Pathogenesis of Urinary Tract Infections

Millions of people suffer each year with urinary tract infections, or UTIs. Over 8 million doctor visits each year are for UTIs, most of which are in women. The National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) estimates that one woman in five will have a UTI in her lifetime. Of this group, 20% will have recurring UTIs.

Causes

• Normal urine is sterile, consisting of body waste, salts and fluids. A UTI begins when bacteria enter the opening of the urethra, which runs from the bladder to outside the body. Most UTIs are caused by Escherichia coli, a bacteria common to the colon. These bacteria travel the pathway up the urethra into the bladder, working their way to the ureters and ultimately, the kidneys if left unchecked.

Types of Infection

• Serious kidney damage, and rarely death, may occur if UTIs are left untreated. When the urethra is infected, this is known as urethritis. A bladder infection is cystitis, with kidney infection, or pyelonephritis, being the most serious.

Symptoms

• Often the first sign of a UTI is burning on urination. The urine may be cloudy or blood-tinged. The urge to urinate may occur frequently, Sometimes the sensation of needing to void is present, but the person cannot pass their urine.

  Other symptoms include low-grade fever, back pain, weakness, and lack of energy. Since early signs can mimic many other illnesses, the UTI may have progressed into the bladder by the time it is caught.

Risk Factors

• UTIs are common in people who have urinary catheters. Hospitals track the infection rate of catheter-induced UTIs in all patients. Eliminating UTIs caused by catheters is one of the patient safety goals of the Joint Commission of Hospital Accreditation. Catheters should be removed as soon as possible.

  Other groups at risk are those with abnormalities of the urinary tract, diabetes, and those with immune-suppressing diseases.

Treatment and Prevention

• UTIs are treated with antibiotics effective on the particular bacteria causing them. There are several drugs available, and treatment may require one to two weeks. It's important to take all antibiotics exactly as prescribed, completing the full course of treatment regardless of how good you feel.

  UTIs can be prevented by drinking plenty of water, taking showers instead of tub baths, and voiding after sexual intercourse. Wipe from front to back to avoid transferring anal bacteria to the urethra. Do not resist the urge to hold back urine. Finally, feminine hygiene sprays and douches should be avoided.