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Urinary tract infection (UTI): symptoms, causes, diagnosis and treatment
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Urinary tract infection (UTI): symptoms, causes, diagnosis and treatment

The bladder is the most common site of UTIs and the linings of the urinary tract become red and irritated. This causes pain in the lower abdomen and back
An illustration showing diagnosis and treatment of urinary tract infections
Representational image | Shutterstock

An illness caused by infection or inflammation of any part of the urinary system is called urinary tract infection (UTI).

UTIs are quite common infections, and although they can cause discomfort and pain, they are easily managed and resolved with appropriate treatment.

The urinary system consists of the following organs:

  • Kidneys: The right and left kidneys remove waste and excess water from the blood by filtration. Urine, which is the liquid waste, must be removed from the body.
  • Ureters: The right and left ureters are thin tubes that transport urine from the respective kidneys to the urinary bladder. They are controlled by muscles which tighten and relax alternately and thus carry the urine downwards. If urine does not move downwards or is pushed back into the kidneys, it can result in kidney infection.
  • Urinary bladder: This hollow organ in the lower abdomen stores urine carried to it. It does this by expanding its walls for storing, and contracts them to let the urine out of the body through the urethra.
  • Urethra: This is a tube that releases urine outside the body.

Normally urine is made up of water with concentrated amounts of salts, soluble wastes and certain bodily chemicals. It does not contain microbes like bacteria or viruses. Sometimes, bacteria manage to enter the urethra due to unhygienic habits, reach the deeper organs and cause UTIs.

Symptoms

The bladder is the most common site of UTIs. The infections cause the linings of the urinary tract to become red and irritated, and this causes pain in the lower abdomen and back.

Some of the typical symptoms of UTIs are:

  • A need to urinate frequently, with sudden urges.
  • Pain or a burning sensation during urination.
  • A feeling of incomplete emptying of the bladder.
  • The urine is dark in colour, cloudy and foul-smelling.
  • Presence of blood in urine.

When the kidneys are affected, there are some additional signs:

  • Fever, shivering and chills
  • Pain on either side of the lower back (flanks).
  • Nausea or vomiting.
  • Confusion, agitation, and a feeling of restlessness.

Causes

UTIs are usually caused by bacteria. In most cases, the causative microbes are E.coli from the intestines and the anal region.

  • Lower UTIs: Sometimes, the bacteria are transported into the urethra and further along into the bladder. When the urethra is infected, it is called urethritis. The term UTI is often interchanged with the term cystitis, which means infection of the urinary bladder.
  • Upper UTIs: These are infections of the kidneys (pyelonephritis) or the ureters and are a serious problem as they can damage the kidneys or enter the bloodstream.

Women are more susceptible to UTIs because their urethral openings are located close to the anus, and the urethras are shorter.

Here are other factors for contracting UTIs.

  • Persons who are sexually active
  • Pregnant women.
  • Women who have undergone menopause and thus lose the protection offered by the hormone oestrogen.
  • Structural abnormalities in the urinary tract, blockages caused due to kidney stones, and other conditions that prevent complete drainage of urine.
  • Chronic conditions like diabetes, an enlarged prostate gland among some men, people with a weakened immune system, and those with urinary catheters (tubes inserted through the urethra to drain urine from the bladder).
  • People who don’t drink enough fluids throughout the day.
  • Not keeping the genital region dry and clean.

Diagnosis

A medical history and physical examination are useful along with a few tests to diagnose a UTI.

Lab tests

Urinalysis and urine culture: A sample of urine is tested for bacteria and white blood cells, which indicate the presence of infection. It may be necessary to culture the urine to isolate and identify the causative microbe to formulate an effective treatment plan.

Imaging

Scans or imaging may be required to detect recurrent bladder infections, or complicated UTIs where the kidneys are involved.

  • Ultrasound: Scans of the kidneys and other organs may be done to check for an abnormal growth, a cyst (pouch of tissue with mostly pus inside it) and presence of kidney stones.
  • Cystoscopy: A special tube with a lens and light is inserted via the urethra to get a view inside the bladder. It can detect blockages and other structural abnormalities in the urinary tract.
  • Computed tomography or CT scan: This can give accurate images of internal organs, identify stones, and detect infections.
  • Renal scans, PET or positron emission tomography scan: These use a small amount of radioactive material with special cameras. They can capture information that is missed by other techniques.
  • In intravenous pyelogram: A series of X-rays are taken with contrast dyes injected into a vein. These procedures can determine blood circulation to the kidneys and detect swellings, kidney stones and other abnormal blockages.

Treatment

The age and overall health and severity of infection determine the treatment plan.

  • Drinking plenty of liquids, especially water, helps to wash away bacteria. It is important to avoid coffee, alcohol and spicy foods when there is active infection.
  • A heated pad for fomentation on the back and abdomen reduces the pain from UTIs.
  • Regular oral painkillers like paracetamol ease the pain.

Antibiotics

  • Based on the severity of the condition, the doctor may prescribe antibiotics.
  • If the infection is in the deep tissue of the kidneys or the prostate gland, the doctor may extend the antibiotics regimen.
  • It is important to finish the prescribed antibiotic course even if one starts feeling relief.
  • Complicated UTIs where the kidneys are affected may require intravenous antibiotics followed by oral capsules. In such cases, a urine culture may be repeated to confirm the absence of infection.
  • Women who get recurrent UTIs and are sexually active may be advised to change their current birth control methods, especially if they are using diaphragms.

A few simple precautions can help a great deal in preventing UTIs.

  • Drinking enough water and staying hydrated through the day.
  • Urinating as often as the need arises, not being in a hurry, and always ensuring that the bladder is empty before leaving the urinal.
  • Ensuring a proper technique of wiping after using the toilet.
  • Washing the genital areas with water and urinating before and after sex.
  • Wearing loose-fitting or cotton garments, especially around the genitals.
  • Regularly changing diapers of children and adults who have urinary incontinence (accidental leaking of urine).
  • Avoiding scented bath products and talcum powder around the genitals.
  • Having a shower instead of a bath.

Sources:

  • Reference 1
  • Reference 2
  • Reference 3

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