UTI (Urinary Tract Infection)
UTI (URINARY TRACT INFECTION)
Urinary tract infection commonly called UTI is an infection in any part of the urinary system — kidneys, ureters, bladder and urethra. It is called pyelonephritis if it infects the kidney, cystitis if it affects the bladder, urethritis if it affects the urethra and epididymo-orchitis if it affects the testicle.
Commonly in layman terms, the term UTI is usually mentioned by the public referring to lower urinary tract infection i.e. the bladder and urethra, what is usually called simple cystitis in a woman. But strictly speaking it can involve any part of the urinary tract.
UTI is usually seen in women. Men very uncommonly get UTI, and if they do so, it is usually due to an underlying cause – for example kidney and ureteric stones, BPH (“prostate enlargement”), etc.
Serious consequences may occur if a simple UTI is not treated early, which then can spread upwards to the kidneys (pyelonephritis), as well as into the blood stream (sepsis and septicemia).
UTI should be diagnosed early and treated with antibiotics.
Effervescent powder medications and alkalinizing agents (eg. Ural, Urocit-K, potassium citrate, mist pot citrate etc) is not a cure for UTI. Alkalizing agents cause symptom improvement and lessens the dysuria (burning sensation / pain on passing urine) because it alkalinizes the infected urine which is usually acidic. The specific treatment for UTI is antibiotics and not alkalizing agents.
Not all patients with symptom of dysuria (burning sensation / pain on passing urine) is necessarily UTI. Vaginitis (vaginal infection), urethral caruncle (a painful lump near the urinary passage) or any inflammation at the surrounding urethra can cause dysuria. If the symptoms persists, it is best to see the urologist to confirm whether it is indeed UTI in the first place, and if so, whether it is due to a bacteria resistant to specific antibiotics.
There are times when a person do not have any symptoms, but the urine test is abnormal. This does not mean it is UTI, even if bacteria is present. This may be what is known as asymptomatic bacteriuria, where there is presence of bacteria but not an infection or bacterial invasion. These patients should not be treated at all in asymptomatic bacteriuria. There are exceptions to this rule, when some elderly people or immunocompromised people do not exhibit symptoms even when they have UTI. In older people, changes in behavior such as severe confusion or agitation may be a presentation of UTI.
For this, the urologist will have to decide on the diagnosis and the treatment. Hence it is always better to obtain clarification from the urologist whether one has UTI or asymptomatic bacteriuria.
Simple uncomplicated UTI may present with:
- Dysuria (burning sensation / pain on passing urine
- Urine frequency and the urge to pass urine very often
- Discomfort of the lower abdomen at the bladder area
You need to see a doctor if you do have these symptoms, and need to confirm if it is UTI, and subsequently require antibiotics
Simple UTI CANNOT have the following:
- Chills and rigor
- Loin / back pain
- Loss of appetite
- Feeling unwell
If you have the above symptom, you may be having a complicated UTI. You will probably need an admission, IV fluids with IV antibiotics. It is best to see a urologist immediately if you do have such symptoms.
UTI is diagnosed mainly by symptoms, which is then supplemented with a urine test.
If you do not have symptoms, then the diagnosis of UTI should be questioned, even if urine test is abnormal (there are exceptions to this as mentioned above).
In a simple UTI (absence of Fever, Chills and rigor, Loin / Back pain, Loss of appetite, Feeling unwell, etc), a urine microscopy test is more than adequate to address the issue.
If you suffer from recurrent UTI, complicated UTI (symptoms as outlined above) or in any male or child even with single episode of UTI, urine culture and sensitivity will be required.
Urine culture and sensitivity consists of placing your urine on top a culture plate (agar plate) and kept for 3 days to allow bacterial growth, for which numerous antibiotics discs are applied to see which antibiotics will be effective against the infective bacteria. However, while waiting for the results due in 3 days, empiric antibiotics need to be started, if not the UTI can spread and worsen.
Prevention of UTI
Although there is no evidence-based way to prevent UTI, the following may be taken to reduce your risk of UTI:
- Drink plenty of liquids, especially water. Drinking water helps dilute your urine and ensures that you’ll urinate more frequently — allowing bacteria to be flushed from your urinary tract before an infection can begin.
- Drink cranberry juice. Although studies are not conclusive that cranberry juice prevents UTIs, it is likely not harmful.
- Wipe from front to back. Doing so after urinating and after a bowel movement helps prevent bacteria in the anal region from spreading to the vagina and urethra.
- Empty your bladder soon after intercourse. Also, drink a full glass of water to help flush bacteria.
- Avoid potentially irritating feminine products. Using deodorant sprays or other feminine products, such as douches and powders, in the genital area can irritate the urethra.
- Change your birth control method. Diaphragms, or unlubricated or spermicide-treated condoms, can all contribute to bacterial growth.
When to see the urologist
- When you have symptoms of UTI as above (dysuria / burning sensation / pain on passing urine, urine frequency and the urge to pass urine very often, discomfort of the lower abdomen at the bladder area)
- When you have features of complicated UTI as above (Fever, Chills and rigor, Loin / back pain, Loss of appetite, Feeling unwell, etc)
- When you have recurrent UTI
- When you are pregnant and suffer UTI symptoms
- When you are a male or a child, and have even a single episode of UTI, as UTI very uncommonly affects males and children. UTI in these group of patients is usually secondary to another underlying cause.
- When you have blood in the urine, which may not necessarily be UTI
Remember,asymptomatic bacteriuria (presence of bacteria in the urine without any symptoms), asymptomatic funguria (presence of fungus in the urine without any symptoms) and asymptomatic pyuria (presence of pus cells in the urine without any symptoms) is not an indication for treatment.
You will require to discuss with your urologist on this issue, and may require investigating the cause.
The exception for treatment of asymptomatic bacteriuria is pregnancy (see the section on Asymptomatic Bacteriuria)