Today, I will talk about urine infections.
One of the commonest reasons why patients come to our general medical clinic is fever.
On questioning, many of them have a high fever for a day or two, that is associated with burning sensation when they pass urine. It is likely that the patient is suffering from an infection in the urine, commonly called UTI, or urinary tract infection.
Given how common this is, we thought we should briefly touch upon what a UTI is, and how it is treated.
What Is A Urine Infection?
A urinary tract infection, also called a urine infection, refers to an infection that has affected the bladder or any other part of the urinary system.
It is commoner in women when compared to men, and is often seen in older individuals.
Before we dive into urine infections and how they are managed, here is a brief look at the urinary tract, or your urinary excretory system.
The Urinary Tract
The urinary tract consists of the following –
1. The kidneys – The kidneys receive impure blood from all parts of the body and purify it. Urine contains all the unnecessary elements and toxins that need removing from the body. Infections of the kidney (called upper UTI) can be very serious and require immediate treatment.
2. The ureters – These are muscular tubes that pass from the kidney to the bladder. They help transfer the urine from the kidney to the bladder where it is stored.
3. The bladder – The bladder acts like a reservoir for urine. Once there is sufficient urine in the bladder, the muscle wall stretches and sends a signal to the brain that the bladder wants to empty.
4. The urethra – The urethra is the tube that passed out from the bladder, and allows for urine to be passed through.
These 4 structures from the urinary tract. An infection in any one of these (or more than one of these) is called a urinary tract infection. This is a rather generalised term, and does not indicate as to which part of the urinary tract is actually affected.
Causes Of Urine Infection
A UTI is caused due to entry of bacteria into the urinary tract, resulting in an infection. It often enters the bladder through the urethra, though in some rare cases it can enter through the blood.
UTI’s are more common in women due to the small urethra and the fact that it lies close to the anus, which has a lot of bacteria around it.
Women can contract a urine infection after marriage in India due to commencement of sexual activity with their partner. It has been aptly called ‘honeymoon cystitis’ (cystitis = bladder infection/inflammation).
It is important to bear in mind that a UTI is NOT a sexually transmitted disease. Women who wear diaphragms as a contraceptive measure are also at a higher risk of developing UTIs.
On the other hand, UTI is rare in men, and is often due to an underlying cause such as enlarged prostate, narrowed urethra or kidney stones.
There are certain rare causes of UTI. These include the presence of HIV infection and treatment with chemotherapy drugs for cancer. Patients admitted to hospital who have had catheters inserted into their bladders can also develop urine infections.
However, there are other recognized bacterial organisms that cause UTI, including Staphylococcus saprophyticus, Proteus mirabilis, Klebsiella subspecies, Proteus vulgaris, Candida albicans and Pseudomonas subspecies.
While it is impossible to remember these names (!!), it is just for your information to let you know that there can be different bacteria that can cause a urine infection.
Finally, using condoms that contain spermicide can increase the risk of urine infections in women. This is because the spermicide can irritate the inner surface of the vagina, making it prone to infections which then spread to the urinary tract.
It may be interesting to know that patients who are admitted for long periods of time in hospitals are at a higher risk of developing urine infections.
Symptoms Of A Urine Infection
If you are suffering from a urine infection, you most certainly will know that you have it.
The urine can appear cloudy, and it causes a great deal of burning when passing urine. Patients who have kidney infections can develop pain in the lower back just under the rib cage.
The table below lists the common symptoms patients experience if they are suffering from a urine infection –
- Burning when passing urine
- Fever and rigors with nausea and vomiting (sometimes)
- Increased urinary frequency
- Passing only small amounts of urine at a time
- Foul smelling, cloudy urine
- Pain in the lower abdomen
- Older patients may be confused
While the symptoms of a UTI are fairly straightforward, certain tests are required to confirm the diagnosis of the infection. These include –
1. Urine analysis – This will reveal the presence of large number for pus cells (more than 3-4) along with the presence of nitrites in the urine. There may even be blood and protein in the urine. A parameter called leukocyte esterase will be positive as well.
2. Urine culture – This will reveal the presence of bacteria. Additional testing is often performed to see which antibiotics the bacteria can be treated with.
3. Ultrasound abdomen and pelvis – This will help identify if there are any abnormalities in the structure of the urinary tract. The urinary bladder needs to be full during the test. The common things looked for are kidney or urethral stones, bladder stones, tumors and any form of obstruction.
These tests provide sufficient information to help commence treatment.
However, on rare occasions, when the infection has spread to the kidneys, a CT scan (called CT KUB) will done to get a clearer picture.
Treatment Of Urine Infections
Urinary tract infections need to be treated promptly in order to prevent the onset of complications.
Some of the complications have been listed in the table below.
- Kidney failure due to spread from the bladder upwards to the kidney
- Pyelonephritis – Infection of the kidney
- Hydronephrosis – Enlargement of the kidney due to blockage of urine flow to the bladder.
- Septicemia – Spread of infection into the blood making the patient very unwell. This requires hospital admission, usually intensive care.
- Kidney abscess formation – This refers to the accumulation of pus within the kidney due to infection.
UTIs are treated with oral or intravenous antibiotics.
In most cases, antibiotics are only needed for a few days to help clear off the infection. Treatment if often started off with broad spectrum antibiotics. Once the results of the urine test are obtained, the antibiotics may need changing. This will be decided by the doctor.
Fever is treated with regular paracetamol. Patients may need stronger tablets if there is no improvement.
It takes a day or two for the patient to start to show improvement. During that time, patients are advised to drink plenty of water and keep well hydrated. This often helps flush out the infection.
In cases where a cause for the UTI is narrowing of the urethra or prostrate problems, the treatment specific to this will be offered.
Preventing Urine Infections
If you have suffered a urinary tract infection, or want to prevent it from occurring, observing the following steps can help you.
A urine infection can be painful and troublesome. Timely treatment and preventative measures can help manage this conditions effectively.