Urinary Tract Infections Diagnosis and Treatment

Urinary Tract Infections Diagnosis and Treatment

A urinary tract infection (UTI) is a common infection that affects any component of the urinary system. The primary cause of UTIs is bacteria, most commonly Escherichia coli (E. coli). Common symptoms include frequent urination, pain during urination, and discomfort in the lower back or side. In most cases, antibiotics are effective in treating UTIs.

UTIs often cause noticeable issues with passing out urine, such as painful urination or urine that appears cloudy or has an unpleasant odour. In addition to urinary problems, individuals may experience flu-like symptoms or pain in the areas affected by the infection.

What is a urinary tract infection (UTI)?

A urinary tract infection occurs when there is an infection in any part of your urinary system.

This can involve the following:

• Urethra (urethritis)
• Bladder (cystitis)
• Kidneys (pyelonephritis)

Urine, commonly referred to as pee, is produced by the kidneys as part of the blood-filtering process. This involves removing waste products and excess water from the bloodstream. Normally, urine travels through the urinary system without becoming contaminated. However, bacteria can sometimes enter the system, leading to a urinary tract infection.

What is the urinary tract?

The urinary tract is responsible for the production and storage of urine. It comprises the following:

• Bladder: A balloon-shaped organ that serves as a storage container for urine before it is expelled from the body.
• Kidneys: These small, bean-shaped organs are located towards the back of your body, just above the hips. Most individuals have two kidneys that filter water and waste, such as urea and creatinine, from the blood to create urine.
• Ureters: Thin tubes that transport urine from the kidneys to the bladder.
• Urethra: This is a tube that carries urine from the bladder to the outside of the body.

How common are urinary tract infections?

UTIs are extremely common, particularly in women and individuals assigned female at birth (AFAB). Approximately 50% of AFAB individuals will experience a UTI at least once in their lifetime. Although less common, men and individuals assigned male at birth (AMAB), as well as children, can also develop UTIs. However, only 1% to 2% of children are affected. Every year, doctors provide treatment for 8 to 10 million individuals with UTIs.

Symptoms and Causes

UTIs are widespread infections of the urinary system.

What are the symptoms of a UTI?

A UTI results in inflammation of the urinary tract's lining, which can cause various symptoms, such as:

• Pain in the flank, abdomen, pelvis, or lower back
• A sensation of pressure in the lower pelvic region
• Cloudy urine
• Foul-smelling urine
• Difficulty in controlling urination (urinary incontinence)
• Urge to urinate frequently
• Sudden, strong urges to urinate (urge incontinence)
• Discomfort or pain during urination (dysuria)
• Blood in the urine (haematuria)

Additional symptoms that may be associated with UTIs include:

• Pain in the penis
• Extreme tiredness or fatigue
• Fever and chills
• Nausea or vomiting
• Confusion or changes in mental state

How do UTIs develop?

UTIs are usually caused by microorganisms, predominantly bacteria. These microorganisms often enter the urinary system through the urethra, where they may travel to infect the bladder. If left untreated, the infection can ascend through the ureters to the kidneys.

What is the leading cause of UTIs?

In over 90% of cases, bladder infections are caused by E. coli, a type of bacteria that typically resides in the lower intestines (large intestine).

What category of people are at higher risk of developing a UTI?

While anyone can develop a UTI, individuals with vaginas are at a higher risk. This increased likelihood is due to the shorter length of the urethra and its closer proximity to the anus, where E. coli bacteria are commonly found.

Can fingers cause UTIs?

Yes, it is possible to introduce bacteria and other microorganisms into the urinary system through fingers. Hands can easily collect bacteria from various surfaces, which may then be accidentally transferred to the urethra during activities such as using the bathroom or engaging in sexual practices, including masturbation or fingering.

To reduce this risk, it is advisable to wash hands thoroughly both before and after using the bathroom or engaging in sexual activity.

How can you tell if you have a UTI?

If you experience UTI symptoms, consult a doctor. They will evaluate your symptoms, review your medical history, and perform a physical examination. Diagnostic tests may also be conducted to confirm the presence of a UTI.

What tests diagnose UTIs?

Doctors may recommend the following tests to diagnose a UTI:

• Urinalysis: This test requires providing a urine sample in a specially designated cup. The sample is sent to a laboratory for examination, where technicians check for signs of a UTI using indicators such as white blood cells, nitrites, and leukocyte esterase.
• Urine Culture: To conduct this test, you'll provide a urine sample in a specialised container. Laboratory technicians will use the sample to grow and identify any bacteria present. A urine culture is essential because it helps the doctor determine the most effective treatment for your specific infection.

If the infection doesn't respond to treatment, the doctor may order further tests to identify potential diseases or injuries in the urinary system. These tests include:

• Ultrasound: This imaging test provides a view of internal organs. It is non-invasive, painless, and doesn't require preparation.
• Computed Tomography (CT) Scan: A CT scan produces detailed cross-sectional images of your body, resulting in 3D visuals that offer a more precise diagnostic capability than standard X-rays.
• Cystoscopy: This procedure involves inserting a cystoscope—a thin instrument with a light and lens—into the bladder via the urethra to closely examine the bladder.

For individuals who experience frequent UTIs, a doctor might investigate other underlying conditions, such as diabetes or abnormalities in the urinary system, which could make infections more likely.

What should you do if you have a UTI?

The most effective way to address a urinary tract infection is to consult a doctor. UTIs require treatment with antibiotics, and the doctor will select the antibiotic best suited to combat the bacteria causing the infection.

After obtaining an antibiotic prescription, it's crucial to follow the instructions precisely. Ensure that you complete the full course, even if your symptoms subside, before finishing the medicine. Stopping the treatment prematurely may result in the recurrence of this infection and become more difficult to treat.

If UTIs are frequent, a doctor may recommend preventative antibiotic use:

• Daily or every other day
• After sexual intercourse
• At the first indication of symptoms

Discuss the most suitable course of treatment with a doctor if you have recurrent UTIs.

Which antibiotics are commonly used for UTIs?

Doctors frequently prescribe the following antibiotics to treat urinary tract infections:

• Amoxicillin
• Nitrofurantoin
• Doxycycline
• Sulfonamides (sulfa drugs), such as sulfamethoxazole/trimethoprim
• Cephalosporins, such as cephalexin
• Fosfomycin
• Quinolones, including ciprofloxacin or levofloxacin

In cases of frequent UTIs, a doctor might prescribe low-dose antibiotics for short-term use to prevent recurring infections. However, this approach is cautious due to concerns over antibiotic resistance and the potential for developing secondary infections such as C. diff colitis. For this reason, this practice is not standard.

Can you become resistant to UTI Antibiotics?

Not exactly. It is the bacteria causing the infection, not your body, that can develop resistance to antibiotics. Each time antibiotics are used, bacteria can adapt, making them harder to eliminate in the future. Because of this, antibiotics are not always the ideal solution.

Doctors may suggest alternative approaches for recurrent UTIs, such as:

• Waiting: Monitoring symptoms while drinking plenty of fluids, particularly water, to help flush out the urinary system.
• Intravenous (IV) Treatment: For severe or antibiotic-resistant infections, you may require hospital care, where medications are administered through a needle placed in a vein (usually in the arm). Once home, you may need additional oral antibiotics to fully eliminate the infection.

Does cranberry juice help prevent UTIs?

Store-bought cranberry juice is not effective at preventing urinary tract infections. However, cranberry extract supplements, such as vitamin tablets, may help reduce the likelihood of developing a UTI. Methenamine hippurate is another non-antibiotic preventative option available for individuals who frequently suffer from UTIs.

Can UTIs resolve on their own?

While minor urinary tract infections can sometimes clear without intervention, the majority require antibiotics. Antibiotics are essential if the UTI is accompanied by:

• Fever
• Chills
• Nausea or vomiting

How quickly will you feel better after treatment?

Most individuals experience noticeable relief within a few days of starting antibiotic treatment for a urinary tract infection.

Can urinary tract infections be prevented?

Yes, you can reduce your risk of developing urinary tract infections by adopting certain lifestyle habits and strategies:

Practise Proper Hygiene

Maintaining good hygiene is one of the most effective ways to prevent urinary tract infections, particularly for those with a vagina, as the shorter urethra allows bacteria like E. Coli to more easily move from the rectum to the urinary system.

After a bowel movement, always wipe from front to back to avoid transferring bacteria. During menstruation, regularly change your pads or tampons to minimise the risk of bacterial growth. Avoid using scented deodorants or sprays in the vaginal area, as they may irritate sensitive tissues.

Stay Hydrated

Increasing your daily fluid intake, particularly water, can help flush bacteria from your urinary tract. Medical professionals often recommend consuming six to eight glasses of water daily to promote urinary health.

Adjust your bathroom habits

Your urination patterns play a significant role in helping to expel bacteria from your system. You should consider peeing frequently and avoid holding urine for long periods, as this reduces the likelihood of bacterial build-up.

Make it a habit to urinate before and immediately after sexual activity, as this helps remove bacteria introduced during intercourse. If urination isn't possible, rinsing the area with warm water may be beneficial.

Rethink your birth control options

Using certain contraceptives, such as diaphragms, may increase the likelihood of developing a UTI. Discuss alternative birth control options with a doctor if you experience recurrent infections.

Choose appropriate lubricants

If you use lubricants during sexual activity, ensure they are water-based to minimise irritation. Additionally, avoid lubricants that contain spermicide, as it can increase your risk of developing urinary tract infections.

Wear comfortable clothing

Opt for loose-fitting clothes and breathable fabrics like cotton for underwear. These materials discourage the growth of bacteria by reducing moisture around the urethral area, creating a less hospitable environment for infection-causing microorganisms.

Consider medical interventions and supplements

For postmenopausal individuals, vaginal oestrogen creams may be recommended. These creams can help reduce the risk of UTIs by altering the vaginal pH, making it less favourable for bacteria to thrive.

Some over-the-counter supplements, such as cranberry extract and probiotics, may also be beneficial for preventing urinary tract infections. However, consult a doctor before introducing any new supplements into your routine.

What can you expect if you have a urinary tract infection?

The prognosis for urinary tract infections is generally positive. Most infections respond well to treatment, particularly when the correct antibiotic is used to target the bacteria causing the infection.

While symptoms like discomfort or irritation may initially be bothersome, a proper diagnosis and appropriate medical care typically result in a rapid improvement of symptoms.

Complete your antibiotic course

Always complete the full course of antibiotics your medical professional prescribes to ensure that the infection is thoroughly treated. If you experience recurrent urinary tract infections or if your symptoms persist despite treatment, your doctor may need to investigate further to determine if the bacteria causing the infection have developed resistance to antibiotics. In cases of antibiotic-resistant infections, alternative treatments such as intravenous (IV) antibiotics may be required.

When should I visit a doctor for a UTI?

Consult a healthcare professional if you experience any symptoms of a urinary tract infection. If you've already been diagnosed with a UTI and your condition worsens or your symptoms fail to improve, contact your doctor, as you may need an alternative treatment approach.

When should I go to the emergency room?

Visit the emergency room immediately if you experience a UTI along with the following severe symptoms:

• Fever
• Pain in the back or flanks
• Persistent vomiting

Questions to ask your medical professional

When discussing UTIs with your healthcare provider, you might consider asking the following questions:

• How did you determine that I have a urinary tract infection?
• If it's not a UTI, what other conditions could be causing my symptoms?
• What bacteria are responsible for my UTI?
• Which antibiotic will you prescribe, and why is it suitable for my case?
• Are there specific instructions I should follow when taking my antibiotics?
• How soon should I expect my symptoms to improve?
• Will I need a follow-up appointment to monitor my condition?
• What can I do at home to help alleviate my symptoms?

Common Questions About UTIs

What Is the Difference Between a UTI and Cystitis?

A urinary tract infection refers broadly to any infection within the urinary system, which includes the kidneys, ureters, bladder, and urethra.

Cystitis, on the other hand, is a more specific term referring to inflammation in the bladder, often caused by a bacterial infection. While cystitis is the most common type of UTI, it represents only one segment of the broader category of urinary tract infections.

How can you differentiate between a UTI and a bladder infection?

Urinary tract infection (UTI) is a general term encompassing infections occurring in any part of the urinary system.

Bladder infection (cystitis): This type of UTI specifically affects the bladder, causing irritation and inflammation.

Although not all urinary tract infections develop into bladder infections, treating UTIs promptly is essential to prevent them from progressing to more serious conditions such as kidney infections (pyelonephritis), which involve the kidneys and require more intensive treatment.

Note

If you have a urinary tract infection, remember there's no need to feel embarrassed. While UTIs often involve symptoms that affect the genital area or urinary incontinence, these infections are very common—especially in people with vaginas.

Medical professionals can prescribe antibiotics that effectively treat the infection, and your symptoms are likely to resolve within just a few days. Ensure you take your antibiotics exactly as prescribed and complete the entire course, even if you start feeling better before finishing the medication, to completely eradicate the infection.

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