Urinary Tract Infections
Urinary tract infections (UTI’s) are one of the most common afflictions which cause patients to go to the doctor. UTI’s can affect men, women and children. However, it is predominantly women that get UTI’s.
The kidneys filter blood and extract waste products and water which constitute urine. The urine then travels down tubes called the ureters to the bladder. The bladder is a muscle which contracts and expels urine out the urine tube called the urethra. Normally the bladder squeezes out almost all of the urine leaving only a small residual of urine behind. However, at times a puddle of urine is left behind, for example, in men with an enlarged prostate, and women with a dropped bladder which may allow bacteria (organisms which can cause UTI’s) to grow and cause infections.
Cystitis refers to bacteria entering the bladder and invading the wall of the bladder causing swelling and inflammation. Common symptoms include burning during urination, severe urgency to void, frequency, malodorous urine, and blood in the urine. At times bacteria can ascend to the kidneys and cause an infection called pyelonephritis. This is a more severe infection which can cause fevers, flank and abdominal pain and similar cystitis-like symptoms. Pyelonephritis is an infection which can damage kidney tissue, and especially in children, must be worked up to rule out any anatomical problems which are predisposing the individual to infections.
Women tend to get more UTI’s because of the urethra being located within the vaginal area. The typical bacteria which affect men and women originate from the bowels. The perineum and genitals of women are usually colonized with bacteria. Sexual activity is often a way that bacteria can enter the urethra and cause cystitis in women. Studies have shown, however, that the bacteria that are found in the bladder of women with cystitis are the same bacteria that inhabit the patient’s vaginal area. This is an important fact because it means the infections are related to sexual activity but are not sexually transmitted.
A thorough history and physical exam are important when dealing with UTI’s. A urinalysis and microscopic examination alone with a urine culture will help determine the types of treatment needed. Usually oral antibiotics and bladder anti-spasmodics will relieve the cystitis symptoms in a few days. The urine culture may alter the course of antibiotics.
A UTI may be related to anatomical problems in the urinary tract and your doctor will need to determine if a more aggressive work-up is needed or simply administrating antibiotics. UTI’s in children and men will need a full work-up. Often, prostate disease or obstruction in men and refluxing of urine up to the kidneys in children will be identified. Blood in the urine may simply be from a UTI, but an individual needs to be followed because it may indicate underlying urinary pathology.
Some women may have a UTI after sexual relations for the reasons described above. In this situation an antibiotic is usually prescribed after each sexual contact. The important aspect of UTI’s is that they may represent underlying problems in the urinary tract. Antibiotics may temporarily relieve the situation, however, the physician and patient need to develop a strategy to treat UTI’s and work them up more aggressively when indicated.
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