Introduction
Urinary Tract Infections (UTIs) are infections of any part of the urinary system — urethra, bladder, ureters or kidneys. UTIs are second only to respiratory infections in frequency. Most UTIs are caused by bacteria, commonly Escherichia coli from the bowel.
Types of UTI
- Urethritis – infection of the urethra.
- Cystitis – bladder infection (most common lower UTI).
- Pyelonephritis – infection of the kidney (upper UTI; more serious).
- Complicated UTI – associated with catheter, obstruction, diabetes, pregnancy or structural problems.
Causes
Most UTIs occur when bacteria from the bowel enter the urethra and travel up to the bladder. Key causes include:
- E. coli contamination from perineal area.
- Catheterization or urinary devices.
- Urinary obstruction (stones, enlarged prostate, tumors).
- Poor genital hygiene or sexual activity (pushes bacteria into urethra).
Risk Factors
- Female anatomy (shorter urethra).
- Sexual intercourse, especially with new partner.
- Use of spermicides or diaphragms.
- Postmenopausal estrogen loss.
- Diabetes, immunosuppression.
- Urinary catheter or recent urinary surgery.
- Urine retention (neurogenic bladder, prostate enlargement).
Symptoms
Symptoms depend on site and severity:
- Lower UTI (cystitis): burning during urination, frequent small-volume urination, urgency, lower abdominal pain, cloudy or foul-smelling urine, sometimes blood in urine.
- Upper UTI (pyelonephritis): high fever, flank pain, nausea, vomiting, chills, and signs of systemic illness.
- In older adults: confusion, weakness, or non-specific decline may be the only sign.
Diagnosis
- Urinalysis: pus cells (pyuria), nitrites, blood.
- Urine culture: confirms the causative organism and antibiotic sensitivity (important for complicated UTI).
- Imaging (USG/CT): when obstruction, stones, recurrent or complicated infections suspected.
- Cystoscopy: if persistent or unusual infections to inspect bladder.
Treatment
Treatment depends on whether the UTI is uncomplicated or complicated.
Uncomplicated UTI (healthy, non-pregnant women)
- Short-course antibiotics (examples): nitrofurantoin, trimethoprim-sulfamethoxazole, or oral fluoroquinolones (depending on local resistance and guidelines).
- Duration commonly 1–5 days depending on drug and local protocol.
- Drink fluids, pain relief (paracetamol), phenazopyridine for dysuria (note: causes orange urine).
Complicated UTI or Pyelonephritis
- Longer antibiotic course; often start with IV antibiotics if severe.
- Tailor antibiotic based on culture and sensitivity.
- Address underlying cause (remove catheter, relieve obstruction, treat stones).
Recurrent UTIs
- Investigate for anatomical or functional problems.
- Consider post-coital single-dose prophylaxis or low-dose daily prophylaxis in selected patients.
- Postmenopausal women may benefit from topical vaginal estrogen.
Complications
- Recurrent infections and chronic pyelonephritis.
- Renal scarring, reduced kidney function or hypertension (especially in children).
- Sepsis in severe cases.
- Pregnancy: increased risk of preterm labour if untreated.
Prevention (Simple Practical Tips)
- Drink plenty of water to flush bacteria.
- Urinate after sexual intercourse.
- Wipe front to back after toilet use (especially women).
- Avoid delaying urination; empty bladder fully.
- Prefer showers over baths; wear cotton underwear and loose clothes.
- In recurrent cases, discuss cranberry products, vitamin C or prophylaxis with your physician (evidence varies).
- Control diabetes and remove unnecessary urinary catheters as soon as possible.
When to See a Doctor
Seek medical help for fever, flank pain, vomiting, blood in urine, severe pain, or symptoms in pregnant women and young children. Early treatment prevents complications.
Detailed Notes:
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