Urinary Tract Infections: causes and prevention
What is a urinary tract infection (UTI)?
A urinary tract infection (UTI) is an infection of the urinary system. This type of infection can involve your urethra (a condition called urethritis), kidneys (a condition called pyelonephritis) or bladder, (a condition called cystitis).
Your urine typically doesn’t contain bacteria (germs). Urine is a byproduct of our filtration system—the kidneys. When waste products and excess water is removed from your blood by the kidneys, urine is created. Normally, urine moves through your urinary system without any contamination. However, bacteria can get into the urinary system from outside of the body, causing problems like infection and inflammation. This is a urinary tract infection (UTI).
What is the urinary tract?
The urinary tract makes and stores urine, one of the body’s liquid waste products. The urinary tract includes the following parts:
- Kidneys: These small organs are located on back of your body, just above the hips. They are the filters of your body — removing waste and water from your blood. This waste becomes urine.
- Ureters: The ureters are thin tubes that carry urine from the kidneys to your bladder.
- Bladder: A sac-like container, the bladder stores your urine before it leaves the body.
- Urethra: This tube carries the urine from your bladder to the outside of the body.
How common are urinary tract infections (UTIs)?
Urinary tract infections are very common, occurring in 1 out of 5 women sometime in their lifetime. Though UTIs are common in women, they can also happen to men, older adults and children. One to 2% of children develop urinary tract infections. Each year, 8 million to 10 million visits to doctors are for urinary tract infections.
Who can get infected with urinary tract infections (UTIs)?
Anyone can get a urinary tract infection, but they are more common in women. This is because the urethra (tube the carries urine out of the body) in females is shorter and closer to the anus, where E. coli bacteria are common. Older adults also are at higher risk for developing cystitis. This increased risk may be due to incomplete emptying of the bladder. There are several medical conditions that can be related to this, including an enlarged prostate or a bladder prolapse (a condition where the bladder falls or slips out of its usual position).
If you get frequent urinary tract infections, your healthcare provider may do tests to check for other health problems — such as diabetes or an abnormal urinary system—that may be contributing to your infections. People with frequent UTIs are occasionally given low-dose antibiotics for a period of time to prevent the infection from coming back. This cautious approach to treating frequent UTIs is because your body can develop a resistance to the antibiotic and you can get other types of infections, such as C. diff colitis. This practice is used very infrequently.
What’s the difference between a urinary tract infection (UTI) and a bladder infection (cystitis)?
A urinary tract infection is a more general type of infection. There are many parts of your urinary tract. A UTI is a term for an infection that takes place throughout the urinary tract. A bladder infection, also called cystitis, is a specific infection. In this infection, bacteria make their way into the bladder and cause inflammation.
Not all urinary tract infections become bladder infections. Preventing the spread of the infection is one of the most important reasons to treat a UTI quickly when you have symptoms. The infection can spread not only to the bladder, but also into your kidneys, which is a more complicated type of infection than a UTI.
SYMPTOMS AND CAUSES
What causes a urinary tract infection (UTI)?
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.
What are the symptoms of a urinary tract infection (UTI)?
A urinary tract infection causes the lining of the urinary tract to become red and irritated (inflammation), which may produce some of the following symptoms:
- Pain in the side (flank), abdomen or pelvic area.
- Pressure in the lower pelvis.
- Frequent need to urinate (frequency), urgent need to urinate (urgency) and Incontinence (urine leakage).
- Painful urination (dysuria) and blood in the urine.
- The need to urinate at night.
- Abnormal urine colour (cloudy urine) and strong or foul-smelling urine.
Other symptoms that may be associated with a urinary tract infection include:
DIAGNOSIS AND TESTS
How are urinary tract infections (UTIs) diagnosed?
Your doctor will use the following tests to diagnose a urinary tract infection:
- Urinalysis: This test will examine the urine for red blood cells, white blood cells and bacteria. The number of white and red blood cells found in your urine can actually indicate an infection.
- Urine culture: A urine culture is used to determine the type of bacteria in your urine. This is an important test because it helps determine the appropriate treatment.
If your infection does not respond to treatment or if you keep getting infections over and over again, your doctor may use the following tests to examine your urinary tract for disease or injury:
- Ultrasound: In this test, sound waves create an image of the internal organs. This test is done on top of your skin, is painless and doesn’t typically need any preparation.
- Cystoscopy: This test uses a special instrument fitted with a lens and a light source (cystoscope) to see inside the bladder from the urethra.
- CT scan: Another imaging test, a CT scan is a type of X-ray that takes cross sections of the body (like slices). This test is much more precise than typical X-rays.
MANAGEMENT AND TREATMENT
How are urinary tract infections (UTI) treated?
You will need to treat a urinary tract infection. Antibiotics are medicines that kill bacteria and fight infection. Antibiotics are typically used to treat urinary tract infections. Your healthcare provider will pick a drug that best treats the particular bacteria that’s causing your infection. Some commonly used antibiotics can include:
- Sulfonamides (sulfa drugs).
- Trimethoprim/sulfamethoxazole (Bactrim®).
- Quinolones (such as ciprofloxacin [Cipro®]).
It’s very important that you follow your healthcare provider’s directions for taking the medicine. Don’t stop taking the antibiotic because your symptoms go away and you start feeling better. If the infection is not treated completely with the full course of antibiotics, it can return.
If you have a history of frequent urinary tract infections, you may be given a prescription for antibiotics that you would take at the first onset of symptoms. Other patients may be given antibiotics to take every day, every other day, or after sexual intercourse to prevent the infection. Talk to your healthcare provider about the best treatment option for you if you have a history of frequent UTIs.
What are the complications of a urinary tract infection (UTI)?
A urinary tract infection can be easily treated with antibiotics. However, if it isn’t treated or if you stop the medication early, this type of infection can lead to a more serious infection, like a kidney infection.
Can I become immune to the antibiotics used to treat a UTI?
Your body can actually get used to the antibiotics typically used to treat a urinary tract infection (UTI). This happens in people who have very frequent infections. With each UTI and the use of antibiotics to treat it, the infection adapts and becomes harder to fight. This is called an antibiotic-resistant infection. Because of this, your healthcare provider may suggest alternative treatments if you have frequent UTIs. These could include:
- Waiting: Your provider may suggest that you watch your symptoms and wait. During this time, you may be encouraged to drink plenty of fluids (especially water) in an effort to “flush out” your system.
- Intravenous treatment: In some very complicated cases, where the UTI is resistant to antibiotics or the infection has moved to your kidneys, you may need to be treated in the hospital. The medicine will be given to you directly in your vein (intravenously). Once you’re home, you will be prescribed antibiotics for a period of time to fully get rid of the infection.
Does cranberry juice prevent a urinary tract infection (UTI)?
Many people say that cranberry juice can help treat, or even prevent, a UTI. Researchers are currently looking into the topic, but haven’t found a definitive answer yet. Healthcare providers recommend drinking lots of fluids if you have, or have a history of getting, a UTI. Adding a glass of unsweetened cranberry juice to your diet isn’t a proven way to prevent a UTI, but it typically won’t hurt you either.
Can I prevent a urinary tract infection (UTI)?
You can usually prevent a urinary tract infection (UTI) with lifestyle changes. These tips can include:
- Practising good hygiene: You can often prevent UTIs by practising 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 to 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.
Over-the-counter supplements are also available for UTIs. These are sometimes recommended for people who have frequent UTIs as another way to prevent them. Talk to your healthcare provider before starting any supplements and ask if these could be a good choice for you.
OUTLOOK / PROGNOSIS
What is the prognosis (outlook) for a person with a urinary tract infection?
Urinary tract infections (UTIs) typically respond very well to treatment. A UTI can be uncomfortable before you start treatment, but once your healthcare provider identifies the type of bacteria and prescribes the right antibiotic medication, your symptoms should improve quickly. It’s important to keep taking your medication for the entire amount of time your healthcare provider prescribed. If you have frequent UTIs or if your symptoms aren’t improving, your provider may test to see if it’s an antibiotic-resistant infection. These are more complicated infections to treat and may require intravenous antibiotics (through an IV) or alternative treatments.
When should I call my healthcare provider?
Call your healthcare provider if you have symptoms of a urinary tract infection. If you have been diagnosed with a UTI and your symptoms are getting worse, call your healthcare provider. You may need a different treatment. Watch out for these symptoms in particular:
- Back pain.
If you have any of these symptoms, or your other symptoms continue after treatment, call your healthcare provider. A UTI can spread throughout your urinary tract and into other parts of your body. However, treatment is very effective and can quickly relieve your symptoms.