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Urinary tract infections are a serious health problem affecting millions of people each year.
Infections of the urinary tract are the second most common type of infection in the body. Urinary tract infections (UTIs) account for about 8.3 million doctor visits each year. Women are especially prone to UTIs for reasons that are not yet well understood. One woman in five develops a UTI during her lifetime. UTIs in men are not as common as in women but can be very serious when they do occur.
The urinary system consists of the kidneys, ureters, bladder, and urethra. The key elements in the system are the kidneys, a pair of purplish-brown organs located below the ribs toward the middle of the back. The kidneys remove excess liquid and wastes from the blood in the form of urine, keep a stable balance of salts and other substances in the blood, and produce a hormone that aids the formation of red blood cells. Narrow tubes called ureters carry urine from the kidneys to the bladder, a sack-like organ in the lower abdomen. Urine is stored in the bladder and emptied through the urethra.
The average adult passes about a quart and a half of urine each day. The amount of urine varies, depending on the fluids and foods a person consumes. The volume formed at night is about half that formed in the daytime.
Alternative Names are Bladder infection; Cystitis; UTI
Normally, urine is sterile. It is usually free of bacteria, viruses, and fungi but does contain fluids, salts, and waste products. An infection occurs when tiny organisms, usually bacteria from the digestive tract, cling to the opening of the urethra and begin to multiply. The urethra is the tube that carries urine from the bladder to outside the body. Most infections arise from one type of bacteria, Escherichia coli (E. coli), which normally lives in the colon.
In many cases, bacteria first travel to the urethra. When bacteria multiply, an infection can occur. An infection limited to the urethra is called urethritis. If bacteria move to the bladder and multiply, a bladder infection, called cystitis, results. If the infection is not treated promptly, bacteria may then travel further up the ureters to multiply and infect the kidneys. A kidney infection is called pyelonephritis.
Microorganisms called Chlamydia and Mycoplasma may also cause UTIs in both men and women, but these infections tend to remain limited to the urethra and reproductive system. Unlike E. coli, Chlamydia and Mycoplasma may be sexually transmitted, and infections require treatment of both partners.
The urinary system is structured in a way that helps ward off infection. The ureters and bladder normally prevent urine from backing up toward the kidneys, and the flow of urine from the bladder helps wash bacteria out of the body. In men, the prostate gland produces secretions that slow bacterial growth. In both sexes, immune defenses also prevent infection. But despite these safeguards, infections still occur.
Cystitis, a common condition, is usually caused by bacteria entering the urethra and then the bladder. This leads to inflammation and infection in the lower urinary tract.
Certain people are more likely to get UTIs. Women tend to get them more often because their urethra is shorter and closer to the anus. Elderly people (especially those in nursing homes) and people with diabetes also get more UTIs.
Some children develop UTIs. In boys, they are most common before the first birthday. In young girls, UTIs are most common around age 3, overlapping with the toilet training period.
Cystitis in children can be promoted by abnormalities in the urinary tract. Therefore, children with cystitis, especially those under age 5, deserve special follow-up to prevent later kidney damage.
The following risk factors increase your chances of getting a UTI:
*Immobility (for example, during recovery from a hip fracture)
*Not drinking enough fluids
*Prostate inflammation or enlargement
*Sexual intercourse, especially if you have multiple partners
*Using a diaphragm for birth control
UTIs are most common in sexually active women and increase in people living with diabetes and people with sickle-cell disease or anatomical malformations of the urinary tract.
Allergies can be a hidden factor in urinary tract infections. For example, allergies to foods can irritate the bladder wall and increase susceptibility to urinary tract infections. Keep track of your diet and have allergy testing done to help eliminate foods that may be a problem. Urinary tract infections after sexual intercourse can be also be due to an allergy to latex condoms, spermicides, or oral contraceptives. In this case review alternative methods of birth control with your doctor.
Elderly individuals, both men and women, are more likely to harbor bacteria in their genitourinary system at any time. These bacteria may be associated with symptoms and thus require treatment with an antibiotic. The presence of bacteria in the urinary tract of older adults, without symptoms or associated consequences, is also a well recognized phenomenon which may not require antibiotics. This is usually referred to as asymptomatic bacteriuria. The overuse of antibiotics in the context of bacteriuria among the elderly is a concerning and controversial issue.
The symptoms of a UTI include:
*Blood in the urine
*Foul or strong urine odor
*Frequent or urgent need to urinate
*Need to urinate at night
*Pain or burning with urination
*Pressure in the lower pelvis
*Young children with UTIs may only have a fever, or no symptoms at all.
Additional symptoms may include:
*Mental changes or confusion (in the elderly, mental changes or confusion often are the only signs of a urinary tract *infection; possible spread to the blood should be considered)
*Flank (side) pain, vomiting, fever, and chills (may be a sign of kidney involvement)
*Painful sexual intercourse
A patient with dysuria (painful voiding) and urinary frequency generally has a spot mid-stream urine sample sent for urinalysis, specifically the presence of nitrites, leukocytes or leukocyte esterase. If there is a high bacterial load without the presence of leukocytes, it is most likely due to contamination. The diagnosis of UTI is confirmed by a urine culture.
If the urine culture is negative:
symptoms of urethritis may point at Chlamydia trachomatis or Neisseria gonorrheae infection. symptoms of cystitis may point at interstitial cystitis.in men, prostatitis may present with dysuria.
In severe infection, characterized by fever, rigors or flank pain, urea and creatinine measurements may be performed to assess whether renal function has been affected.
Most cases of lower urinary tract infections in females are benign and do not need exhaustive laboratory work-ups. However, UTI in young infants must receive some imaging study, typically a retrograde urethrogram, to ascertain the presence/absence of congenital urinary tract anomalies. Males too must be investigated further. Specific methods of investigation include x-ray, Nuclear Medicine, MRI and CAT scan technology.
Exams and Tests :
Tests generally include taking a urine sample.
Urinalysis commonly reveals nitrates, white blood cells, and red blood cells. See also: RBC – urine
A urine culture (clean catch) or catheterized urine specimen may be done to determine the type of bacteria in the urine and the appropriate antibiotic for treatment.
TESTING IN CHILDREN
Many children with cystitis need special imaging studies to determine why they got a urinary tract infection. Many of them have something abnormal about their anatomy that predispose them to infections. The long-term consequences of repeated urinary tract infections in children can be quite serious. However, these infections can usually be prevented.
Special studies usually include an ultrasound of the kidneys and an x-ray taken during urination (called a voiding cystourethrogram or VCUG).
Most experts recommend this evaluation for:
*Girls over age 5 who have had two or more urinary tract infections
*All boys with their first urinary tract infection
*All children who have a fever along with their urinary tract infection
*All children under age 5 with their first urinary tract infection
Most uncomplicated UTIs can be treated with oral antibiotics such as trimethoprim, cephalosporins, nitrofurantoin, or a fluoroquinolone (e.g., ciprofloxacin or levofloxacin). Trimethoprim is probably the most widely used antibiotic for UTIs and is usually taken for 7 days. It is often recommended that trimethoprim be taken at night to ensure maximal urinary concentrations and increase its effectiveness. Whilst co-trimoxazole was previously internationally used (and continues to be used in the U.S.), the additional of the sulfonamide gave little additional benefit compared to the trimethoprim component alone, but was responsible for its high incidence of mild allergic reactions and rare but serious complications.
If the patient has symptoms consistent with pyelonephritis, intravenous antibiotics may be indicated. Regimens vary, usually Aminoglycosides (such as Gentamicin) are used in combination with a beta-lactam, such as Ampicillin or Ceftriaxone. These are continued for 48 hours after fever subsides. The patient may then be discharged home on oral antibiotics for a further 5 days.
If the patient makes a poor response to IV antibiotics (marked by persistent fever, worsening renal function), then imaging is indicated to rule out formation of an abscess either within or around the kidney, or the presence of an obstructing lesion such as a stone or tumor.
As an at-home treatment, increased water-intake, frequent voiding, the avoidance of sugars and sugary foods, drinking unsweetened cranberry juice, taking cranberry supplements, as well as taking vitamin C with the last meal of the day can shorten the time duration of the infection. Sugars and alcohol can feed the bacteria causing the infection, and worsen pain and other symptoms. Vitamin C at night raises the acidity of the urine}, which retards the growth of bacteria in the urinary tract. However, if pain is in the back region (suggesting kidney infection) or if pain persists, if there is fever, or if blood is present in the urine, doctor care is recommended.
In complementary and alternative medicine, D-mannose pills are advocated as a herbal remedy for urinary tract infections. Theoretically, if D-mannose would be present in sufficient concentration in the urine, it could interfere with the adherence of the bacterium E. coli to the epithelial cells lining the urinary tract (similar to the mechanism underlying the effect of cranberry juice). One study showed that it could significantly influence bacteriuria in rats, but there are no studies showing any effect in humans.
Herbal Treatment:YOU can fight bladder infection, cystitis (inflammation), urgent desire to empty the bladder, frequent urination, strong urine odor associated with bladder infection with these herbs from Mother Nature’s medicine chest:
Buchu, cornsilk, Oregon grape root, marshmallow root.
Quik Herbal Tip: Cornsilk is an excellent herbal diuretic and urinary cleanser. Men with prostate problems find it helpful, too.
You may click to see :Study Supports Cranberry Dose Levels for Urinary Health
Recurrent UTIs :
Patients with recurrent UTIs may need further investigation. This may include ultrasound scans of the kidneys and bladder or intravenous urography (X-rays of the urological system following intravenous injection of iodinated contrast material). If there is no response to treatments, interstitial cystitis may be a possibility.
During cystitis, uropathogenic Escherichia coli (UPEC) subvert innate defenses by invading superficial umbrella cells and rapidly increasing in numbers to form intracellular bacterial communities (IBCs).
Possible Complications :
*Chronic or recurrent urinary tract infection — defined as at least two infections in 6 months or at least three in 1 year
The following are measures that studies suggest may reduce the incidence of urinary tract infections. These may be appropriate for people, especially women, with recurrent infections:
Cleaning the urethral meatus (the opening of the urethra) after intercourse has been shown to be of some benefit; however, whether this is done with an antiseptic or a placebo ointment (an ointment containing no active ingredient) does not appear to matter.
Appropriate hygiene and cleanliness of the genital area may help reduce the chances of introducing bacteria through the urethra. Females are especially vulnerable to this, because the urethra is in close proximity to the rectum. The genitals should be cleaned and wiped from front to back to reduce the chance of dragging E. coli bacteria from the rectal area to the urethra.
It has been advocated that cranberry juice can decrease the incidence of UTI (some of these opinions are referenced in External Links section). A specific type of tannin found only in cranberries and blueberries prevents the adherence of certain pathogens (eg. E. coli) to the epithelium of the urinary bladder. A review by the Cochrane Collaboration of randomized controlled trials states “some evidence from trials to show cranberries (juice and capsules) can prevent recurrent infections in women. Many people in the trials stopped drinking the juice, suggesting it may not be a popular intervention”.
For post-menopausal women, a randomized controlled trial has shown that intravaginal application of topical estrogen cream can prevent recurrent cystitis. In this study, patients in the experimental group applied 0.5 mg of estriol vaginal cream nightly for two weeks followed by twice-weekly applications for eight months.
Often long courses of low dose antibiotics are taken at night to help prevent otherwise unexplained cases of recurring cystitis.
Acupuncture has been shown to be effective in preventing new infections in recurrent cases. One study showed that urinary tract infection occurrence was reduced by 50% for 6 months. However, this study has been criticized for several reasons. Acupuncture appears to reduce the total amount of residual urine in the bladder. All of the studies are done by one research team without independent reproduction of results.
Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.
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