Infectious diseases are caused by microorganisms such as bacteria, viruses, fungi or parasites. Urinary tract infections (UTIs) are infections of the urinary tract. The urinary tract is made up of kidneys, ureters, bladder and urethra. The urinary system is the body’s drainage system for removing wastes and excess water. This tract collects and stores urine and provides the system of tubes necessary to release it from the body.
UTIs are much more common in girls and women than in boys and men younger than 50 years of age. The proximity of the urethra of women to the anus and vagina and the shorter urethra they have make them more predisposed to UTIs. About 40-50% of women and 12% of men have a urinary tract infection at some time in their life.
Susceptibility traits
- People with kidney stones
- Immunosuppressed persons e.g., HIV-infected persons, diabetes (high sugar level encouraged bacterial growth)
- Sexually active women
- Women who use diaphragm for birth control
- People on immunosuppressant drugs such as cancer chemotherapy
- Men with enlarged prostate or those that have prostatitis
- Young children, mostly due to poor hygiene
- Delaying or retaining urine
- Taking frequent baths
- Catheterization
- Pregnancy
Clinical manifestations of UTIs
Clinical manifestations of UTIs are mostly asymptomatic, but symptoms are dependent on whether it is upper or lower UTI and also on age
Lower UTIs (Adults)
- Frequency
- Dysuria
- Urgency
- Haematuria
- Urethritis (burning with urination)
- Lower abdominal pain
- Bad/foul smelling urine
- Lower abdominal pain or pelvic pressure
Upper UTIs
- Fever (usually higher than 38˚C)
- Rigors
- Nausea and vomiting
- Flank pain on one side
Symptoms in other age groups
Babies and infants
- Failure to thrive, vomitting, fever, diarrhea, apathy, odd-smelling urine
Children
- Frequency, dysuria, haematuria, abdominal discomfort
Elderly
- Mainly asymptomatic but may show only symptoms of agitation, delirium, confusion and/or behavioural changes.
- Have higher risk of developing complications such as kidney infections or sepsis from UTIs.
Complications of UTI
- Kidney failure or damage as a result of spread of infection to the kidney especially if not treated
- Infecting organism may infect other organs through the bloodstream (septicaemia)
- May result to preterm labour in pregnant women
- Diabetes considerably contributes to the development and the deterioration of LUTS
How To Prevent UTI When You Feel It Coming
- Drinking a lot of water
- Not delaying urination
- Taking showers instead of bath
- Wiping from the front when cleaning after using the toilet
Treatment
- Asymptomatic cases not usually treated except in children and pregnant women.
- Antibiotics: mainstay, choice based on efficacy, safety and cost.
- Blood levels important in pyelonephritis while in lower UTI, urine level is important.
- Urinary analgesics (potassium or sodium citrate) but must be used in conjunction with antibiotics.
UTI in pregnancy
- Hormonal changes alter normal urinary tract function and predispose women to infections
- Increased pressure on the bladder prevents the complete emptying of the bladder leading to favorable growth conditions for bacteria
- Untreated bacteriuria can lead to acute pyelonephritis with attending consequences like maternal anaemia, low neonatal birth weight, hypertension, and premature birth.
See also: Common exercises to do and avoid when pregnant
UTIs and menopause
Reduction in the estrogen levels during menopause predispose some women to be more susceptible to UTI because estrogen provides some level of protection against UTI.