MfA - Urinary Tract Infection, UTI

Definition:

Acute, uncomplicated urinary tract infections (UTI) are much more common in women than in men. They are caused by bacteria, which are usually transmitted by the sexual partner or originate from the woman's anal area.

The E. coli bacterium (Escherichia coli), which is normally present in the large intestine (colon) where it takes part in the normal process of digestion, is the causative agent in more than 75% of cases. Frequent sexual intercourse, the use of a vaginal diaphragm combined with a spermicidal cream (a cream that kills the sperms), as well as recurring bladder infections are linked with the disease.

Spermicidal cream which is almost always used in combination with a diaphragm alters the normal vaginal acidity thereby promoting bacterial overgrowth which again leads to recurrent urinary tract infections.

Symptoms:

Almost 50% of women know the typical symptoms of an acute uncomplicated UTI. There is the burning sensation while voiding and the constant urge to urinate although only a few drops may be produced, usually of a cloudy, often strong smelling urine.

As unpleasant as these symptoms may be, the acute uncomplicated UTI is not a severe disease and damage to the kidneys is extremely rare. However, if pain in the lower abdomen is accompanied by fever and stabbing pains in the side or lower back, it may be a sign of a beginning infection of the renal pelvis (pyelonephritis). In such a case, the bacteria have moved beyond the bladder and up the ureter towards the kidney where they can cause permanent damage.

Therefore it is of utmost importance to consult a physician as soon as any ONE of the following symptoms occurs:

Diagnosis:

The most important test to perform is to examine the urine - urinalysis - in order to confirm that the infection is indeed a UTI. This can be done via a simple and easily performed dipstick test, providing there are no signs of renal involvement or any other complications. In addition, it is also important to take urine for a culture test, in order to properly identify the infectious agent and to adjust the therapy accordingly. Possible urethral blockage can usually be ruled out by sonography.

The diagnosis of an acute uncomplicated UTI can be made, if pain is limited and if there are no other symptoms as listed above. In such a case, it is acceptable for the patients to try treating the infection themselves.

Therapy:

Self-treatment measures include: ample drinking: at least 8 filled (8-oz.) glasses a day - this is supposed to flush out the bacteria. But beware of cramps - a large amount of urine can, at times, worsen the pain; alcohol and caffeine containing drinks such as coffee or black tea should be avoided; the use of warmth is pleasant and can relieve cramps, especially of the lower abdomen - use warm water bottles, infra red lights or warm clothing !

2x daily - measure your body temperature - it has to stay below 39°C (102.2°F) !

2x daily - inspect the genital area for suspicious discharge;

Important: If the pain becomes worse or has not dissipated after 24 hours,
you must consult a physician.

The UTI associated pain can best be managed by starting treatment with an antibiotic drug as soon as possible. The physician can start the patient on her first antibiotic tablet during the course of the practice visit. Nevertheless, urine has to be sent for culture in order to confirm that the antibiotic chosen for treatment will indeed be effective. Trimethoprim or Cotrimoxazol have shown good results as first-line drugs. The pain and discomfort often subside within hours or usually within a day, eliminating the need to take additional painkillers.

An acute uncomplicated UTI can usually be treated with a 3-day antibiotic regimen under the supervision of a physician. To take these antibiotic drugs for more than 3 days could cause negative changes to the body's own flora and increase the chance of experiencing more side effects.

Should the pain not decrease dramatically within a few hours, the physician needs to start a thorough search for its cause. At this time, it may become necessary for the patient to be admitted to a hospital for further work up. Fortunately, this occurs less frequently since most infectious agents are highly sensitive to antibiotic treatment.

Prevention:

To prevent recurring UTIs, birth control should not consist of diaphragms combined with a spermicidal cream nor of a condom covered with a spermicidal lubricant. However, this does NOT mean that one should avoid condoms !!

Regular gentle hygienic care is necessary and useful. However, sprays, excessive vaginal douching or the use of disinfecting solutions can alter the normal vaginal flora and change the vaginal pH (acidity) which then provides fertile grounds for the growth of bacteria and fosters the infection.

Ample daily water intake is advised in order to keep the urinary tract well flushed - the urine should always be clear or pale yellow in color.

Do not delay going to the bathroom when the urge arises. Urinate without haste and try to empty the bladder as completely as possible. Always wipe from the front backwards after urinating or a bowel movement - this prevents bacteria from the colon gaining access to the vagina or urethra.

Voiding after intercourse is often recommended. While it has not been established that this prevents bladder infections, it certainly does not hurt. Beware of whirlpools - stay as far away from them as possible!!

Clothing should not be worn too tight and your underwear should be made of cotton. Synthetic materials retain dampness which could enhance bacterial growth - while cotton 'breathes'. Make sure that your daily nutrition contains sufficient amounts of Vitamin C. This vitamin acidifies the urine thereby preventing bacterial growth. Cranberry juice has become famous for this purpose. Keep warm - even cold feet can cause another bout of UTI.

If in spite of all careful behavior another bladder infection arises, a responsible patient could try a round of selftreatment: the physician prescribes ahead of time an antibiotic drug which the patient starts to take immediately upon the first signs and symptoms of a UTI (but for not more than 3 days!). That way, no time is wasted and the bacteria are killed before they have a chance to spread.

At this time, several different scientific groups are working on the development of a vaccine against the most common causative bacteria for UTI. However, as long as effective protection is not yet available, the only way to fight these bacteria is through antibiotic drugs and the preventive measurements described above.

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DISCLAIMER: The above article is only intended to provide general information regarding this topic. It is not intended and does NOT replace the need to consult a medical or other professional person, if you have or believe to have this disease/disorder. While the article was researched, written and reviewed by medical professionals, and Medicine for Africa, its staff and publisher made every effort to assure accuracy and correctness, it does not claim to be complete, correct or to reflect the very latest stand of medical/scientific knowledge in the disease’s/syndrome’s pathology, diagnostic and/or therapeutic development. Medicine for Africa, its founder, management, staff, writers, reviewers or publishers may NOT be made responsible or legally bound to any information provided above, and cannot be held liable to any conclusions or decisions the reader may draw after reading this article. The reader is explicitly advised to consult a licensed physician and to present his/her specific situation before making any health related decisions.

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