urinary tract infection (UTI)


DR Z,

What exactly is a urinary tract infection?

A urinary tract infection (UTI) is an infection of either your upper or lower urinary system. The urinary system is made up of your bladder, kidneys, ureters, and urethra. Physiologically, the kidneys are responsible for “concentrating” the urine. This means that the kidneys are the last stop to remove any essential water and/or electrolytes before filtering this fluid into urine. The ureters are tube-like structures that connect the kidneys to the bladder. The bladder is responsible for storing urine in between episodes of going to the bathroom and the urethra is the tube that connects the bladder to the outside of the body.
An infection of the “upper” urinary tract involves the kidneys and the ureters while a “lower” urinary tract infection involves the bladder and urethra. A UTI can be thought of as an “ascending” infection. This means that an infection that begins in the urethra and bladder can spread upward to involve the ureters and ultimately, the kidneys, which is one of the complications of a lower urinary tract infection.

What causes it?

The majority of UTIs are caused by bacteria that normally live around the pelvic area or around the rectum and spread to involve the urethra and eventually the bladder. This “overgrowth” and spread of bacteria can happen spontaneously, with no known cause or by other things such as sexual intercourse or waiting too long to urinate.
Women are at a greater risk of developing a UTI because of their anatomy. The urethra in women is significantly shorter than in men, allowing bacteria to spread to the bladder much easier. Women who are sexually active have a higher chance of infections because sexual intercourse can irritate the urethra, allowing bacteria to invade and spread.
Waiting too long to urinate can also lead to a UTI. The bladder is actually a muscle that stretches to hold urine and contracts when the urine is released. Waiting very long past the time you first feel the need to urinate causes the bladder to stretch beyond its capacity which over time can weaken the bladder muscle. When the bladder is weakened it may not empty completely and some urine is left in the bladder. This allows bacteria to grow, thus increasing the risk of a urinary tract infection.

Who gets it? Are there risk factors?

Women are much more prone to developing a UTI than are men. In fact, approximately 50%-60% of adult women report having a UTI at some point in there lives. Young, sexually active women are also at a higher risk of developing an infection. In children, 3% of adolescent girls will develop a UTI before the age of ten compared to about 1% of boys in the same age category. The most common risk factors include:

What are the signs and symptoms?

While some people with an infection can have no symptoms, the majority of people complain of some discomfort related to the area involved. General symptoms that can involve the entire urinary tract include:
  • An increased urge to urinate with smaller then normal amounts of urine
  • A burning sensation or pain when urinating
  • Blood in the urine or a cloudy, strong-smelling urine
  • Back Pain
  • Abdominal pain or pressure
  • Fever

    How is it diagnosed?

    If you experience any of the above symptoms, you should visit your medical home. Most urinary tract infections can be treated by your family doctor or general practitioner. If you have recurrent infections, you may be referred to a urologist, a doctor who specializes in kidneys and urinary system.
    After a general physical exam, if your doctor suspects you to have a UTI, they will most likely ask you for a urine sample. The presence of blood, pus, or bacteria in the urine can usually be made immediately. If your sample is found to be normal but you have symptoms of an infection, your doctor may send your urine sample to a laboratory for further evaluation.

    Are there any complications?

    Yes! While the majority of women will have a UTI at some point in their lives, untreated or recurrent infections can be rather serious. Untreated urinary tract infections can lead to acute or chronic kidney infections which may cause permanent damage. Early detection and reatment is most serious for the very young and very old as their symptoms are often overlooked or misdiagnosed.

    How is it treated?

    For the vast majority of simple lower urinary tract infections, antibiotics are the first line of treatment. Make sure to tell your doctor of any medications you may be taking or if there are any medications you believe you are allergic to. Depending on the bacteria suspected, your overall health, and severity of your symptoms will depend what antibiotic is prescribed and for how long you should take it. Make sure to take the entire dose of the drug regardless of if your symptoms resolve sooner.
    If pain is a significant complaint, your doctor can also prescribe you a pain medication that numbs your bladder. A common side effect of urinary tract analgesics is discolored urine, usually bright orange or blue.

    Can they be prevented?

    You can greatly reduce your risk of a urinary tract infection by practicing the following:
    • Urinate promptly
    • Wipe from front to back
    • Go to the bathroom after intercourse
    • Avoid feminine cleaning products
    • Wear underwear with a cotton crotch
    If you have any questions or concerns, visit your “Medical Home” for further evaluation.
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