Urinary Tract Infections

Urinary tract infection (UTI) is the name given to an infection of any part of the urinary system.

The urinary system is made up of the kidneys, the ureters (the tubes that carry urine from the kidneys to the bladder), the bladder, and the urethra (the tube that passes from the bladder through the penis in men or the vulva in women - which is located between the vaginal opening and the clitoris) through which we urinate.

A UTI develops when part of the urinary system becomes infected, usually by bacteria. The normal urinary tract is sterile (germ free), but can become infected when bacteria enters the urinary system through the urethra, or more rarely, though the bloodstream.

There are two types of UTI:
1. Lower UTI: this is an infection of the lower part of the urinary tract. Examples of lower UTIs include: cystitis, which is an infection of the bladder, and urethritis, which is an infection of the urethra.
2. Upper UTI: this is an infection of the upper part of the urinary tract that includes the kidneys and the ureters. Upper UTIs can result in kidney damage and, for this reason, are potentially more serious than lower UTIs.

CAUSE
In the majority of cases UTI is caused by Escherichia coli (E coli) bacteria that normally lives in the bowel (colon) and around the anus. The two most common causes of this bacteria moving to the opening of the urethra are poor toilet hygiene and sexual intercourse. Usually, urinating flushes the bacteria out of the urethra. If there are too many bacteria, urinating may not stop the spread.

The bacteria can travel up the urethra to the bladder, causing an infection. The infection can spread further as the bacteria move up from the bladder via the ureters. If the bacteria reach the kidneys a kidney infection (pyelonephritis), may develop which can become a very serious condition if not treated promptly.

RISK FACTORS
There are a number of factors that increase the risk of UTI. These include:
• Conditions that block (obstruct) the urinary tract, such as kidney stones.
• Medical conditions that cause incomplete bladder emptying (for example, spinal cord injury or bladder decompensation after menopause).
• Suppressed immune systems e.g. in cases of AIDS and diabetes. People who take immunosuppressant medications also are at increased risk.
• Women who are sexually active. Sexual intercourse can introduce larger numbers of bacteria into the bladder. Infection is more likely in women who have frequent intercourse. Urinating after intercourse seems to decrease the likelihood of developing a urinary tract infection.
• Women who use a diaphragm for birth control.
• Prostatitis or obstruction of the urethra by an enlarged prostate can lead to incomplete bladder emptying, thus increasing the risk of infection. This is most common in older men.
• Infants born with abnormalities of the urinary tract, which sometimes need to be corrected with surgery.
• Uncircumcised males. This risk is still relatively low, but it is higher than in circumcised males.
•Women are more likely to develop UTIs because the female urethra is shorter allowing bacteria quick access to the bladder.

SIGNS AND SYMPTOMS
The symptoms of a lower urinary tract infection can include:
• pain, or a burning sensation during urination (dysuria),
• a strong, persistent urge to urinate
• feeling that you are unable to urinate fully,
• blood in the urine or cloudy, strong-smelling urine
• pain in your lower abdomen, and
• mild fever

The symptoms of an upper urinary tract infection can include:
• any of the symptoms of a lower urinary tract infection,
• a high fever
• nausea or vomiting,
• shaking or chills, and
• pain in your lower back or side which is usually only on one side.

TREATMENT OPTIONS
Always consult your Doctor for the diagnosis and treatment of UTI. It is important that patients suffering UTI seek medical attention, as untreated UTI can cause permanent damage. The diagnosis of UTI usually involves the patient providing a urine sample, which will be analysed in a laboratory to determine the type of organism (e.g. bacteria) that is causing the infection. Your Doctor will give you instructions on how to collect this sample. Your Doctor may prescribe a course of oral antibiotic medications to treat the infection. More severe upper UTI infections may require intravenous antibiotics. Your Doctor may also recommend steps you can take to reduce your risks of contracting another infection.

PREGNANCY
A pregnant woman who develops a UTI should be treated promptly to avoid premature delivery of her baby and other risks such as high blood pressure. Some antibiotics are not safe to take during pregnancy. Your Doctor will recommend the most suitable type.

DIET HINTS
• Drink plenty of water.
• Avoid coffee, alcohol, and spicy foods, all of which can irritate the bladder.

VITAMINS/MINERALS/HERBS
• Garlic is a natural antibiotic, which can improve immune function.
• Vitamin C can enhance immune function. It may inhibit the growth of some bacteria in the urinary tract.
• Acidophilus is needed to restore 'friendly' bacteria, especially if antibiotics have been taken Research is currently evaluating the potential role of probiotics such as acidophilus in the prevention of recurrent UTIs.
• Cranberry is the herb of choice for bladder infections. Components in cranberry juice prevent bacteria from adhering to the lining of the bladder. If pure cranberry juice is unavailable, cranberry capsules may be substituted.
• Marshmallow root may help inhibit bacterial growth by increasing the acidity of urine.
• Horsetail herb has a diuretic action and has a long history for use in urinary tract infections.

PHARMACIST'S ADVICE
Ask your MedAux Pharmacist for advice.
1. After going to the toilet, wipe from the vagina towards the anus (front to back) to avoid spreading bacteria.
2. Avoid using strong or highly perfumed soaps, talcum powder or deodorants in the vaginal and anal areas.
3. Drink plenty of water (2 litres a day) to dilute the urine
4. Urinate when the need is there and do not put it off.
5. During your period, change tampons and pads regularly.
6. Ask your Pharmacist for a urinary tract alkaliser which will help to make the urine more alkaline. Mix the recommended volume by the pharmacist in water & drink it. This will decrease the burning sensation.
7. Quit smoking. Smoking irritates the bladder and increases the risk of bladder cancer.
8. Wear cool cotton underwear, rather than a synthetic material to help with ventilation. Avoid wearing pantyhose and tight jeans. Do not sit in cold or draughty areas, particularly when you are wet e.g. after swimming.
9. If the diet is inadequate consider some supplements. Ask your Pharmacist for advice.