What Is Urinary Tract Infection (UTI)

Overview

An infection of any part of the genitourinary system can be classified as an Urinary Tract Infection (UTI). Often, the lower urinary tract is involved ie Bladder and urethra, and women are at greater risk of developing UTIs compared to Men. If left untreated, UTIs can ascend and infect the kidneys and spread systemically via the bloodstream and affect the entire body. UTIs are usually treated with antibiotics and preventative measures can be taken.

Symptoms

• Burning sensation or pain while urinating
• Increased frequency of urination with small amounts voided each time. 
• Persistent and strong urges to urinate. 
• Cloudy urine, or urine stained brownish or light pink in colour. 
• Foul smelling urine
• If the UTI affects the kidneys, patients might experience pain over the loin regions where the kidneys are located. 

Classification

The terms used by your doctor to describe UTIs might be confusing. Listed below are explanations of some common terms used by doctors.

Acute Pyelonephritis:

• This refers to an acute situation where the kidneys have become infected. 
• “Pyelo-” refers to “fever”, “-nephritis” refers to inflammation of the kidneys. Hence Pyelonephritis literally means fever due to a kidney infection. 

Cystitis:

• This refers to infection of the Bladder
• “Cyst-” refers to the bladder while “-itis” refers to inflammation. Hence Cystitis means inflammation of the bladder due to an infection, likely an ascending UTI. 

Urethritis:

• This refers to an infection of the urethra. Ie the UTI only involves the lower urinary tract. 

Causes

Urinary tract infections typically occur when bacteria enter the urinary tract through the urethra and begin to multiply in the bladder. Although the urinary system is designed to keep out such microscopic invaders, these defenses sometimes fail. When that happens, bacteria may take hold and grow into a full-blown infection in the urinary tract.

The most common UTIs occur mainly in women and affect the bladder and urethra.

• Infection of the bladder (cystitis). This type of UTI is usually caused by Escherichia coli (E. coli), a type of bacteria commonly found in the gastrointestinal (GI) tract. However, sometimes other bacteria are responsible. Sexual intercourse may lead to cystitis, but you don't have to be sexually active to develop it. All women are at risk of cystitis because of their anatomy — specifically, the short distance from the urethra to the anus and the urethral opening to the bladder.
• Infection of the urethra (urethritis). This type of UTI can occur when GI bacteria spread from the anus to the urethra. Also, because the female urethra is close to the vagina, sexually transmitted infections, such as herpes, gonorrhea, chlamydia and mycoplasma, can cause urethritis.

Risk Factors

• Females: Females are more likely than men to develop severe UTIs because the female urethra is much shorter than men. Ie the distance from the external environment to the bladder is much shorter. 
• Increased Sexual activity. While sexually active women tend to have more UTIs than do women who aren't sexually active, promiscuity, new sexual partners, or even having a sexual partner who is promiscuous increases the risks of UTIs. 
• Menopause. Women past menopause have reduced mucus production in their genital tissues due to the decline in circulating oestrogen. As a result, the genital regions are less lubricated and that in turn increases the chances of atypical bacterial colonisation and UTIs. 
• Structural abnormalities. Patients born with genetic defects affecting the urinary system with obstruction to urinary flow or patients afflicted with renal calculi (kidney stones) are more prone to developing UTIs due to the retention of urine. Patients who have recently undergone surgical procedures and trauma are also prone to developing UTIs, 
• Immunocompromised Patients. Immunocompromised patients are at an increased risk of develop all sorts of infections, UTIs being one of them. 
• Catheter use. The presence of a foreign body within the urinary tract, even that of an indwelling urinary catheter to assist urinary flow, increases the risk of UTIs. 

Complications

• Systemic spread of UTIs can be life threatening. If untreated and left unchecked, UTIs that overcome the body’s defences can ascend and infect the kidneys and become blood borne, thereby infecting all other organs and cause multi-organ failure. 
• Permanent organ damage, usually renal, are known sequelae of untreated UTIs. 
• Recurrent UTIs 

Diagnosis

• Urinalysis. Analysis of a urine sample is the most common way of diagnosing UTIs. A sample of urine is collected and can be tested with a dipstick on site, or sent off to an approved laboratory for further analysis.
• When collecting the urine sample, be sure to clean the genital area and collect midstream urine. Ie Pass urine normally but do not collect the initial sample. 
• Dipstick testing of urine reveals macro-abnormalities and is a convenient and quick way for clinicians to perform bedside testing. 
• Urine samples can also be sent off to a lab where the sample is incubated at optimal temperatures for bacterial growth. If bacteria is successfully cultured, they are then tested against a range of antibiotics to identify further options with regards to antibiotic therapy. 
• Imaging - Direct and Indirect
• Your doctor might recommend imaging for you if you experience recurrent UTIs. 
• Indirect Imaging involves either computerized tomography (CT) or magnetic resonance imaging (MRI). Your doctor will decide the modality to use. In most situations, contrast media is usually injected during the imaging process so if you are allergic to contrast media, definitely highlight your allergy. 
• Direct imaging involves a surgical procedure where your urologist will insert a scope up and through your urethra to view the bladder directly. This is a surgical procedure and is normally done under anaesthesia.

Treatment

Antibiotics remain the mainstay of treatment for UTIs. Choice of antibiotics to be used depend on the local epidemiology and will be made at your physician’s discretion.

Oral antibiotics are usually given as first line therapy though intravenous antibiotics are usually used for more serious infections, especially if the UTI has spread systemically.

For symptom control, your physician may also prescribe some analgesics to help control the pain and discomfort from the UTI.

Prevention

• Increase water intake. Increasing water intake increases urine output, resulting in more flushing of the urinary tract. 
• Personal Hygiene. Keep the genital area clean. When cleaning the perineum, wipe from front to back. 
• Avoid beverages that change the pH of urine. Beverages like citrus juices can cause changes in the acidity of urine, resulting in more bacterial growth. 
• Void after sexual intercourse. Voiding the bladder and passing urine post sexual intercourse flushes the urinary tract and prevents bacteria from manifesting. 
• Avoid contraceptives if viable. Contraceptives like diaphragms, intra-uterine devices, and spermicides all alter the bacterial flora within the genital region and can contribute to higher rates of UTIs. 

About The Author

Dr Lau Tzun Hon is a resident housecall doctor at CMY Medical. He received his MBBS (Hons) from Sydney University in 2001 and has served in the both private and government restructured hospitals prior to commencing his practice in Home Care.

While in the Government Restructured Hospitals, Dr Lau served primarily in the Department of Accident & Emergency Medicine and Anaesthesia. Upon entering the Private sector, Dr Lau worked in both public and private A&E departments before venturing into Home Care.

Over the years, he has developed a strong passion to maintain and  enhance the quality of life for patients under his care.  A strong believer that healthcare does not need to be financially straining, Dr Lau often delivers more value beyond expectations.