Prevent Urinary Tract Infections (UTI)

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Urinary Tract Infections (UTI)

Urinary tract infection is the most common non-intestinal infection in women worldwide [1]. The pathogens causing UTI are consistent across the globe. The pathogenesis of urinary tract infection involves ascending infection with coliform bacteria colonizing the perineum in susceptible women. While not generally considered a cause of significant mortality, UTI do represent an important cause of morbidity.

Position of organs of the urinary tract (Kidne...

Position of organs of the urinary tract (Kidney, Ureter, Urinary bladder, Urethra (Photo credit: Wikipedia)

Urinary Tract Infections can be divided into:

1. Lower urinary tract Infection:

It is also known as cystitis (inflammation of the bladder). Most of the time, the inflammation is caused by a bacterial infection. A bladder infection can be painful and annoying.

According to Medilexicon’s medical dictionary,

Cystitis is:  Inflammation of the urinary bladder.”

English: Anatomy of Urinary bladder

English: Anatomy of Urinary bladder (Photo credit: Wikipedia)

It is important to understand that bladder is just a part of the urinary system, hence bladder infection could form just one of the urinary tract infections. Bladder infection could occur due to various reasons with inadequate emptying of the bladder being a predominant factor.

{Note: The normal adult bladder is not palpable unless filled with at least 150 ml of urine}.

UTI can become a serious health problem if the infection spreads to the kidneys (known as Pyelonephritis).

2. Upper urinary tract Infection:

It is also known as Pyelonephritis. The involved part is kidney – kidney parenchyma and renal pelvis. The infection usually ascends from the lower urinary tract. If the upper tract is involved, and the person has diabetes mellitus, is pregnant, is male, or immunocompromised, it is considered complicated. [2,3] Otherwise if a woman is healthy and pre-menopausal it is considered uncomplicated.[2]

Urinary Tract Infections are more common in women than men because of their anatomy. Though children can also get infected but they are less prone to it. 

In children when a urinary tract infection is associated with fever, it is deemed to be an upper urinary tract infection[4]. Therefore the accurate diagnosis of UTI in children is necessary to ensure appropriate therapy and follow-up. Children who are toilet trained can provide clean voided urine samples. Samples of urine from children who are not toilet trained can be obtained by “clean voided” bag samples, suprapubic bladder aspiration (SPA), or transurethral bladder catheterization (TUBC). SPA and TUBC are invasive but are the only valid ways to collect urine for culture in febrile young infants under two months of age[5] and older infants and children with unexplained fever who are younger than two years of age and ill enough to merit immediate antimicrobial therapy.

Accurate and timely diagnosis of pediatric UTI can prevent short-term complications, such as severe pyelonephritis or sepsis, and long-term sequelae including scarring of the kidneys, hypertension, and ultimately chronic renal insufficiency and need for transplant.

The bacteria that cause urinary tract infections typically enter the bladder via the urethra. However, infection may also occur via the blood or lymph. It is believed that the bacteria are usually transmitted to the urethra from the bowel. After gaining entry to the bladder, the bacteria are able to attach to the bladder wall and form a biofilm that resists the body’s immune response[6].

{

Note: Approximately 80%-90% of all urinary tract infections are caused by Escherichia coli, and 5–10% Staphylococcus saprophyticus with the remainder caused by Proteus and other Gram negative rods[7]

}

A diagnosis may be made and treatment can be given based on either

– symptoms alone (in straightforward cases) or

– urinalysis (in complicated or questionable cases): by looking for the

Note: In the elderly, the diagnosis can be difficult as the symptoms can be vague[8].

Diagnosis, in general[9]:

Acute Cystitis symptoms include:

  • Irritative voiding symptoms
    • Urgency – sudden desire to void (also observed in neuropathic conditions such as neurogenic bladders (spasticity and reduced compliance) resulting from upper motor neuron lesions).
    • Dysuria – painful urination. It is usually associated with inflammation. The pain is typically referred to the tip of the penis in men or to the urethra in women.
    • Frequency – increased number of voids during the daytime, and nocturia is the nocturnal frequency. Please note that adults normally void five or six times a day and once at most during the nighttime. Increased frequency may be due to Diabetes, diuretics etc., where as decreased frequency could be due to bladder outlet obstruction (e.g., due to prostatic hyperplasia), neurogenic bladder disorders, extrinsic bladder compression (e.g., uterine fibroids, pelvic neoplasm), or anxiety.
  • Patient usually afebrile (without fever)
  • Positive urine culture; blood culture may also be positive

Acute Pyelonephritis symptoms include:

  • Fever
  • Flank pain – Flank pain refers to pain in one side of the body between the upper abdomen and the back. Flank pain often means kidney trouble. If flank pain is accompanied by fever, chills, blood in the urine, or frequent or urgent urination, then a kidney problem is the likely cause.
  • Shaking chills
  • Irritable voiding symptoms (see above)
  • Nausea and vomiting and diarrhea
  • Positive Urine Culture

Signs include fever and tachycardia. Costovertebral angle tenderness is usually pronounced.

The costovertebral angle is the acute angle formed on either side of the human back between the twelfth rib and the vertebral column. The kidney lies directly below this area, so is the place where, with percussion, pain is elicited when the person has kidney stones or kidney inflammation. The presence of pain is marked as a positive Murphy’s punch sign or as costovertebral angle tenderness[10]

UTI Pregnancy during:

Urinary tract infections are more concerning in pregnancy due to the increased risk of kidney infections. During pregnancy, high progesterone levels elevate the risk of decreased muscle tone of the ureters and bladder, which leads to a greater likelihood of reflux, where urine flows back up the ureters and towards the kidneys. While pregnant women do not have an increased risk of asymptomatic bacteriuria, if bacteriuria is present they do have a 25-40% risk of a kidney infection[12]. A kidney infection during pregnancy may result in premature birth or pre-eclampsia (a state of high blood pressure and kidney dysfunction during pregnancy that can lead to seizures)[11].

Prevention[12] is the ‘key’

For both men and women of all age groups, hygiene and cleanliness of private parts is very important. Therefore, proper personal hygiene and a few other simple tips (see blow) can help prevent UTI, says Dr Shobha Mathur, an eminent Consultant Obstetrician & Gynaecologist.

  • Wear only cotton undergarments; do not sport any other materials. Wash them with a detergent everyday after use.
  • There is no need of using antiseptic in water to wash the private parts unless advised by the doctor. Antiseptics kill the normal protective bacterial layer of the skin and increase the chances of skin allergy and susceptibility to infections.
  • Drink plenty of oral liquids such as water, juice and coconut water.
  • To maintain safety in kids, mothers should check that their undergarments are always dry to prevent nappy rash. Playing in sand pits may lead to skin infections and then UTI if not cleaned properly.

It is important for men to know that circumcision helps in preventing STD, UTI and cancer. Also in old age, Prostatic Hypertrophy, which is enlargement of the prostrate gland, must be treated well in time because it increases the chances of UTI.

Important tips for women to stay fit and free of infections: 

  • Women have an increased susceptibility due to small length of urethra; hence hygiene is important especially during menstruation cycle.
  • Always use clean and dry sanitary napkins. It is vital to wash your private parts daily.
  • On honeymoon, UTI is common problem but can be prevented by maintaining clean hygiene practices, increasing water intake and by having gentle sex.
  • Menstrual hygiene must be followed.
  • Do not wash from back (anal area) to front (vaginal area). Instead use a mild soap to lather from front to back and then wash with warm water. Doing so and avoiding the use of water jets in western toilet is a must. Instead Use hand held shower.
  • Ageing women develop senile atrophic degeneration of vagina, which increases incidence of UTI. After consultation from a gynecologist, use a medicated hormonal cream to avoid UTI.

The good news is that, says Dr Shobha Mathur, the UTI infection can be controlled with antibiotics if discovered at the right time. Therefore, follow healthy practices and if you still notice any symptom that is causing discomfort or is unusual, please see the doctor immediately.

Treatment:* (please note that any of this information is “not a medical advice”). Consult your physician for the appropriate treatment options. The purpose of this work is Information Integration / Information Fusion on UTI.
Allopathy:

The main stay of treatment in Allopathy is antibiotics.

Ayurveda:

Please those who wish to share your experience can send your input (with references) to my email id (preventivecatalyst@gmail.com) to insert here after careful review.

Homoeopathy:

Please those who wish to share their experience can send their input (with references) to the email id (preventivecatalyst@gmail.com) to insert here after careful review. Also consider the above general signs and symptoms as possible rubrics and suggest remedies from repertories only. Please indicate which repertory (with page numbers) was consulted. TGI understands that homoeopathy works based on individualization however, this is an attempt to see how homeopathy addresses the individual disease conditions based on the established disease signs and symptoms in the medical literature.

Others:

Send your input to preventivecatalyst@gmail.com

*All your contributions will be suitably acknowledged

  1. Dielubanza EJ (2011) Urinary tract infections in women. Med Clin North Am 95(1): 27–41. FIND THIS ARTICLE ONLINE
  2. Colgan, R; Williams, M (2011-10-01). “Diagnosis and treatment of acute uncomplicated cystitis.”. American family physician 84 (7): 771–6. PMID 22010614.
  3. Salvatore, S; Salvatore, S, Cattoni, E, Siesto, G, Serati, M, Sorice, P, Torella, M (2011 Jun). “Urinary tract infections in women.”. European journal of obstetrics, gynecology, and reproductive biology 156 (2): 131–6.doi:10.1016/j.ejogrb.2011.01.028PMID 21349630.
  4. Bhat, RG; Katy, TA, Place, FC (2011 Aug). “Pediatric urinary tract infections.”. Emergency medicine clinics of North America 29 (3): 637–53. doi:10.1016/j.emc.2011.04.004.PMID 21782079.
  5. Practice parameter: the diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children. American Academy of Pediatrics. Committee on Quality Improvement. Subcommittee on Urinary Tract Infection. Erratum in Pediatrics 1999 May;103(5 Pt 1):1052, 1999 Jul;104(1 Pt 1):118. 2000 Jan;105(1 Pt 1):141.
  6.  Salvatore, S; Salvatore, S, Cattoni, E, Siesto, G, Serati, M, Sorice, P, Torella, M (2011 Jun). “Urinary tract infections in women.”. European journal of obstetrics, gynecology, and reproductive biology 156 (2): 131–6.doi:10.1016/j.ejogrb.2011.01.028PMID 21349630.
  7. Zalmanovici Trestioreanu A, Green H, Paul M, Yaphe J, et al.. (2010) Antimicrobial agents for treating uncomplicated urinary tract infection in women. Cochrane Database of Systemic Reviews, Issue 10. Art. No.: CD007182. DOI: 10.1002/14651858.CD007182.pub2.
  8. Woodford, HJ; George, J (2011 Feb). “Diagnosis and management of urinary infections in older people.”. Clinical medicine (London, England) 11 (1): 80–3. PMID 21404794.
  9. Current Medical Diagnosis & Treatment-CMDT-2004, p905
  10. Musana KA, Yale SH (August 2005). “Murphy’s Sign”Clin Med Res 3 (3): 132.PMC 1237152PMID 16160065.
  11. Dielubanza, EJ; Schaeffer, AJ (2011 Jan). “Urinary tract infections in women.”. The Medical clinics of North America 95 (1): 27–41. doi:10.1016/j.mcna.2010.08.023.PMID 21095409.
  12. Expert Ways to Prevent Urinary Tract Infections

# Any suggestions or recommendations to further improve this curation is highly and  truly appreciated #

 

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