Urinary tract infection (UTI) is one of the most common infections affecting people of all ages – infants, toddlers, children, teens, and adults. As the term implies, it is an infection that involves the urinary system, or the so-called renal system. Patients typically complain of painful urination, pelvic pain, urgent need to urinate, and increased voiding frequency in scant amounts. Learn about the causes, symptoms, complications, natural and medical treatments, and prevention of this infection.
1 Understanding the Urinary System
The urinary system, or renal system, is responsible for the excretion of waste from the body through filtration by the kidneys and elimination in the form of urine. The kidneys, urinary bladder, ureters, and urethra make up the urinary system.
The kidneys are paired, bean-shaped organs located on each side of the spine below the ribs. Their main function is to filter waste products and excess water from the blood, thereby producing urine. The kidneys play an important role in regulating the blood pressure. They also regulate red blood cell production and electrolyte balance.
The ureters are paired narrow fibromuscular tubes, with each ureter attached to each kidney and connected to the urinary bladder. Measuring approximately 10-12 inches long, these tubes function to carry urine from the kidneys to the bladder.
From the kidneys, the urine passes through the ureters, then collected and stored in the urinary bladder until it is discharged from the body by urination. The bladder, which is a distensible hollow organ, can hold about 600 milliliters of urine.
The urethra is the tube connecting the bladder to the urinary meatus. It is where the urine makes its final journey for excretion. The urethras in females are shorter than males and closer to the anus, the reason why females are mostly prone to urinary tract infection. In males, the urethra also serves as passageway for sperm and semen during ejaculation.
2 Types and Causes of Urinary Tract Infection
The type and causes of urinary tract infection depend on which part of the urinary system is affected:
Inflammation of the urethra is known as urethritis. The cause of the infection may be bacterial or viral; bacterial infection is mainly caused by the bacteria Escherichia coli, while viral infection can be attributed to the herpes simplex virus (HSV). Other bacteria may also be responsible for urethritis, such as Chlamydia trachomatis which causes chlamydia, and Neisseria gonorrhoea which is the causative agent of gonorrhoea. The herpes simplex virus, chlamydia, and gonorrhoea are sexually transmitted, meaning they can be passed on from one person to another through sexual contact. In some cases, and mostly in women, urethritis may also occur if the bacteria normally inhabiting the anal area enter the urinary tract. Other factors which may result to urethritis include prolonged usage of the catheter, and products that may irritate the urethra such as soaps and douches.
Symptoms of urethritis include:
- Burning pain when passing urine
- Urinary urgency and frequency
- Urinating in scant amounts
- Yellowy or bloody discharge from the penis
- Bloody urine or semen
- Irritation, itching or tenderness around the penis
- Painful intercourse or ejaculation
- Pelvic pain which may be accompanied by fever and chills
While both men and women can be affected by urethritis, women may not show any symptoms, or their symptoms may be difficult to distinguish from a bladder infection.
Cystitis refers to the inflammation of the urinary bladder. There are many factors that contribute to developing a bladder infection, but the most common causative agent is the bacteria Escherichia coli. Conditions such as pregnancy or an enlarged prostate may result to the individual’s inability to empty the bladder properly, which in turn, may cause cystitis.
Risk factors also include prolonged use of the catheter, irritants such as hygiene sprays or spermicides, diabetes, immobility, using tampons, using diaphragm as a contraceptive, being sexually active, menopause, and rarely, as a reaction to certain drugs. Women are more prone to developing cystitis, since the female urethra is shorter and closer to the anus than the male urethra. Men are less likely to contract this infection, but when they do, it is usually more serious, as it could indicate underlying problems such as prostatitis or tumor.
Symptoms of cystitis include:
- Burning sensation during urination
- Strong urgency to urinate
- Frequent passing of scant amounts of urine
- Bloody and foul smelling urine
- Pain in the lower back or abdomen
- Low-grade fever
Pyelonephritis, also known as kidney or renal infection, is a type of UTI which involves the kidneys. Often caused by the bacteria Escherichia coli, pyelonephritis can also be secondary to urethritis and cystitis, since the bacteria and viruses causing such infections may travel to the kidneys and may also reach the bloodstream, spreading to different parts of the body.
Factors that increase the incidence of kidney infection include pregnancy, prolonged catheter use, diabetes, blockage in the urinary tract, abnormal structure of the urinary system, weakened immune system, and vesicoureteral reflux (VUR) – a condition wherein urine backflows from the bladder to the ureters and kidneys.
Kidney infection patients may develop the following symptoms:
- Painful, frequent urination
- Persistent urinary urgency
- Back or flank pain
- Abdominal pain
- Groin pain
- Nausea or vomiting
- Fever and chills
- Bloody or cloudy urine
- Burning pain when passing urine
The elderly may not develop these symptoms, but may demonstrate mental confusion, speech impairment, or delusions, while children below age two may not show symptoms other than fever.
5 General Diagnosis and Treatment of UTI
There are numerous ways to diagnose urinary tract infection, as well as its complications. Physicians may ask about the patient’s medical history and symptoms, and may also perform physical and laboratory examinations depending on the severity and upon consideration of other related diseases. Basic tests include urinalysis, urine culture and sensitivity, as well as blood tests. Pelvic examination may also be performed on sexually-active female patients, while male patients may undergo genital or rectal examinations to check the prostate. The following imaging studies may also be carried out: ultrasound, to assess urinary bladder and kidney problems; cystoscopy, which uses a tiny camera to view and detect abnormalities in the urinary tract; intravenous pyelogram (IVP), which uses a radiopaque dye to get X-ray pictures of the ureters and kidneys; fluoroscopic studies; and CT scan. There are also available over the counter home test strips to detect UTI, although it is still best to be seen and properly assessed by the physician.
Depending on medical history, severity, or if there are complications, urinary tract infection can be treated with a course of antibiotics. For mild cases, a three-day-course of oral antibiotics is sufficient, but for moderate bladder infections or mild kidney infections, a 7- to 14-day-course of treatment may be required. A more severe kidney infection or severe symptoms may require hospital confinement and antibiotics may be given intravenously. Commonly used drugs to treat UTI include trimethoprim/sulfamethoxazole, doxycycline, cephalexin, ciprofloxacin, amoxicillin, Augmentin, and fluoroquinolones.
Precaution must be taken before taking antibiotics, and it is recommended to consult your health practitioner if you are pregnant, diabetic, or under medication with immunosuppressant drugs. Patients with sexually transmitted diseases should be given appropriate treatment, since some bacteria that cause STDs also cause urethritis in both men and women.
6 Prevention and Natural Remedies for UTI
Good hygiene is of great importance, especially in women after urinating and defecating. Wiping should be from front to back and not the other way around to avoid the spread of bacteria from the anus to the vagina and urethra. Increasing water intake, avoiding irritants such as feminine wash and douches, avoiding usage of diaphragms as contraceptives, and emptying the bladder regularly especially after sexual intercourse are other ways to reduce the risk of having urinary tract infection. Maintaining a healthy diet and lifestyle also help in its prevention, and the estrogen cream given to menopausal women also reduces the infection.
Although studies are not conclusive, many people resort to taking cranberry juice or supplements as a natural way of preventing and treating UTI. Cranberry juice is said to stop the bacteria from adhering to the bladder wall and helps flush them away. The unsweetened juice is preferred to avoid the sugar. However, some people are unable to tolerate the juice and may end up with diarrhea or an upset stomach. In addition, drinking cranberry juice should be avoided by people taking blood-thinning drugs like warfarin.
Herbal remedies such as Arctostaphylos uva-ursi, Oregon grape root, and goldenseal help combat inflammation and Escherichia coli, which is the most common bacteria that causes the infection.
7 Complications of the Infection
An infection of the urinary system may lead to complications such as:
- Lasting damage to one or both kidneys, most likely in younger kids
- Repeated infections in women
- Higher risk of delivering premature, low birth weight babies in pregnant women
- Narrowing of the urethra in men due to recurrent urethritis
- Septicemia, a condition where an infection causes virulent microorganisms to invade the bloodstream
- Sepsis, a complication where there is presence of pus-producing bacteria and their toxins in tissues or in the blood, which may be life-threatening
Urinary tract infection can be easily managed when treated early. A course of low-dose antibiotics is sufficient to fight off mild infection without complications, however, infections involving the kidney and more severe complications can be dangerous and may require intravenous administration of antibiotics and hospitalization. It is important to maintain a healthy lifestyle, good hygiene, and to increase water intake to avoid the infection. It also helps to watch for the early signs of infection and immediately consulting health care practitioners to provide relief and treatment to bothersome and possible life-threatening pee problems.