What is a urinary tract infection?
A urinary tract infection, or UTI, is an inflammatory process in the bladder and/or urinary tract that is caused by the presence of bacteria. About 50% of women will develop a UTI during their lifetime. If a UTI spreads to the kidneys or into the bloodstream, it can cause serious medical problems. Therefore, it is very important to properly diagnose and treat a urinary tract infection as soon as possible.
How urinary tract infections start
The urinary system is comprised of several muscles, organs, and nerves which collect, store, and release urine; the bladder is one of those organs. In simple terms, the bladder opens into the urethra, the tube which allows urine to pass outside the body. In women, the vagina opens just behind the urethra and is a reservoir for different types of organisms. Normal vaginal flora consists of bacteria including lactobacillus, staphylococcus species, streptococcus, and fecal organisms such as E.coli, and Klebsiella. These fecal organisms, or coliform bacteria, most often cause urinary tract infections (UTIs). E.coli is responsible for approximately 85% of uncomplicated UTIs.
The organisms that live in the vagina often crawl or get pushed through the short urethra of women and get into the bladder. Most often these bacteria are flushed out with the next void, but sometimes they begin to multiply and an infection develops. Women are more likely to develop UTIs compared to men, because their urethra is much shorter. For men, a UTI may be identified with a kidney stone or an enlarged prostate.
- Pain or burning with urination.
- Urinary urgency.
- Urinary frequency.
- Pain in the lower abdomen or kidneys.
- Increased incontinence.
- Occasionally blood in the urine.
- Dark, foul smelling or cloudy urine.
- Some people may have no symptoms (asymptomatic bacteriuria).
A urinalysis is performed to detect the presence of a bacterial infection, and to determine any resistance patterns that may be present. This is important especially for patients who have recurrent UTIs. Simple, uncomplicated UTIs often respond to a short course of antibiotics. More complicated and/or recurrent UTIs require different treatment options.
UTIs are very common among the elderly. For older adults who are not able to adequately describe their symptoms, a caregiver may observe agitation, delirium, behavioral changes, and/or dark, foul smelling or cloudy urine.
Factors that may increase the risk for UTIs
- Infrequent voiding – This allows bacteria to spend longer amounts of time in the bladder, giving it the opportunity to replicate and take hold.
- Incomplete voiding – An excess amount of urine is left in the bladder, which means that bacteria is not completely flushed out with each void.
- Personal hygiene – Improper personal hygience can result in perineal contamination with feces, which increases the risk of coliform bacteria in the vagina and near the urethra.
- Sexual activity – Trauma to the urethra and surrounding tissue may increase susceptibility to infection, and allow bacteria to be mechanically pushed into the urethra.
- Use of spermicidal contraception – Spermicide changes the normal flora in the vagina which can allow coliform bacteria to colonize the area.
- Genetics – Certain cells on the vaginal mucosa and the urethra can express receptors that allow certain bacteria to attach and pull themselves into the bladder. This receptor expression tends to run in families.
- Menopause – A lack of estrogen allows for thinning of tissue in the vagina and urethra that may allow for greater susceptibility to UTIs. This lack of estrogen also changes the pH of the vagina which allows for colonization with more coliform bacteria.
- Diabetes – Persistently high blood sugar levels cause immunosuppression which allows for greater susceptibility to UTIs. Additionally, transient high blood sugars cause a spilling of sugar into the urine which acts as food for bacteria and makes it much easier for bacteria to grow and replicate.
- Weakened immune system – There are a variety of causes of immunosupression which decreases a person’s ability to fight off infections.
Additional factors include:
- Kidney stones.
- Tub bathing.
- Urinary Incontinence.
- Chronic Foley catheter use.
If you feel that you might have a urinary tract infection, or you struggle with recurrent UTIs, contact Urology Austin to schedule an appointment with one of our urologists.