormalities, or men who have prostate infections. Longer treatment is also needed by patients with infections that also affect the prostate or the testis. It is important to take the full course of treatment because symptoms may disappear before the infection is fully cleared. A pregnant woman who develops a UTI should be treated promptly. Only certain antibiotics are advisable during pregnancy and the doctor should be consulted.

Severely ill patients with kidney infections may be hospitalized until they can take fluids and needed drugs on their own. Kidney infections generally require several weeks of antibiotic treatment.

Various drugs are available to relieve the pain of a UTI. A heating pad or a warm bath may also help. Most doctors suggest that drinking plenty of water helps cleanse the urinary tract of bacteria. Occasionally, urine alkalinizing agents such as citrate and bicarbonate can significantly alleviate the irritative symptoms associated with UTI.

Recurrent Infections in WomenWomen who have frequent recurrences may benefit from preventive therapy. About 4 out of 5 women who have a UTI get another in 18 months. Many women have them even more often. A woman who has frequent recurrences (three or more a year) should ask her doctor about one of the following treatment options:

• Take low doses of an antibiotic daily for 6 months or longer. (If taken at bedtime, the drug remains in the bladder longer and may be more effective.) This therapy can be effective without causing serious side effects.
• Take a single dose of an antibiotic after sexual intercourse.
• Take a short course (1 or 2 days) of antibiotics when symptoms appear.

Doctors suggest some additional steps that a woman can take on her own to avoid an infection:

• Drink plenty of water every day. Some doctors suggest drinking cranberry juice, which in large amounts inhibits the growth of some bacteria by acidifying the urine. Vitamin C (Ascorbic Acid) supplements have the same effect;
• Urinate when you feel the need; don't resist the urge to urinate;
• Wipe from front to back to prevent bacteria around the anus from entering the vagina or urethra;
• Take showers instead of tub baths;
• Cleanse the genital area before sexual intercourse
• Avoid using feminine hygiene sprays and scented douches, which may irritate the urethra.
• Pass urine immediately after sexual intercourse
• Avoid excessive talcum powder over the genital area
• Cut down on the consumption of sugar and sweets whilst increasing dietary fibres.

Complicated Infections

When the infection proves difficult to treat, an underlying cause should be suspected. This can range from