Urinary Tract Infection
Urinary Tract Infection: Description:
Alternative Names: Bladder infection; Cystitis; UTI.
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.
Lower urinary tract infection (cystitis): The lining of the urethra and bladder becomes inflamed and irritated.
Dysuria - Pain or burning during urination.
Frequency - More frequent urination (or waking up at night to urinate).
Urgency - The sensation of not being able to hold urine.
Hesitancy - The sensation of not being able to urinate easily or completely (or feeling that you have to urinate but only a few drops of urine come out).
Cloudy, bad smelling, or bloody urine.
Mild fever (less than 101°F), chills, and "just not feeling well" (malaise).
Upper urinary tract infection (pyelonephritis): Symptoms develop rapidly and may or may not include the symptoms for a lower urinary tract infection.
Fairly high fever (higher than 101°F).
Flank pain - Pain in your back or side, usually on only one side at about waist level.
TREATMENT AT HOME: A mild urinary tract infection may go away on its own without treatment. However, antibiotics are usually recommended because there is a risk that the infection can spread to the kidneys. Antibiotics are taken by mouth, usually from 3 to 7 days. It is important that you finish all the medication.
Commonly used antibiotics include: Amoxicillin or Augmentin Cephalosporins Doxycycline (should not be used under age 8) Nitrofurantoin Sulfa drugs (sulfonamides) Trimethoprim-sulfamethoxazole Quinolones (should not be used in children). Your doctor may also recommend drugs to relieve the burning pain and urgent need to urinate, and to decrease bacteria in your urine.
Such medicines include: Acidifying medications such as ascorbic acid to lower the concentration of bacteria in the urine Phenazopyridine hydrochloride (Pyridium) to reduce urgency and burning with urination
TREATMENT IN THE HOSPITAL: If you are very sick and cannot take medicines by mouth or drink enough fluids, you may be admitted to the hospital. You may also be admitted to the hospital if you:
Are elderly Have kidney stones or other medical problems Have recently had urinary track surgery at the hospital; you will receive fluids and antibiotics through a vein.
LONG-TERM TREATMENT: Some people have urinary tract infections that keep coming back or that do not go away with treatment. Such infections are called chronic UTIs. If you have a chronic UTI, you may need antibiotics for a long period of time, perhaps as long as 6 months to 2 years, or stronger antibiotics may be prescribed.
A urinary tract infection is considered chronic if any of the following occur:
The infection does not respond to usual treatment It lasts longer than 2 weeks It occurs more than twice in 6 months Your health care provider may also recommend low-dose antibiotics after acute symptoms go away.
SURGERY: If a structural (anatomical) problem is causing the infection, surgery may be recommended.
Causes and Risk factors:
Certain people are more likely to get Urinary Tract Infections. 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.
To find out whether you have a Urinary Tract Infection, your doctor will test a sample of urine for pus and bacteria. You will be asked to give a "clean catch" urine sample by washing the genital area and collecting a "midstream" sample of urine in a sterile container. This method of collecting urine helps prevent bacteria around the genital area from getting into the sample and confusing the test results. Usually, the sample is sent to a laboratory, although some doctors' offices are equipped to do the testing.
In the urinalysis test, the urine is examined for white and red blood cells and bacteria. Then the bacteria are grown in a culture and tested against different antibiotics to see which drug best destroys the bacteria. This last step is called a sensitivity test.
Some microbes, like Chlamydia and Mycoplasma, can be detected only with special bacterial cultures. A doctor suspects one of these infections when a person has symptoms of a UTI and pus in the urine, but a standard culture fails to grow any bacteria.
When an infection does not clear up with treatment and is traced to the same strain of bacteria, the doctor may order some tests to determine if your system is normal. One of these tests is an intravenous pyelogram, which gives x-ray images of the bladder, kidneys, and ureters. An opaque dye visible on x-ray film is injected into a vein, and a series of x-rays is taken. The film shows an outline of the urinary tract, revealing even small changes in the structure of the tract.
If you have recurrent infections, your doctor also may recommend an ultrasound exam, which gives pictures from the echo patterns of soundwaves bounced back from internal organs. Another useful test is cystoscopy. A cystoscope is an instrument made of a hollow tube with several lenses and a light source, which allows the doctor to see inside the bladder from the urethra.
Medicine and medications:
UTIs are treated with antibacterial drugs. The choice of drug and length of treatment depend on the patient's history and the urine tests that identify the offending bacteria. The sensitivity test is especially useful in helping the doctor select the most effective drug. The drugs most often used to treat routine, uncomplicated UTIs are trimethoprim (Trimpex), trimethoprim/sulfamethoxazole (Bactrim, Septra, Cotrim), amoxicillin (Amoxil, Trimox, Wymox), nitrofurantoin (Macrodantin, Furadantin), and ampicillin (Omnipen, Polycillin, Principen, Totacillin). A class of drugs called quinolones includes four drugs approved in recent years for treating UTI. These drugs include ofloxacin (Floxin), norfloxacin (Noroxin), ciprofloxacin (Cipro), and trovafloxin (Trovan).
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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