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The urinary tract consists of the kidneys, ureters, bladder and urethra. A urinary tract infection (UTI) occurs when excessive bacteria grow in the urinary tract, most commonly in the lower urinary tract (bladder and urethra), a condition known as cystitis. E. coli, a common pathogen that crosses over from the anal region, accounts for a whopping 85% of all UTI.
 The Urinary Tract
UTIs are the second most common type of infection in the body. Women are more prone to UTIs than men, which is likely due to their having shorter urethra (the tube that carries urine out from the bladder during urination), which makes it easier for bacteria to move up to the bladder. The urethral opening in women is also nearer sources of bacteria from the anus and vagina. According to the Department of Urogynaecology at KK Women’s and Children’s Hospital, as many as 1 in 2 women will experience at least one UTI during their lifetime.
About 1 in 5 between the ages of 20 to 65 will suffer at least one attack every year, and 3% of the cases turn into chronic recurrent UTI (RUTI).
Recurrent UTIs
A recurrent urinary tract infection (RUTI) is described as symptomatic UTI occurring after the apparent cure of a previous UTI, typically more than twice over a 6-month period. Two-thirds of all RUTI have been found to be due to same strains of E. coli despite adequate treatment.
The mainstay investigations for diagnosing UTI include urinalysis or urine culture; where microscopy looks for white blood cells, red blood cells, the presence of nitrites and leukocytes, and bacteria that point to a UTI. The culture identifies the specific bacteria causing the UTI, and indicating a specific antibiotic that can treat the UTI. An alkalinising agent may also be administered concurrently to make the urine more hostile to bacteria.
In RUTI, further tests are required, which include the following:
• Renal Ultrasound: to look at the kidneys and to measure residual urine volume
• Abdominal X-ray: This is to detect urinary tract stones
• Urine Culture: To test for tuberculosis
• Urine cytology: To assess for any cancerous cells in the urinary tract (which most commonly presents with blood in the urine)
• Cystoscopy: A specialised camera is inserted through the urethra to look for abnormalities such as stones and tumour in the bladder.
Treatment for RUTI sufferers typically includes antibiotics for the longer term, or stronger antibiotics, although follow-up urine culture is necessary to “test-for-cure”. If left untreated, the infection can spread upwards to the kidneys, leading to renal infection and increasing the risk of renal failure or permanent damage. In extreme situations, bacteria may spread via the bloodstream, leading to a generalised body-wide infection or septicaemia (blood-poisoning), which may be fatal in certain cases. .
Risk Factors
Some factors that increase women’s risk of developing UTI include:
• Age: The rate of UTIs in women gradually increases with age.
• Incomplete bladder emptying, which allows the residual urine to be rapidly infected by bacteria present. Causes include:
- Pregnancy - about 15% of pregnant women will experience a UTI
- Bladder, uterine or any other pelvic organ prolapse
• Sexual intercourse, which seems to trigger a UTI infection in many women, although the reason for this is unclear.
• Use of diaphragm and condoms with spermicidal foam as contraceptives
• Immunosuppression with certain medications or drugs
• Diabetes
• Menopause with the attendant loss of oestrogen
• Abnormalities of the urinary tract, such as kidney or renal stones, which act as a focus for infection
• Instrumentation of the urinary tract (e.g. catheterisation, cystoscopy)
Signs & Symptoms
Early recognition and adequate treatment of UTI is necessary to prevent complications. Signs to look out for include:
• Painful, burning sensation during urination (dysuria)
• High frequency and feeling of urgency of urination, even when there’s little urine
• Cloudy, dark, foul-smelling or bloody urine
• Discomfort at the lower abdomen
• Fever, tiredness or shakiness
• Nausea or back pain (signs of renal infection)
It is advisable to seek treatment if the infection doesn’t clear up in a few days. The infection is normally confined to the bladder, but may spread to the kidneys, which is serious and may cause permanent damage.
Treating & Preventing UTI
The main treatment for urinary tract infection is antibiotics, together with an adequate intake (3–4 litres a day) of water and other fluids. Drinking cranberry and blueberry juices is also believed to help prevent infection, as certain chemicals contained in them reduce the chance of bacteria sticking to the bladder skin lining, which leads to infection. Probiotics (live culture yoghurt) have also been shown to reduce the chance of getting a UTI, as "good" live bacteria is introduced into the bowels of patients and reduces the chance of the "bad" bacteria in our bowels spreading and causing UTI.
UTIs can be prevented by ensuring proper personal hygiene and regular emptying of the bladder. As the source of the bacteria comes from the bowels, it is also vitally important to clean from front to back after defecation to avoid faecal contamination of the vaginal region.
Regular, daily cleansing of the genital area with water is encouraged, especially before and after sexual intercourse, but avoid the overzealous use of vaginal cleansers to reduce the chances of getting UTI. Urination after sexual intercourse also helps flush away urine possibly contaminated with bacteria. All active vaginal infections should also be treated, or bacteria may spread on to the urinary tract. |
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