Everyone has gone through the trouble of holding in their urge to urinate urgently. It is a momentary nuisance that provides major relief when one finally hits the loo. But some people get this urge quite frequently and to their surprise, when they urinate, little to no urine is released. Add to that, there can be a painful, burning sensation. These can be symptoms of urinary tract infection (UTI) which occurs when bacteria, usually E Coli that is found in fecal matter, enter the urinary tract through the urethra.
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Types of recurrent UTIs
According to Dr Mandeep Phukan, associate professor at Gauhati Medical College, the urinary tract comprises the kidneys, bladder, ureters (the tube that connects the kidney and bladder), and the urethra (the tube that removes urine from the bladder). Depending on the location of the infection, UTIs can be classified into the following:
- Urethritis: affects the urethra
- Cystitis: affects the bladder
- Pyelonephritis: affects the kidneys
Cystitis is the most common UTI. Pyelonephritis is more serious than cystitis, although its occurrence is not common, according to the Centers for Disease Control & Prevention (CDC).
What is recurrent UTIs?
According to an article published in 2014 in Urological Science, in the last 20 years reputed publications have defined RUTI (recurrent urinary tract infections) as ‘three episodes of urine culture positive UTI in the previous 12 months or two episodes within the six months.’
The American Urological Association mentions the typical symptoms of an uncomplicated RUTI infection (where the urinary tract is structurally and physiologically normal):
- Dysuria (painful urination)
- Increased frequency
- Increased urgency (even when the bladder is empty)
- Hematuria (presence of blood in the urine)
- Nocturia (disturbed sleep due to urge to urinate)
“If the infection reaches the kidneys, symptoms like pain in the area where the kidneys are situated, chills, fever and back pain are usually noticed,” says Dr Phukan.
Causes
On a call with Happiest Health, Dr Vinay D, an infectious diseases specialist at Apollo Hospitals, Bengaluru, gets to the root of this infection.
“The ureters connect the kidney and the urinary bladder, the place where urine gets collected. When bacteria enter the urethra either due to a local structural defect, or reduction in immunity, it can reach the bladder and cause cystitis or urethritis,” says Dr Vinay.
Dr Mandeep states that the reasons for the recurrence of UTI depend on the bacteria’s virulence and adherence degree in the urinary tract after the first UTI is over. Immunocompromised people, diabetics and people who have undergone organ transplantations are prone to recurrence. In some cases, urinary tract abnormalities also increase the chances of another episode of UTI.
When does it reach the kidneys?
Dr Vinay explains why inflammation of the kidney due to an infection (pyelonephritis) is not common. “It is not easy enough for the infection to climb up to your kidneys from the bladder. So, for cystitis to cause pyelonephritis, the infection should be intense – it should keep happening repeatedly through the ureters, in which case it may climb up and then may infect the kidney. If the person’s immune system is not good enough to tackle that recurrence, or blood sugar control is not adequate, then in such cases, it may go up and infect the kidney — that is what we call, pyelonephritis.”
He further mentions, “since the kidneys lack pain fibres, you won’t experience any symptoms of pyelonephritis, if at all the inflammation (of the kidneys) is intense. In such circumstances, the infection might be so severe that it manifests as drowsiness. Consequently, people affected could appear quite lethargic, which could result in poor oral intake. Occasionally in severe cases, the inflammation can lead to pus formation, also called kidney abscess. But such symptoms are not very specific to kidney infection. But if you already know that a person has cystitis, and the fever becomes worse, or they tend to have more chills, along with poor oral intake and drowsiness, you should start suspecting that maybe cystitis has extended into pyelonephritis.”
Diagnosis
Urine culture reports are usually enough to diagnose a mild UTI, says Dr Mandeep. “But if it is recurrent, the person affected is asked to go for an ultrasound imaging or a CT scan, as urine culture reports aren’t enough to know the exact cause of the infection,” he adds.
He further adds that these tests are important to rule out different causes like urinary tract obstruction due to kidney stones that might cause pyelonephritis. “No matter how much antibiotics are taken, if the stones aren’t removed, the infection won’t be cured,” he says.
How to prevent UTI
The CDC has suggested the following to prevent UTIs:
- Urinate after having sex
- Keep yourself hydrated
- Showers are recommended
- Reduce the use of powders, sprays and douching in the genital area
- Encourage girls to wipe from front to back
Women and menopause
According to an observational study published in 2014 by the US Government’s National Library of Medicine, UTIs are at least 50 times more common in pre-menopausal (pre-menopause or perimenopause is the time when the body transitions to menopause) women than in males, and it is predicted that one in two women will experience at least one UTI episode in their lifetime. Furthermore, recurrent uncomplicated UTIs can occur in up to 20 per cent of women with acute cystitis. This occurs as bacteria find it easy to enter the urethra in women, as it is shorter when compared to men.
Dr Vinay adds, “post-menopausal women are at greater risk due to the absence of the mechanism that regulates acidic balance in the urinary tract, which resists the bacteria going upwards to the urinary tract during menses. Thus, bacteria find room to grow and the risk of contracting UTI increases,” he says.
How Richa battled RUTI with water
Dr Mandeep advises drinking ten to 12 glasses of water a day to combat UTI.
Dr Vinay explains how hydrating well keeps bacteria away. “If you drink an adequate amount of fluids, the urine production will be enough to flush out the bacteria from your urinary system,” he says.
Richa Dugar, a 21-year-old recent college graduate from Guwahati, has gone through four episodes of UTI in the past nine months. She tried several home remedies to get temporary relief, until a month ago when her cramps peaked, and she got a fever.
“I finally decided to go to the doctor. I am on antibiotics now, and I feel much better. Hydration is so important. And so is seeing a doctor. Natural remedies are temporary. But with proper medication, hygiene and hydration, I am getting better,” says an optimistic Richa.
One Response
Good work on the article.