Urinary tract infections

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Overview

Urinary tract infection (UTI) remains very common. As many as 50% of women report having had at least one UTI in their lifetimes. Urinary tract infection is the most common cause of infection in nursing home residents and the most common source of bacteremia in the elderly population. Urinary tract infection occurs in patients with structurally or functionally abnormal urinary tracts (complicated UTI) and in patients with anatomically normal urinary tracts (uncomplicated UTI). Escherichia coli (E coli) is the most common cause of uncomplicated UTI, whereas antibiotic-resistant Enterobacteriaceae, enterococci, and Candida species often are the causes of complicated UTI. In this article we review current concepts of the epidemiology, microbiology, pathophysiology, clinical manifestations, diagnosis, and treatment of urinary tract infection.

Symptoms

Urinary tract infections don't always cause signs and symptoms, but when they do they may include:

A strong, persistent urge to urinate

A burning sensation when urinating

Passing frequent, small amounts of urine

Urine that appears cloudy

Urine that appears red, bright pink or cola-colored — a sign of blood in the urine

Strong-smelling urine

Pelvic pain, in women — especially in the center of the pelvis and around the area of the pubic bone

UTIs may be overlooked or mistaken for other conditions in older adults.

Types of urinary tract infection

Each type of UTI may result in more-specific signs and symptoms, depending on which part of your urinary tract is infected.

Part of urinary tract affected Signs and symptoms

Kidneys (acute pyelonephritis)

Back pain or side (flank) pain

High fever

Shaking and chills

Nausea

Vomiting

Bladder (cystitis)

Pelvic pressure

Lower abdomen discomfort

Frequent, painful urination

Blood in urine

Urethra (urethritis)

Burning with urination

Discharge

Causes

Urinary tract infections are caused by microorganisms — usually bacteria — that enter the urethra and bladder, causing inflammation and infection. Though a UTI most commonly happens in the urethra and bladder, bacteria can also travel up the ureters and infect your kidneys.


More than 90% of bladder infection (cystitis) cases are caused by E. coli, a bacterium normally found in the intestines.

having sex.

pregnancy.

conditions that block the urinary tract – such as kidney stones.

conditions that make it difficult to fully empty the bladder – such as an enlarged prostate in men and constipation in children.

urinary catheters (a tube in your bladder used to drain urine)

Risk factors

Anything that reduces your bladder emptying or irritates the urinary tract can lead to a UTI. There are also many factors that can put you at an increased risk of getting a UTI.

These risk factors include:

age (older adults are more likely to get UTIs)

reduced mobility after surgery or prolonged bed rest

kidney stones

a previous UTI

urinary tract obstructions or blockages, like:

enlarged prostate

kidney stones

certain forms of cancer

prolonged use of urinary catheters, which may make it easier for bacteria to get into your bladder

diabetes

pregnancy

abnormally developed urinary structures from birth

weakened immune system

Additional UTI risk factors for men

Most UTI risk factors for men are the same as those for women. But having an enlarged prostate can also increase UTI risk.

Additional UTI risk factors for women

While it’s widely believed that wiping from back to front after using the bathroom increases the risk of recurring UTIs, older research showed that this isn’t the case.

Female anatomy. A woman has a shorter urethra than a man does, which shortens the distance that bacteria must travel to reach the bladder.

Sexual activity. Sexually active women tend to have more UTIs than do women who aren't sexually active. ...

Certain types of birth control. ...

Menopause.

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Complications

When treated promptly and properly, lower urinary tract infections rarely lead to complications. But left untreated, a urinary tract infection can have serious consequences.

Complications of a UTI may include:

Recurrent infections, especially in women who experience two or more UTIs in a six-month period or four or more within a year.

Permanent kidney damage from an acute or chronic kidney infection (pyelonephritis) due to an untreated UTI.

Increased risk in pregnant women of delivering low birth weight or premature infants.

Urethral narrowing (stricture) in men from recurrent urethritis, previously seen with gonococcal urethritis.

Sepsis, a potentially life-threatening complication of an infection, especially if the infection works its way up your urinary tract to your kidneys.

Prevention

You can usually prevent a urinary tract infection (UTI) with lifestyle changes. These tips can include:

Practicing good hygiene: You can often prevent UTIs by practicing good personal hygiene. This is especially important for women. Because the urethra in women is much shorter than it is in men, it’s easier for E. coli bacteria to move from the rectum back into the body. To avoid this, it’s recommended that you always wipe from front to back after a bowel movement. Women should also use good hygiene practices during their menstrual cycle avoid infections. Changing pads and tampons frequently, as well as not using feminine deodorants can also help prevent UTIs.

Drinking plenty of fluids: Adding extra fluids, especially water, to your daily routine can help remove extra bacteria from your urinary tract. Drinking six to eight glasses of water per day is recommended.

Changing your urination habits: Urination can play a big role in getting rid of bacteria from the body. Your urine is a waste product and each time you empty your bladder, you’re removing that waste from your body. Urinating frequently can reduce your risk of developing an infection, especially if you have a history of frequent UTIs. Drinking plenty of fluids will encourage this, but makes sure to avoid fluids and foods that could irritate your bladder. These can include alcohol, citrus juices, caffeinated drinks and spicy foods. You should also try to urinate immediately before and after sex. This could help flush out any bacteria that may have been introduced during intercourse. You can also wash the genital area with warm water before having sex. Don’t douche. This practice isn’t recommended by healthcare providers.

Changing your birth control: Some women have an increased risk of developing a UTI if they use a diaphragm for birth control. Talk to your healthcare provider about other options for birth control.

Using a water-based lubricant during sex: If you experience vaginal dryness and use a lubricant during sex, use one that is water-based. You may also need to avoid spermicide if you have frequent UTIs.

Changing your clothing: Avoiding tight-fitting clothing can actually help keep you dry, preventing bacteria from growing in the urinary tract. You can also switch to cotton underwear. This will prevent extra moisture from getting trapped around your urethra.

In some post-menopausal women, a healthcare provider may suggest an estrogen-containing vaginal cream. This may reduce the risk of developing a UTI by changing the pH of the vagina. Talk to your healthcare provider if you have recurrent UTIs and have already gone through menopause.

You can usually prevent a urinary tract infection (UTI) with lifestyle changes. These tips can include:

Practicing good hygiene: You can often prevent UTIs by practicing good personal hygiene. This is especially important for women. Because the urethra in women is much shorter than it is in men, it’s easier for E. coli bacteria to move from the rectum back into the body. To avoid this, it’s recommended that you always wipe from front to back after a bowel movement. Women should also use good hygiene practices during their menstrual cycle avoid infections. Changing pads and tampons frequently, as well as not using feminine deodorants can also help prevent UTIs.

Drinking plenty of fluids: Adding extra fluids, especially water, to your daily routine can help remove extra bacteria from your urinary tract. Drinking six to eight glasses of water per day is recommended.

Changing your urination habits: Urination can play a big role in getting rid of bacteria from the body. Your urine is a waste product and each time you empty your bladder, you’re removing that waste from your body. Urinating frequently can reduce your risk of developing an infection, especially if you have a history of frequent UTIs. Drinking plenty of fluids will encourage this, but makes sure to avoid fluids and foods that could irritate your bladder. These can include alcohol, citrus juices, caffeinated drinks and spicy foods. You should also try to urinate immediately before and after sex. This could help flush out any bacteria that may have been introduced during intercourse. You can also wash the genital area with warm water before having sex. Don’t douche. This practice isn’t recommended by healthcare providers.

Changing your birth control: Some women have an increased risk of developing a UTI if they use a diaphragm for birth control. Talk to your healthcare provider about other options for birth control.

Using a water-based lubricant during sex: If you experience vaginal dryness and use a lubricant during sex, use one that is water-based. You may also need to avoid spermicide if you have frequent UTIs.

Changing your clothing: Avoiding tight-fitting clothing can actually help keep you dry, preventing bacteria from growing in the urinary tract. You can also switch to cotton underwear. This will prevent extra moisture from getting trapped around your urethra.

In some post-menopausal women, a healthcare provider may suggest an estrogen-containing vaginal cream. This may reduce the risk of developing a UTI by changing the pH of the vagina. Talk to your healthcare provider if you have recurrent UTIs and have already gone through menopause.

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