Wellbeing / 25 May, 2020

Preventing urinary tract infections

Dr Lau Pik Onn

What is a urinary tract infection?

A urinary tract infection (UTI) is an infection which occurs in any part of the urinary system, including the kidneys, ureters, bladder and urethra. It is one of the most common infections, especially among women. An adult woman is 30 times more likely to develop a UTI compared to a man.

Bladder infection (cystitis) makes up the majority of UTIs. If the infection spreads to the kidneys (pyelonephritis), this can lead to serious consequences.

Causes of UTIs

Most urinary tract infections are caused by bacteria, although they occasionally develop due from the presence of fungi and in rare cases, from viruses.

As urine is usually sterile, a UTI occurs when a microorganism, usually bacteria, enters the urinary system through the urethra and begins to multiply in the bladder. Bacteria that enters the bladder are usually excreted during urination, but if they remain they can grow easily and result in infection.

Most infections are caused by the bacteria Escherichia coli (E.coli) and spread to the urethra from the anus. E.coli is a bacteria normally found in the gastrointestinal tract.

Other microorganisms that can cause UTIs are chlamydia and mycoplasma, which are sexually transmitted. In such cases both partners will need treatment.

What are some predisposing factors for UTIs?

Adult women are more prone to UTIs as their urethra is much shorter and closer to the anus compared to men.

Anything that reduces bladder emptying or irritates the urinary tract can lead to a UTI.

Some factors include:

  • Not drinking enough water
  • Dehydration – from sports or vomiting and diarrhoea
  • Passing urine infrequently – holding your bladder
  • Sexual activity – increases risk of cystitis as bacteria can enter the bladder through the urethra
  • Menopause – loss of oestrogen after menopause leads to changes in the vaginal flora, especially loss of lactobacilli which inhabits the vagina of fertile women and prevents other bacteria from invading the urethra. After menopause the mucous lining of the uterus also becomes thinner reducing ability to resist bacterial invasion.
  • Unhygienic toilet habits – e.g. wiping from back to front
  • Blockage in urinary tract – kidney or bladder stones or an enlarged prostate can trap urine in the bladder and increase your risk of UTI
  • Diabetes – especially when poorly controlled
  • Urinary tract abnormalities – abnormally developed urinary structures from birth
  • Reduced mobility – after surgery or prolonged bed rest
  • Certain types of birth control – such as diaphragms and spermicidal agents which can change vaginal flora and eradicate lactobacilli

Signs and symptoms of UTIs

Not all urinary tract infections have symptoms. The symptoms may also differ depending on the type of infection and your age.

When symptoms are present, they can include:

A persistent urge to urinate

Burning sensation on passing urine

Increased frequency of urination

with small amounts of urine each time

Cloudy/blood stained urine

Foul smelling urine

Lower abdominal or loin pain

Nausea and vomiting

Fever and chills

How is a UTI diagnosed?

It’s important to consult your doctor if you have any of the symptoms mentioned above.

A urine sample analysis will be required to assess for presence of infection and a urine culture may also be conducted to identify the bacteria.

Treatment for UTIs

Mild cases of acute cystitis may disappear spontaneously without treatment, but because of the risk of complications treatment is recommended.

A course of antibiotics is usually adequate to treat simple UTIs. The type of antibiotics and length of treatment will depend on the bacteria and your medical history.

For recurrent UTIs (defined as having a UTI three or four times each year), further investigations may be needed. This may include renal ultrasound, intravenous pyelogram, CT KUB and cystoscopy.

Prevention

There are several things you can do to assist in preventing UTIs. These include:

  • Drinking plenty of water (at least 2 litres a day), especially on hot days or when exercising. This will help dilute your urine and urinate more often, allowing bacteria to be flushed out.
  • Drinking cranberry juice or taking vitamin C. This will increase acidity of the urine which reduces bacterial growth.
  • Don’t hold urine for long periods of time.
  • Wiping from front to back after defecating to prevent contamination from the anus. This will prevent bacteria in anal region from spreading to vagina and urethra.
  • Emptying your bladder soon after sexual intercourse.
  • Avoiding using feminine products that may irritate the urethra (e.g. scented douches, vaginal deodorants).
  • For post-menopausal women, you can use topical oestrogen, daily cranberry supplements and vaginal probiotics.

Complications

When treated promptly and properly, UTIs rarely lead to complications. However, if untreated:

  • Kidney damage may occur if cystitis is not successfully treated, as infection can move upwards to the kidneys
  • Septicemia (blood infection) can occur if the bacteria enters the blood stream. This is potentially life threatening
  • Premature birth may occur during pregnancy
  • Urethral narrowing (stricture) can occur in men with recurrent urethritis
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